Flatter but Wiser?

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Last week I said that the United States was poised to become the world leader in coronavirus cases very soon. That milestone has now been reached, as our 20,608 deaths have surpassed every other country. That includes China, despite the fact that it is less economically developed, has four times our population, and was first to be hit by what became a pandemic.

However, this week we also had evidence that our steeply rising mortality curve is starting to flatten. Total deaths did increase 142% during the week—that is, they more than doubled—but they had nearly quadrupled the previous week. Deaths are still rising, but the rate of increase declined in almost every state. (The exceptions were Idaho, Missouri and Oregon.)

Nevertheless, the spread of the disease remains alarming. With over 20,000 deaths already, any more weekly doublings would result in astronomical death tolls. Epidemiologists have developed much more sophisticated models for the spread than I can describe here. One of them that has gotten a lot of attention projects that we can hold this year’s ultimate death toll to 60,000. Whether we can do that while quickly putting the country back to work is not as clear.

What have we learned?

What have we learned from experiencing this pandemic so far? Are we drawing the right lessons? In particular, what has President Trump learned? We know that he initially underestimated the problem, and that he continued to treat it dismissively for weeks after being briefed by both intelligence officials and medical experts. We also know that previous administrations—both Republican and Democrat—had developed plans and proposals for dealing with a pandemic, and that this administration chose to ignore them. How much has the President wised up since then?

The first lesson most of us have learned is that a pandemic requires a quick and decisive response, since every week counts. Locating cases and quarantining the infected are crucial.

The second lesson is that a country can slow the transmission of a contagious disease by telling most people to stay home, although that is a crude way of doing it. At the very least that strategy can spread the caseload over a longer time, easing the burden on medical facilities. Hopefully, few states will now experience what New York has just been through.

But then what? How does a country permanently limit the number of people who contract the disease and the number who die from it? The ideal solution is general vaccination, but that appears to be at least a year away. Another possibility is a breakthrough in treatment, to make the disease less life-threatening, but that also appears a number of months off.

Advocates of a quick return to business as usual seem to be relying heavily on “herd immunity,” the idea that once a lot of people have survived the disease and developed immunity, new cases will peter out. We can also use the antibodies in the blood of survivors to treat those who do get sick. But how large would such a “herd” of survivors be? Right now, we have about one death for every 25 confirmed cases. That means that we could get to 60,000 cases with only 1.5 million Americans having contracted the disease, leaving the vast majority of our 330-million population still at risk with no immunity. Of course, the reported numbers of deaths and cases could be wrong. Maybe a lot of deaths have yet to show up, since it is a “lagging indicator,” and some deaths occur at home without being correctly classified. The number of cases could be even more seriously underestimated, since people can have mild symptoms without reporting it as covid-19 at all. But even if the real ratio of deaths to cases is only one in 100, we could have 60,000 deaths from only 6 million cases, still leaving most of the population unprotected.

Most medical experts are dubious about the President’s eagerness to “reopen” the economy. We would be ending the strategy we’ve been relying on to stop the dying, and sending people back into society with no more protection than homemade face masks.

Test, test, test

What the experts do recommend is what should have been done earlier on. Scale up testing to the point where new cases can be quickly identified and selectively quarantined, while other people start to feel safer going about their business. That’s what countries with the most success in halting the epidemic have been doing. In contrast, President Trump’s consistent pattern of over-promising and under-delivering testing is a national embarrassment.

I doubt that the economy can restart with one big rush of people back to work. It’s going to be a while before people are comfortable in crowded workplaces, shopping malls, stadiums, or on buses, subways or airplanes. Given the great variety of workplaces, shopping areas, entertainments and methods of transportation, I suspect we will have a patchwork economy for a time, with some places a lot safer than others. That should make the overall recovery a bit sluggish, especially since the various parts of the economy are interdependent. One business cannot thrive if some other business it depends on cannot operate safely.

Another widespread prediction is that technological means of interacting and producing without face-to-face interaction—automated production, teleconferencing, online shopping, etc.—will get a permanent boost from this experience. But reorganizing along those lines will take time, and it will require some upgrading of the skills of many workers if they are to remain employed.

Instead of a quick return to “normal”, we should expect a painstaking transition to a new normal.

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