Resist Covid-19 Fundamentalism

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.

  1. 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.
  2. 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.
  3. 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)
  4. 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.

3 thoughts on “Resist Covid-19 Fundamentalism

  1. Brian Vowinkel

    Cypress Semiconductor founder T.J. Rodger conducted a study with two fellow tech entrepreneurs conducted to try to measure the value of shutdowns:
    Do quick shutdowns work to fight the spread of Covid-19? Joe Malchow, Yinon Weiss and I wanted to find out. We set out to quantify how many deaths were caused by delayed shutdown orders on a state-by-state basis.To normalize for an unambiguous comparison of deaths between states at the midpoint of an epidemic, we counted deaths per million population for a fixed 21-day period, measured from when the death rate first hit 1 per million—e.g.,‒three deaths in Iowa or 19 in New York state. A state’s “days to shutdown” was the time after a state crossed the 1 per million threshold until it ordered businesses shut down.

    We ran a simple one-variable correlation of deaths per million and days to shutdown, which ranged from minus-10 days (some states shut down before any sign of Covid-19) to 35 days for South Dakota, one of seven states with limited or no shutdown. The correlation coefficient was 5.5%—so low that the engineers I used to employ would have summarized it as “no correlation” and moved on to find the real cause of the problem. (The trendline sloped downward—states that delayed more tended to have lower death rates—but that’s also a meaningless result due to the low correlation coefficient.)No conclusions can be drawn about the states that sheltered quickly, because their death rates ran the full gamut, from 20 per million in Oregon to 360 in New York. This wide variation means that other variables—like population density or subway use—were more important.

    Our correlation coefficient for per-capita death rates vs. the population density was 44%. That suggests New York City might have benefited from its shutdown—but blindly copying New York’s policies in places with low Covid-19 death rates, such as my native Wisconsin, doesn’t make sense.

    Sweden is fighting coronavirus with common-sense guidelines that are much less economically destructive than the lockdowns in most U.S. states. Since people over 65 account for about 80% of Covid-19 deaths, Sweden asked only seniors to shelter in place rather than shutting down the rest of the country; and since Sweden had no pediatric deaths, it didn’t shut down elementary and middle schools. Sweden’s containment measures are less onerous than America’s, so it can keep them in place longer to prevent Covid-19 from recurring. Sweden did not shut down stores, restaurants and most businesses, but did shut down the Volvo automotive plant, which has since reopened, while the Tesla plant in Fremont, Calif., was shuttered by police and remains closed.How did the Swedes do? They suffered 80 deaths per million 21 days after crossing the 1 per million threshold level.

    With 10 million people, Sweden’s death rate‒without a shutdown and massive unemployment‒is lower than that of the seven hardest-hit U.S. states—Massachusetts, Rhode Island, Louisiana, Connecticut, Michigan, New Jersey and New York—all of which, except Louisiana, shut down in three days or less. Despite stories about high death rates, Sweden’s is in the middle of the pack in Europe, comparable to France; better than Italy, Spain and the U.K.; and worse than Finland, Denmark and Norway. Older people in care homes accounted for half of Sweden’s deaths.We should cheer for Sweden to succeed, not ghoulishly bash them. They may prove that many aspects of the U.S. shutdown were mistakes—ineffective but economically devastating—and point the way to correcting them. -Mr. Rodgers was founding CEO of Cypress Semiconductor Corp.

  2. Bernard Moon

    Social distancing DOES NOT EQUAL LOCKDOWN. You can open parts of the U.S. while still maintaining SOCIAL DISTANCING, masks and other safety measures.

  3. Bernard Moon

    “The relative success of early and aggressive social distancing on the part of Seattle and the Bay Area only reinforces my belief.”

    Lockdown for me doesn’t equate “aggressive social distancing” but more of lazy and intellectual policy approach. Probably because I’ve seen closely what they have done in South Korea and Taiwan, those measures are aggressive by my definition. A completely lockdown on its own is a lazy in my eyes.

    San Francisco and the State of CA has poor messaged and informed its citizens on social distancing; obtaining masks, and other measures. There were so many intermediate steps that could have been enforced and taken.

    People cite that we didn’t have the contact tracing technology that South Korea had. We couldn’t do what they did in “Asia”. Do you know what Taiwan did for “contact tracing”? Paper forms! More effort, more thoughtful taken into account overall.

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