It’s Not Time…Yet

Photo by Philafrenzy via Wikimedia Commons

There is a growing chorus of voices asking when we are going to end the mass quarantines, social distancing and lockdowns that have been instituted to deal with the coronavirus and get back to work. Their concern, they claim, is that if America is effectively shut down for several weeks or a couple of months it will destroy our economy and plunge us into a second Great Depression. And surely even stopping the Coronavirus is not worth such a great price. This perhaps was most exemplified by Texas Lt. Governor Dan Patrick:

Tx Lt Gov Dan Patrick says grandparents would be willing to die to save the economy for their grandchildren pic.twitter.com/wC3Ngvtsbj

— Andrew Lawrence (@ndrew_lawrence) March 24, 2020

This call has now been taken up by various online conservatives and even echoed by the President, who set a goal of having churches packed on Easter.

I hesitate to even address this, since I think that the vast majority of Americans understand how serious the situation is and that we are in this for the long haul. We are still in the midst of the outbreak stage, with cases and deaths rising exponentially. But with prominent voices, including, the President, agitating to end lockdowns early; with people like Lt. Gov Patrick saying that old people will willingly die to keep the economy going (as if they speak for 50 million seniors), I think it’s time to address this line of reasoning.

First of all, the economic concerns are not illegitimate. We may be facing the sharpest spike in unemployment in American history and arguably the worst quarter of economic growth… maybe ever. Even beyond that, many businesses are teetering on the edge. Not just big business like Boeing, which could at least be bought up cheap by entrepreneurs. But small shops, mom-and-pop stores, little businesses that people have invested their lives in. That’s not a small consideration, especially considering that the economic havoc being visited upon them is not their fault. It’s easy for people who have semi-secure jobs to say “Damn the economy”. But that damning is inflicting real pain and, ultimately, real suffering: depression, anxiety, possibly even a spike in suicides (although such claims are controversial). It’s not crazy to ask “is it worth it”?

And the answer is unequivocally “Yes”.

First of all, we are not in the midst of an “economic collapse” just yet. Factories are not disappearing into thin air. People are not losing skills. It is quite possible, once the crisis has passed, for our economy to come roaring back. And while I would usually oppose massive handouts, the stimulus bill Congress is working on — as flawed as it is — would be a big help in bridging the gap between now and then.

And this is especially critical because letting the pandemic spread would be an economic collapse, arguably far greater than the one we’re facing now. Let’s ballpark the damage a COVID epidemic could do. Let’s say 100 million Americans are infected. Of those, 20 million end up in the hospital and two million die (being optimistic because, as we’re seeing in Italy, death rates go up significantly when hospitals are overwhelmed). Let’s also remember that it’s not just the old people who suffer. About half the hospital admissions have been people under 50. And even if you assume, optimistically, a 0.2% fatality rate for those, we’re still talking about ten million people in the prime of life enduring a very serious illness with 20,000 of them struck down and God knows how many with permanent disability.

Those 20 million hospitalizations alone, assuming conservatively a $100,000 cost per hospitalization, would cost $2 trillion. That is, they would cost everything we are spending on the new stimulus bill and then some. That’s not including the economic losses of such a large population being physically unable to work for months and possibly suffering permanent disability. Add it all up and you are looking at a massive economic impact measured in many trillions of dollars.

We’re still not done. Because people are not going to simply stand around working heroically at their desks while a third of the population gets sick and 20 million people get deathly ill. They’ll stop working. They’ll stay home. They’ll panic.

And we’re still not done. Because COVID is unlikely to disappear off the face of the Earth. Even if we develop a vaccine — still a big if — it is unlikely to be 100% effective and there will be many who won’t be able to take it for medical reasons. We have no idea how long someone who has had COVID maintains immunity (or if they get immunity at all). So it will come back.

And what happens when it comes back? You remember those 20 million people we hospitalized? They are suddenly extremely vulnerable. Many of them will have permanent lung damage and other long-term health issues. As a result, the second wave of COVID could be far far deadlier than the first as it mows down those it failed to kill the first time. And God helps us if it mutates into something that kills children as readily as it kills adults. It’s worth remembering that that 1918 Flu Pandemic came back after the first wave and it was far deadlier the second time around.

Call me a sentimentalist. But even putting aside the catastrophic economic impact of an uncontrolled pandemic, I don’t think hundreds of thousands to millions of deaths is a thing to just shrug off. I don’t think the downside risk of a second far deadlier wave is something to shrug off. And I especially think they are not something to shrug off because we don’t have to. We are being presented with a false choice.

The Way Forward

The good news is that we are not faced with this kind of stark binary choice. The options before us are not “burn the economy down through quarantine” and “burn the economy down through an epidemic”. The options are to deal with this wisely or to deal with this foolishly. And the good news is that we know how to deal with this wisely. I refer you to one of the more important articles written about COVID, called The Hammer and the Dance. What it argues is that we need a massive initial response — lockdowns, social distancing, etc. In other words, what we’re doing now. That will contain the initial outbreak and eventually reduce the number of cases, as we’re seeing in South Korea.¹. One of the key things to take away here is that the easiest way to shorten the duration of the pain is to amplify the clampdown. The more aggressively we respond, the sooner we can beat this down and get back to something approaching normal.

But the second part is the more important. In that time, we anticipate that there will be outbreaks. We anticipate that COVID will come back. And we prepare. We stockpile masses of tests, PPE and ventilators. And we monitor. We do spot temperature checks. We immediately test anyone who has COVID symptoms. And when we see an outbreak, we activate our army. We surround the area, test everyone, contact trace from positive detections, and isolate those with the disease. If necessary, we do lockdowns again for areas where the infection has been detected. This “dance” of constantly playing defense against the virus goes on until we have a vaccine.

That’s the way forward. And it’s the way we can do it if we’re smart. Hammer the current outbreak into the dust. And then maintain an ongoing cold war against this cold.

And what of the economy? Well, there’s good news there too. Congress’s stimulus bill should help with the immediate problem. But it’s actually even better than that. One way to think of our response to the virus is in terms of the DEFCON system used for national defense. In this case, DEFCON 5 would be business as usual. And DEFCON 1 would be Wuhan-style welding people into their homes. Right now, most of the country is in, say, DEFCON 3 (work from home, non-essential businesses closed, social distancing) and DEFCON 2 (shelter in place).

At some point, these outbreaks are going to start to get better. And then they do, we can start lowering our DEFCON for individual cities and states (probably with travel restrictions for areas still fighting it). We do not go instantly from DEFCON 2 to DEFCON 5, as the President is advocating. We will not wake up one day to hear, “Everything’s cool, go back to normal”. What we will do, if we’re smart, is descend the DEFCON scale the same way we ascended it. Shelter in place is lifted but social distancing is still mandated. Then some social distancing measure are lifted. Then some more. All with the readiness to ramp back up should COVID reassert itself. Needless to say, this is only possible if we have massive testing available to monitor the decline or resurgence of the virus.

This response and the creation of a large army of doctors and specialist ready to race in while also be useful for future outbreaks. COVID is unlikely to be our last challenge here — even if we can get China to shut down their wet markets. And the next outbreak may be even worse. We need to anticipate that we need to maintain constant vigilance, as we did during the Cold War.

I don’t know that we will ever get back to DEFCON 5 with the packed churches and bars that Trump envisions. Not until there is a vaccine at least. But we can get back to a functional economy. Some sectors, travel in particular, may be wiped out. Others will surge. There will be pain, no question. But maybe, if we’re very lucky, a vaccine and/or a global eradication campaign can get us back to where we once were.

We are at a vergence point on this where we have different futures laid out before us, some horrifying, some optimistic. We can choose the better future. But that only happens if we remain patient, if we accept that this is not going to end tomorrow or next week or next month.

As I said early on, this is a war. And wars take time. If the outbreak was Pearl Harbor, we’re not even planning Midway right now. We need to be patient. We need to anticipate that things will be tough for a few years at least. But we need to do that because the cost of not having those tough weeks and months and years is even greater suffering and cost.

1. The NYT has a toy model here where you can vary the intensity of measures, the duration and the particular of the virus. The biggest unknown, at his point, is whether the virus will fade in warmer weather. We simply don’t know right now. And that not knowing is the difference between beating this down with a 30-60 day measure and having it come roaring out the second we lift restrictions.