The Four Levers To Combat Coronavirus

During a call with my fellow Silicon Guild members today, I shared my “three lever” model for addressing the coronavirus crisis. Based on their feedback, I’ve expanded it to four. The key levers that we as a society can pull are:

1. Testing

2. Tracking

3. Treatment

4. Behavior Change

These levers are, to a certain extent, compounding, which means that you can compensate for missing one by pulling harder on another lever.

The ultimate lever, of course, is treatment (or even prevention). Imagine if we had a cheap, safe, 100% effective drug that would cure Covid-19 whenever administered. This would completely eliminate the need for social distancing and allow us to go back to our pre-coronavirus lives almost immediately. Let us hope that some of the clinical trials currently underway produce promising results and drug approvals!

Until then, we have to make do with the other three levers. Testing is key because it provides visibility into the disease, and makes the other two levers, Tracking and Behavior Change, easier to pull. If we could easily administer 100% accurate tests to our entire population each morning, we would have very little to worry about because we could simply ask every person who contracted the disease to go into quarantine, while the uninfected could go about their daily lives, just as before. One of the reasons that South Korea has been able to control the outbreak (so far) without imposing harsh lockdowns (Behavior Change) is that it has an excellent testing infrastructure.

Tracking and Behavior Change are all about slowing or stopping the transmission of the virus. Perfect Tracking means that once a person was identified as infected, the authorities could quickly trace their past movements, and track down everyone who had come into contact with them. (It also means zero privacy.) Singapore has successfully employed extreme Tracking to keep its outbreak under control. If you go to your office or a restaurant in Singapore, you have to check in (reporting your location to the government) as soon as you arrive. You will also be required to take a temperature test; if you have a fever, you won’t be allowed to enter.

The final lever is Behavior Change. When the pandemic began, most societies tried mild forms of Behavior Change, like reminding people to wash their hands. As the situation worsened, they switched to more extreme forms, all the way up to full-blown “shelter in place” guidelines that ask people to stay home unless obtaining essential needs like food or medical care. (There is an even more extreme version that China employed in Wuhan, where the government literally welded doors shut to keep people locked in.) Pulling hard on this lever is very, very expensive; shelter in place causes significant portions of the economy to grind to a halt. Some of the startups I’ve invested in have seen 90% drops in their revenue, and the airline industry is actually seeing negative revenue, as cancellations and refunds far outnumber new travel bookings.

Pulling hard on the Behavior Change lever sucks, as anyone who has looked at their 401(k) balance lately, or worse, lost a job can tell you. But the dilemma that America faces right now is that it can’t pull the other levers.

The president’s statements to the contrary, testing has been insufficient, and healthcare professionals here in the Bay Area report that the tests are in such short supply that only a tiny fraction of potential coronavirus cases are tested, let alone a significant chunk of the general population.

Tracking is a violation of civil liberties, and unlikely to be obeyed. If Florida can’t even get people to stop going to the beach and partying, are we really going to be able to get everyone to check in every time they drive to their office?

We all hold out hope for rapid progress on treatments, and game-changing treatments may only be weeks away. But until they actually arrive, we can’t pull that lever.

Which brings America back to its core coronavirus dilemma: Do we pull the Behavior Change lever to slow the spread of the virus because it is the only one we have? Or do we give up on trying to “flatten the curve,” and just hope that the coronavirus is milder than doctors think?

I’ve had a long debate with a friend who argues that we shouldn’t employ extreme social distancing. He is a strong advocate of social isolation solely for the elderly and vulnerable, and ending shelter in place guidelines for the young and healthy, while I am a strong advocate for maintaining shelter in place guidelines for all until we have either better testing or effective treatments. We agree on general principles, such as the belief that if the coronavirus were to cause only 60,000 American deaths over the next year, then we should end shelter in place. But we disagree on our predictions for the future. He thinks that shelter in place is a panic reaction, and that the coronavirus is no more dangerous than the flu, especially if you are young and healthy. I think that if we abandon shelter in place before we have better testing or effective treatments (in other words, before we are able to pull any other levers besides Behavior Change) we will overwhelm our healthcare system (which my healthcare professional friends tell me is already stretched to the breaking point) and cause hundreds of thousands of needless deaths, including many young and healthy people.

I hope that he is right. But the overflowing morgues and overcapacity crematoria in Northern Italy tell me that he is wrong. And until we have the power to pull some of the other levers, I hope that our leaders keep the Behavior Change lever fully pulled.

If you found this post interesting, you may want to read why I am still hopeful for a good outcome to this pandemic.

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