Here’s my fairly detailed take on where we are with COVID19. First, I’ve heard through my numerous sources inside the healthcare system that many hospitals are now doing fine on capacity and PPE. I’m sure there are exceptions, but my sample size of about 15 major US hospitals is large enough that I feel confident that, at least so far, we haven’t seen many hospitals totally overrun as perhaps they did in Italy.
Second, I continue to believe that when the numbers are all in, the virus will be far less lethal than originally thought – almost certainly less than 1% and probably in line with influenza.
It strikes me that you have to be in favor of one of two high-level strategies at this point: (1) Everyone stays quarantined until we are confident we have a vaccine and enough people are vaccinated that the risk is very low to everyone else or (2) We start reopen the country to build herd immunity pre-vaccine. I’m in favor of #2 as I think #1 is not viable for numerous reasons.
Thus, I believe we need to start staging the recovery. I favor a “regional release,” based on hospital supply/demand. The main rationale for the nationwide shutdown of all social and economic activity was to slow down the virus spread enough that hospitals could cope with demand and have enough PPE to safely manage it. While we’re not there in every corner of this vast country, we’re there in a lot of areas. Again, that doesn’t mean we won; it just means we’re managing it.
In those regions where we are managing the volume, we need to start opening up businesses. To be clear, we should maintain all the norms of safe social distancing and, where appropriate, use masks and gloves. To be even more clear, I’m NOT suggesting we should all run to our local bar and stand shoulder to shoulder. But, over the next 2-3 weeks, business must resume in a safe and measured manner.
We also need a plan for assessing whether we opened too soon as it will be hard to know a priori. I propose that assessment is based on regional assessments of hospital capacity. Yes, we will likely have more cases as we open up, but as long as we’re managing it, that has to be OK, unless you’re willing to keep us shutdown until the vaccine is available. I am not.
Before you jump all over me for putting older and more vulnerable people at risk, let me ask that you consider the costs of NOT starting to resume our lives. Here are just a few, as yet un-quantified costs:
– By how much will the suicide rate rise as people’s lives are ruined by loss of jobs, income, etc.?
– How else will health suffer from such massive disruption of people’s lives? The memes about all the liquor bottles in the recycling bins across America are only funny until you realize how serious it is.
– What is the health impact of loss of health insurance as people lose jobs? The person who develops a life-threatening illness a year from now and is unemployed without insurance might have been treated more easily prior to losing his/her job and insurance.
– What is the long-term health impact of patients not getting “elective procedures,” when that term now includes things like cardiac ablations, critical limb angioplasties, and injections for macular degeneration, just to name a few?
Finally, I have a prediction that also drives my thinking. I believe we are about 2-3 weeks away from what could turn into fairly massive resistance to continued shutdowns. I think there are a lot of people who’s lives have been ruined to the point that they have nothing much to lose by defying these orders. I think small business owners will start to say “eff it; I’m opening; what can you do to me that could be any worse than what’s already happened to me?” That would be really bad b/c it would be highly chaotic as opposed to a more orderly, sanctioned, and phased reopening of the country. As an aside, it’s not at all clear to me that the governments even have the authority they’re claiming they do so the legal battles could be interesting.
Just my thoughts.