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While most other states implemented stay-at-home orders to slow the spread of covid-19, Arkansas Gov. Asa Hutchinson opted for a targeted strategy, temporarily closing certain types of businesses and public facilities but allowing others to remain open.

As the state gradually lifts restrictions, policymakers face a new “iron triangle” of interrelated issues, each requiring tradeoffs with the others.

PUBLIC HEALTH

Arkansas’ covid-19 case count is climbing, partly because of expanded testing. By the end of April, Arkansas had conducted fewer than 50,000 tests, but more than 80,000 tests were conducted in May, and the governor has set a goal of another 120,000 tests in June. Some infected people experience mild or no symptoms, so widespread testing is crucial in determining how many people are infected. It is logical to expect that as testing expands, the case count will climb.

Unfortunately, the case growth cannot be attributed only to testing. We have also seen increasing hospitalizations, patients on ventilators, and deaths. Our hospitals are not overwhelmed—a fear early in the pandemic—but the numbers are concerning. In May, the Institute for Health Metrics and Evaluation at the University of Washington projected that covid-19 deaths in Arkansas would total 140 by early August, but it recently revised that projection to 411 deaths, with 1,650 deaths projected by October.

Some downplayed the seriousness of covid-19 by citing estimates that its case fatality rate is around 1 percent. To put that in perspective, 1 percent of Arkansas’ population would be 30,000 people; no reasonable person would consider that an acceptable number of our relatives, friends, and neighbors to lose to this disease. Limiting the spread of covid-19 must remain a priority for the foreseeable future.

ECONOMIC HEALTH

We have fared better economically than many states, perhaps because we never completely shut down our economy. Our May sales-tax collections were down 2.8 percent from a year ago, compared to Texas’ drop of 13.2 percent, for example.

But the pandemic has had a profound economic impact nonetheless. The state’s unemployment rate soared to 10.2 percent in April, reaching double digits for the first time in more than 35 years. More than 240,000 Arkansans have filed unemployment claims since mid-March.

Many individuals in white-collar jobs who had Internet access were able to work from home; many blue-collar workers did not have that option. In terms of both job losses and rates of infection, low-income and minority families were disproportionately affected. Clearly, public health mitigation actions were required. However, those actions were not without economic costs and associated negative health impacts.

Arkansas’ phased reopening attempts to balance public health concerns with economic concerns—but there is a third factor in the mix.

PERSONAL FREEDOMS

Covid-19 spreads through respiratory droplets expelled by coughing, sneezing, or talking. It is likely that many are infected and do not know it, but if we all wear masks when out in public, we will not spread the droplets as much as we otherwise would. More than 30 countries have mandated wearing masks in public during the pandemic, with evidence that mask use reduces mortality, but the United States and Arkansas have declined to impose such a mandate.

During our phased reopening, Arkansas has imposed mask requirements on some businesses. In restaurants, for example, masks must be worn by workers who come in close contact with patrons, and patrons must wear masks until food or drink is served. Some businesses have encountered resistance from customers, however, and lax adherence appears to be increasing.

Masks can be uncomfortable, especially as it gets warmer. It is also inconvenient to wash hands frequently, try to maintain at least 6 feet of separation from others when out in public, and quarantine yourself at home for 14 days after exposure to an infected person. While many are being diligent, a lack of personal responsibility is visibly growing, often because of a perceived need to demonstrate individual liberty.

The health of the public—your family, your faith group, your city, your state, our nation—depends upon personal responsibility and recognition that sacrificing some personal freedoms is an obligation.

Finding the way forward requires a balancing act. Our public health efforts must be effective, our economy must rebound, and our personal actions must align to make both successful. No single one of these factors can or should be considered in isolation.

Policymakers have their work cut out for them, but we individually can help by recognizing the continued risk, safely re-engaging in our economy, and adhering to guidelines and restrictions as best we can until this public health emergency is over.

—––––– –––––—

JoeThompson, MD,MPH, is president and CEO of the Arkansas Center for Health Improvement and was Arkansas’ surgeon general under Govs. Mike Huckabee and Mike Beebe.

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