Well, another week flies by, but it isn’t because we are having fun. We are watching the fast-motion disaster that is the shutdown of our economy and we all seem trapped in one of those dreams where you want to run away but you just can’t get your legs to move. So once again, I will summarize where I think we are in regard to the most pertinent facts relating to the epidemic and the reaction to the epidemic, updated with what has occurred in the past few days.
1. The virus clearly is a serious public health issue, causing significant illness and deaths. But most of the serious illness and deaths are occurring in sub-populations, particularly the infirm elderly. The risk of serious illness or death to younger Americans, in particular is extremely small.
2. The virus has a high level of transmissibility. It likely transmits by direct contact, airborne virus and surface contact. It may be fairly hardy, able to persist outside a human or other host for some period of time.
3. The virus probably began circulating in the United States earlier than we have realized and probably became more widespread than was initially understood, infecting more people. There are likely substantially more infections than are reflected in positive test results.
4. The epidemic level spread of the virus can only be stopped by a few methods. One is eradication, but that is extremely unlikely, given the widespread nature of the virus at this point. Another is such a severe lockdown that people literally have almost no contact with each other, but that is unrealistic. A third is that sufficient immunity develops, either through antibodies after infection, and/or by a vaccine, to limit transmissibility to a low level. A vaccine is by most expert estimates a year or more out. It is most likely that the virus will linger and cause some level of infections into the future. The greater the suppression of spread now, the more infections we will experience in the future if those suppression measures are lifted, until there is a high level of natural and/or vaccine-induced immunity.
5. A variety of mitigation of spread measures are available. Each of these will have some effect on the speed and level of spread and each has some economic and non-economic cost. The incremental benefits and harms of each should be considered in deciding what package of mitigation measures to adopt.
6. Mitigation of spread measures do not stop infections or deaths permanently but only defer them, in the absence of eradication or a vaccine. The exception would be excess deaths that might occur due to cases in a greater number than the capacity of health resources, primarily ICU beds and ventilators, available to treat that number of cases. To date this has not occurred, primarily due to low number of serious illnesses in most areas and flexibility and creativity in creating new capacity in hotspots.
7. The mitigation measures adopted to date have tended to lead to large-scale business and social shutdowns, which in turn have created very significant job losses and an abrupt decline in economic activity. The mitigation measures are being applied to the population as a whole, and not targeted to the sub-populations at risk. Those job losses will lead to a variety of health and other non-economic harms.
8. The country is largely being run in a very un-democratic method, with emergency orders dictating who can do what. At the same time, there is no reason why legislatures could not be more involved and they are more representative than the executive branch. Social tension will increase if the lockdowns drag on for more than a few weeks.
9. The economic downturn significantly affects state and federal revenues and affects their ability to address the needs of those losing jobs.
Based on this assessment of the situation, the most realistic scenario for the year ahead is a choice between A) maintaining a fairly extreme shutdown which will cause continuing job and economic losses and B) lessening the mitigation measures and targeting them at the populations most at risk, while allowing the working-age population to return to work and to normal social life. We need to not engage in wishful thinking about either the likelihood that current lockdowns eliminate the virus or that if they were removed immediately there would be a sharp economic rebound. But in the long run, it appears we are going to get a certain number of infections and deaths, it just is a matter of when, and we can’t sustain this level of job loss for an extended time. Therefore, we should change the shutdowns now and move to the more targeted mitigation of spread measures, accepting that this may lead to more infections and death in the short run, but fewer in the long run, and this approach avoids much of that job loss and consequent non-economic harms.