By Kevin Roche
Just trying, like many of you, to take a deep breath and see if we understand a few key facts of where we seem to be on the coronavirus epidemic and what that suggests for appropriate courses of action.
- This is a serious public health threat, causing widespread illness and significant numbers of deaths. No one should be disputing that. Some significant effort to avoid infections and illness is worthwhile.
- Infection rates, based on testing, seem surprisingly low, considering that the virus is apparently highly transmissible and very hardy and has been percolating in the United States for some time. Why are there so few positive test results, especially when testing is limited to those with symptoms or who think they may have been infected? We need to know the answer to this question. Is it immunity or some other protective factor? It matters a lot in terms of what we think the ultimate toll of disease and death might be from the virus and what our strategy to control the epidemic should be.
- Death rates are completely unpredictable at this point, but almost certainly will be far lower than many “models” are projecting.
- There are a few sub-populations, some quite large, that are responsible for the great majority of infections and almost all deaths. These include the elderly, people with some serious chronic diseases and people with immune system problems.
- There appear to be significant geographic variations in infection rates and death rates. Why does the Southwestern corner of the United States–California, Nevada, New Mexico, Arizona–have seemingly much lower rates than other places in the country. Seems unlikely to be just based on testing; even if testing rates were low, people would still be showing up at medical facilities and hospitals when they got sick. And it can’t be lockdowns, there is no dissimilarity in these states’ tactics compared to many other states. It is weather? Are Hispanics more likely to have some natural immunity or protection against infection? Something seems very odd. And there are such wide variations across even different urban areas that you wonder if there are aspects of who the virus infects that we don’t understand.
- Most social distancing and other precautions may be based on outdated research, as new studies on the bio-physics of human respiratory exhalations suggest stronger transmission dynamics. This feeds into the mystery about why infection rates appear to be so low. And it calls into question the value of some mitigation tactics, like staying 6 feet away from other people. But it also suggests that wearing masks may have more benefit than we realize.
- Mitigation measures are likely only spreading out infections and deaths. If this is not the case, someone needs to explain why. We aren’t eradicating the virus, we don’t have enough infections to build up immunity in enough of the population to substantially slow transmission chains with lockdowns, so we are only deferring the inevitable. We may get a seasonable respite, but return with a vengeance in the fall.
- A vaccine is a long way off. There are reasons to be encouraged about a vaccine and reasons to be concerned. The virus isn’t highly mutable, so a vaccine could provide long-lasting immunity. But this is the third outbreak of a serious coronavirus strain in the last 20 years–if a general vaccine could be developed, why hasn’t it been, and even though coronavirus may not mutate as frequently as the flu virus, for example, it apparently has sufficient capability to periodically create quite deadly strains. Vaccines are less likely to work well for the elderly, who are the most at-risk group. But the main problem is that a vaccine is just too far off when our primary strategy appears to be extreme economic shutdowns.
- The economic damage from the lockdowns is simply unfathomable. I have run out of words to describe it. Job loss and all the consequent financial and non-financial harms are just beginning to set in. It is like a tsunami that we glimpse far out but you can’t really appreciate the size or the power of the wave until it is upon you. 20 million people out of work already.
- We are being given no real guidance on how long the shutdowns will last and what the damage is for each additional week that they do last. That uncertainty compounds the economic damage. It simply isn’t possible for any country, even the United States, to endure a lengthy shutdown of large segments of the economy.
- No balancing of the potential toll from the coronavirus epidemic and the known harms of the economic shutdowns is being done, it just isn’t.
- We are giving a few individuals far too much power to unilaterally make decisions that affect everyone. Those decisions belong to the legislatures or the people, not the executive branch.
- We are deferring far too much to public health experts. These people, whose expertise may not be what it seems, have tunnel vision and see only one aspect of the larger situation. Yet they are driving every decision and we are told that we must defer to the scientists, the experts. No, we musn’t, in fact it is dangerous to do so. We need to consider the views of all experts, especially economists, but also people generally.
- My conclusion is that we need to stop the shutdown now. We need to get businesses open, people back to work, people spending. We know there are limited vulnerable populations, we should isolate the elderly and other at-risk groups; we should continue to take prudent hygienic measures that may limit transmission, including quarantining of those who are infected and testing of those they may have may been in contact with. We need widespread antibody testing immediately, so we know who is safe from infection and infecting others. If we don’t change course, we are flirting with chaos and irrecoverable economic harm.