Ready or Not, Here We Come

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As of this morning, the official death toll from covid-19 in the United States stood at 53,314, an increase of 14,224 in the past week. However, the rate of increase slowed to 36%, compared to 90% the previous week and 142% the week before that.

Passing the peak

This week the Institute for Health Metrics and Evaluation reported its latest estimates of peak mortality for countries and states. For the US as a whole, deaths are thought to have peaked on April 15 at over 2,600 a day. That should now fall pretty quickly, but additional deaths are projected to bring the total deaths to 67,641 by the time this wave of the virus peters out in August. Such projections have a large margin of error, and so total deaths could reach as high as 123,157.

A number of individual states have not yet reached their peak daily mortality, but are expected to by the end of May. These include Arkansas, Georgia, Iowa, Kansas, Kentucky, Montana, Nebraska, North Dakota, Rhode Island, South Dakota, Vermont and Wyoming. Most of these states are farther inland than the coastal cities which experienced the epidemic first. All of them except Rhode Island are red states, which may also have been slower to issue stay-at-home orders. Where the mortality has been greatest, the restrictions on public activity are credited with bending the exponential growth curve downward.

When to reopen?

The IHME also suggested dates on which the states could safely lift their restrictions and let people go back to work. The assumption is that if states would keep their restrictions in place until these dates, the rate of infection would then be very low. States could theoretically manage the remaining infections with testing and quarantines, avoiding a serious resurgence of cases and deaths.

Here are the suggested dates, by week:

May 4-10: Montana, West Virginia, Arkansas, Hawaii, Vermont

May 11-17: Idaho, North Carolina, Ohio, New Hampshire, Maine

May 18-24: California, Nevada, New Mexico, Louisiana, Alabama, Tennessee, Illinois, Indiana, Michigan, Wisconsin, Delaware

May 25-31: Washington, Oregon, Wyoming, Colorado, Minnesota, Mississippi, Pennsylvania, New Jersey, New York

June 1-7: Maryland, Virginia

June 8 or later: Arizona, Utah, Texas, Oklahoma, Nebraska, Kansas, North Dakota, South Dakota, Arkansas, Missouri, Iowa, Kentucky, Florida, Georgia, South Carolina, Massachusetts, Rhode Island, Connecticut

The dates reflect both how many cases states have had, but also when they had them. Although the states with the earliest reopening dates have had low mortality, the states with the latest reopening dates are not, for the most part, the states with the highest mortality. Of the ten states with the highest covid-19 death rates per 100,000 population, only three—Massachusetts, Rhode Island and Connecticut—have reopening dates this late. But of the states whose death rates have not yet peaked, all except two—Montana and Wyoming—have the latest reopening dates. That means that some of the states with the highest mortality, especially New York and New Jersey, can reopen before states with relatively low mortality, such as Utah and South Dakota. That will make the later reopening dates a tough sell in many states.

The suggested reopening dates also come with important conditions. They work only if restrictions remain in place up to the reopening date, and they assume that the state is then ready to implement containment strategies including “widely available testing, contact tracing and case-based isolation, restrictions on mass gatherings.” Otherwise surges in cases can occur, even in places that have not experienced them already.

States that are not prepared to do these things will be strongly tempted to try and reopen anyway. Why accept the real hardships of economic recession, with the national unemployment rate already around 16% and climbing, in order to avoid a spike in mortality that is only a mathematical projection? A case in point is Georgia, which has seen only 9 deaths per 100,000 population (a little less than one death per 10,000). And yet epidemiologists do not see it as a good candidate for reopening, since its death rate has not yet peaked and its testing rate is among the lowest in the nation.

The fact that most of the late-peaking states recommended for late openings are red states adds a political component to the mix. If the climate-change debate is any indication, most Republicans would rather risk future catastrophic change than disrupt the existing economy. It should be no surprise that “the easing will not be universal and is cleaved largely along party lines, with some Republican governors moving to reopen key sectors and Democrats moving more slowly” (The Washington Post).

So here we come, ready or not. Some states will throw caution to the winds and forge ahead recklessly. Others may be too cautious and hurt more people than they help. That is where the national mismanagement of the crisis from the beginning has left us. We can only hope that we manage the recovery from this wave of the virus better than we managed the initial spread. And commit to being better prepared for the next one.

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