I don’t know if my ideas are logistically or politically possible, or if they are, whether the stupid or selfish or irresponsible folks among us would destroy the plan, and who am I anyway? I am a nobody, just a guy…who thinks a lot. Before I break down my alternative plan (not a road map, for reasons discussed in the previous post), I want to explain why I would start it from right now, April 4, 2020. It is both useless and counterproductive to criticize what has already been done or what we failed to do.
Why? January 22, 2020, from Smithsonianmag.com: For now, the Center for Disease Control has declared the immediate health risk the virus poses to the American public to be low. The infected patient, a man from Washington state who recently returned home from a trip to Wuhan, China, began experiencing symptoms last week, and was quickly hospitalized. He remains in isolation at Providence Regional Medical Center in Everett, Washington. This week, millions of people will be traveling to China for Lunar New Year on January 25. However, as Qin and Wang report for the New York Times, many have begun to cancel their trips to the Wuhan and surrounding regions. Until we have more information, it’s really hard to know how worried we should be,” says Josie Golding, an infectious disease expert at the Wellcome Trust, in an interview with the BBC. Already, comparisons to SARS have fueled some fear, she says. But a lot has changed since then, she adds. Now, “we’re a lot more prepared to deal with those types of diseases.”
Were we? From Newsweek, April 3, 2020: As of this morning, over 245,000 cases have been reported in the U.S., by far the highest tally in the world. More than 6,000 deaths have been recorded in the U.S. and over 9,200 people have recovered, according to Johns Hopkins University, which has been tracking the outbreak using combined data sources. Over 53,000 people have died globally since the outbreak of coronavirus began in Wuhan late last year. There have been over one million confirmed cases globally, with almost 212,000 recoveries.
So the reality is, the normal human cocktail of hubris, wishful thinking, shortsightedness, and “business as usual” scurrying about has allowed a faster and wider distribution of this “a lot more prepared to deal with those type of disease.” My plan will be heavier on human psychology, crowd behavior and economic/health long term tradeoffs and lighter on immediate public health considerations than the official “road map”.
We are already in official phase 1, and I believe we have been in it too long already. There comes a point–I call it the “crossover point”–when the financial and emotional damage to families and individuals (from the imposed conditions) will kill, or irreparably harm, more people than would have died from the disease itself. Neither I nor anyone can prove when that occurs. In part, the reason for the government’s distress is a widely accepted estimate that up to 240,000 Americans could lose their lives even with current measures against the virus. That’s computer modeling, but according to the Washington Post, several White House staffers have doubted the accuracy of the figures. One source said Anthony Fauci told others there were too many factors at play to come up with an accurate estimate. “I’ve looked at all the models. I’ve spent a lot of time on the models. They don’t tell you anything. You can’t really rely upon models,” he said to members of the task force, according to the Post. So why do I think that the more draconian and lengthy shutdowns do more harm than good? Government officials and the experts they call on are, understandably, more afraid of blame for underestimating the severity of the virus than for overestimating the severity of the disease. Why? Damage from the “cure” takes a much longer time to manifest than damage from the disease. Blame for deaths from the virus is NOW, blame for deaths, business failures and other damages takes longer. Human beings always opt to “kick the can down the road”, government officials even more so.
“Down the road” is the explicit economic threat: a depression-like downturn rivaling the 1930s—prolonged double-digit joblessness, an unprecedented economic contraction, and widespread bankruptcy. The reason for the grim economic outlook is, oddly enough, the government’s very concentration of its financial cannons on the economy. When the government shows it has a convincing regime in place to restrain the virus — massive, population-wide testing, and a way to trace and quarantine those with whom victims have been in contact — the markets will gain confidence, and a floor will be created underneath the economic collapse. Until then, we are looking at the current freefall.
In a rare peek at official thinking, James Bullard, president of the St. Louis Fed, told Bloomberg last week that the jobless rate could climb to 30% next quarter and that the economy could contract by 50%. That was not counting for the impact of hundreds of billions of dollars thrown at companies by Congress as support to hold on to their workers. But even so, private estimates after the legislation are similar — Goldman Sachs forecasts a 34% economic contraction and 13.2% unemployment in the second quarter, and Deutsche Bank 33% and 12%. Although no one placed the forecasts in historical context, if we reach anywhere near those numbers, it will be far worse than the Great Recession, and nearly the magnitude of the Great Depression.
History has many examples. The current lockdown strategy is a bleak choice of (allegedly) fewer short term deaths against a much larger long-term death toll. The following examples, both negative and positive (S. Korea), are the basis of my belief that a 14-day “hard lockdown” would have been preferable to the multiple months of uncertainty we are experiencing.
Italy, for example, already had a 135 percent debt-to-GDP ratio before the crisis. It is hard to imagine how it will be able to borrow more without a commitment from other European countries to jointly be responsible for more Italian debt—something the northern European countries are still strongly opposed to. The ECB is already printing money like crazy, and another Greece-like situation will make it ramp up the printing presses even more. We have been down this path many times before, where the cure could be worse than the disease. The German hyperinflation of 1921-1923 created a resentful, impoverished middle class which ultimately led to Hitler’s rise to power. How many victims of financial ruin will end their own lives? In the modern era, for every one percent increase in the unemployment rate, there has typically been an increase of about one percent in the number of suicides. A study conducted by Brenner in 1979, found that for every 10 percent increase in the unemployment rate, mortality increased by 1.2 percent, cardiovascular disease by 1.7 percent, cirrhosis of the liver by 1.3 percent, suicides by 1.7%, arrests by 4 percent, and reported assaults by 0.8 percent. How many lost lives out of 300 million in the USA does a 10 percent, 15 percent, 20 percent unemployment rate represent?
South Korea has emerged as a sign of hope and a possibly model to emulate. The country of 50 million appears to have greatly slowed its epidemic; it reported only 74 new cases today, down from 909 at its peak on 29 February. And it has done so without locking down entire cities or taking some of the other authoritarian measures that helped China bring its epidemic under control. “South Korea is a democratic republic, we feel a lockdown is not a reasonable choice,” says Kim Woo-Joo, an infectious disease specialist at Korea University. South Korea’s success may hold lessons for other countries—and also a warning: Even after driving case numbers down, the country is braced for a resurgence. New case numbers are declining largely because the herculean effort to investigate a massive cluster of more than 5000 cases—60% of the nation’s total—linked to the Shincheonji Church of Jesus, a secretive, messianic megachurch, is winding down. But because of that effort, “We have not looked hard in other parts of Korea,” says Oh Myoung-Don, an infectious disease specialist at Seoul National University.
South Korea learned the importance of preparedness the hard way. In 2015, a South Korean businessman came down with Middle East respiratory syndrome (MERS) after returning from a visit to three Middle Eastern countries. He was treated at three South Korean health facilities before he was diagnosed with MERS and isolated. By then, he had set off a chain of transmission that infected 186 and killed 36, including many patients hospitalized for other ailments, visitors, and hospital staff. Tracing, testing, and quarantining nearly 17,000 people quashed the outbreak after 2 months. The specter of a runaway epidemic alarmed the nation and dented the economy. “That experience showed that laboratory testing is essential to control an emerging infectious disease,” Kim says. In addition, Oh says, “The MERS experience certainly helped us to improve hospital infection prevention and control.” So far, there are no reports of infections of COVID-19 among South Korean health care workers, he says.
MY PHASE 1: Legislation S. Korea enacted since then gave the government authority to collect mobile phone, credit card, and other data from those who test positive to reconstruct their recent whereabouts. That information, stripped of personal identifiers, is shared on social media apps that allow others to determine whether they may have crossed paths with an infected person. This would be part of my phase 1 plan, since we are so far behind S. Korea in our capabilities to test and trace and understand how a respiratory virus spreads. Passing such legislation during a 14-day “hard lockdown” of any city or town with any known infected persons I believe would better serve our populace, even starting now, than what we are doing now.
Caveats: Could the US and all the state governments actually agree on and pass legislation similar to that of S. Korea? What I am calling a “hard lockdown” means NO travel allowed by any means to or from any city or town with documented cases for 14 days, along with the current rules of closing “non-essential” businesses and group activities, and required wearing of masks of the asymptomatic (protection for others rather than the wearer) for 14 days! How could travel be prevented? How can closures and mask wearing be enforced? I will address those questions in Part 3.