The Covid-19 pandemic may be the greatest threat the world has faced in over a century. All of humanity has a common enemy, a merciless, exponentially-spreading virus. If ever we needed to unite against a common enemy, now is the time.
And of course, not only are nations at loggerheads, even within the United States, the response to the pandemic threatens to become a holy war.
One side argues that Covid-19 isn’t as dangerous as feared, that most people have probably already had the disease, and that the economic consequences of continuing a policy of social distancing are far more damaging than the additional deaths (mostly among the old and already sick) that opening up the economy might cause. They point to Sweden as an example of a country that has avoided a lockdown, yet whose per capita rate of Covid-19 deaths is only slightly higher than that of the United States (256 per million, versus 192, as of April 30, 2020).
This side avoids the subject when reminded that the 1918 influenza pandemic saw multiple waves of infection when social distancing policies were dropped, makes the false claim that economic contraction leads to higher overall death rates, and remains curiously silent on the much greater successes achieved by nations like South Korea (5 deaths per million) and Taiwan (6 deaths TOTAL out of a population of 24 million), presumably because their stories underline how badly the United States has handled the crisis to date.
The other side argues that the only valid response to Covid-19 is to continue social distancing, quickly amplifies news stories about the failure of clinical trials for potential treatments, and attacks anyone who suggests re-opening the economy by literally saying that doing so “will send us to Hell.” Scientists and studies that contradict their beliefs are dismissed as flawed, biased, or both.
This side tries to avoid the question of whether radically different geographies in radically different situations should really have to follow a uniform set of national social distancing policies, generally refuses to discuss the economic tradeoffs involved in maintaining our social distancing policies, and whether some of the bold government actions that have been taken are actually legal.
My personal belief is that given the fact that the United States has already lost more lives to Covid-19 than it did during the Vietnam War, and has averaged close to 2,000 deaths per day for the entire month of April, that the virus is a major threat, is far deadlier than the flu, and that the situation would have been far, far worse if we had not instituted social distancing. The relative success of early and aggressive social distancing on the part of Seattle and the Bay Area only reinforces my belief.
But, that doesn’t mean I believe that aggressive social distancing will always be the right policy.
We should maintain our focus on our overall goals, which are to minimize both loss of life AND economic damage. Sometimes these goals will come into conflict. Sometimes new technologies or discoveries will change the balance between the two. But taking a fundamentalist approach that focus solely on one of the goals and ignores evidence that doesn’t confirm your current beliefs is will almost certainly lead to a worse outcome than focusing on the facts.
If someone advocates relaxing restrictions and opening up the economy, ask them, “What are the criteria that can tell a particular geography when it is safe to re-open? How do they differ from geography to geography? And how will you tell if you need to re-impose social distancing?”
If someone insists on indefinite social distancing, ask them, ask them “What are the criteria that can tell a particular geography when it is safe to re-open? How do they differ from geography to geography? And how will you tell if you need to re-impose social distancing?”
In case you didn’t notice, they are the exact same questions. Because we’re all trying to achieve the same goal of defeating the same common enemy, which means we should all want the answers to the same questions. And we’ll be able to achieve that goal faster, with less loss of life, and with less economic damage if both sides realize the senselessness of their holy war against the opposite side and focus instead on a pragmatic, evidence-based approach.
P.S. UPDATE: My old friend Matt Frank pointed out that in my haste to finish my post and get to sleep, I didn’t answer my own questions! I will do so now:
“What are the criteria that can tell a particular geography when it is safe to re-open?”
To date, the geographies that have best controlled the pandemic have taken an aggressive approach to testing and isolation. Taiwan has been successful at containment, but is helped by being an island nation (albeit one just off the shore of China). But the example of the town of Vo in Italy, near the heart of the outbreak is illustrative. The town was able to test 86% of its residents, isolate those who tested positive, and shut down the outbreak, despite being in the middle of a hotspot.
One criteria then would be the ability to test the majority of the population in less than 14 days, and the ability to isolate any positive results, including providing shelter if the person could not afford their own.
In the absence of this criteria, we have to approach the problem of mitigation indirectly. We can do this by requiring a sustained decline in Covid-19 deaths (California has suggested 14 days) to indicate that mitigation has worked, and aggressive indirect testing and contact tracing to consolidate and maintain that progress. It is critical, and I cannot underscore this enough, that our “success” at mitigating Covid-19 to date has relied on social distancing. We haven’t beaten the virus, we’ve just gotten better at hiding from it. If we stop hiding, we go back to the previous exponential spread. To ease up on the lever of behavior, we need to pull other levers more aggressively.
Aggressive testing and tracing would require the local authorities and population agreeing to temperature checks at any business or gathering, and signing in via official ID to make it possible to track who might have come into contact with someone infected, and the ability of the authorities to contact them and require them to self-isolate and take an actual test.
“How do they differ from geography to geography?”
The primary differences are population density, social contact frequency, healthcare capacity (testing and treatment), and compliance. The denser the population, the greater the social contact frequency, the more stringent the criteria. The greater the healthcare capacity, the better the population’s compliance with restrictions, the less stringent the criteria.
Finally, and more controversially, a lot will depend on demographics and our willingness to impose discriminatory restrictions. All evidence is that Covid-19 is more deadly for those over the age of 65, and those with chronic health issues including obesity. Both can vary greatly by geography. Even Georgia governor Brian Kemp, who has been eager to re-open his state, has extended the shelter-in-place order for the elderly and “medically fragile.”
“How will you tell if you need to re-impose social distancing?”
Unfortunately, deaths are a trailing indicator, as are positive test results. Nonetheless, if these start to rise beyond a predetermined “acceptable” level, then social distancing will have to broaden again. An earlier indicator would be a rise in the rate of fever, as measured by the spot temperature checks described above.
P.P.S. Here, in no particular order, are some of the policies I think will help achieve the twin goals of minimizing deaths and economic damage until we find effective treatments.
- State governments should pay for Covid-19 tests (with financial aid from the Federal government) so that testing is free for all residents. The economic benefits of being able to isolate the sick far exceed the costs of testing.
- Similarly, governments should pay hotels to provide quarantine quarters for those who do not want to self-isolate at home. This will support those businesses and cut down on viral spread.
- Every resident should be required to wear a mask outside the home, and masks should be available for free to all residents. If you consider this a violation of your rights, show me the part of the Constitution that says this is a violation. (Note: Making mask-wearing mandatory may require new legislation)
- To the extent that civil liberties allow, we should be much more aggressive about contact tracing, likely by taking advantage of smartphone-based tracking. For a sense of how this might work, we can look to Taiwan.