In the Age of the Coronavirus

In spite of being quarantined for several weeks I have avoided writing here about the Coronavirus Covid-19. I am not trained in the subject of viruses and their prevention and treatment. I have, however, in these last weeks read a great deal about it, most of it written by people who don’t seem to know any more about it than I do. Worse, even the medical and scientific experts seem not to know too much about this particular virus, learning about it only along the rest of us.

As they learn, these experts develop models for the predicted behavior of the virus. They are mostly frank to admit that the models keep changing as facts come in because there was very little knowledge to begin with. Whether and to what extent and by what means the spread can be controlled are also uncertain. This doesn’t mean the experts should be disregarded. An educated guess is much better than an uninformed one. It is useful, though, to keep the weakness of both the models and prescriptions in mind, as we make truly consequential decisions in reliance upon them

There are some things we now know about the Covid-19 Coronavirus:

  • It originated in Wuhan, China from natural causes and was not engineered by humans. It may have spread from a food market selling wild animals or escaped from a laboratory where it was being studied. It doesn’t much matter which at this point.
  • It is very highly contagious, spreading from human to human, exhaled by one and infecting the other through the mouth, nose or eyes.
  • It is probable but not certain that infection by the virus provides immunity to further infection.
  • A very large and unquantified portion of the population becomes infected without noticeable symptoms.
  • Another substantial portion of the population becomes ill when infected with symptoms much like a bad flu, which, of course, is exactly what it is.
  • A smaller portion of those infected becomes seriously ill with respiratory difficulties requiring hospitalization and, in some cases, use of a ventilator to breathe.
  • A still smaller, even tiny percentage dies from the virus.
  • The people most susceptible to serious illness and death are overwhelmingly the elderly and those with comorbidities – serious underlying medical conditions acting together with the virus.

A problem in analyzing the risks of re-opening the economy is the same one the government experts face in constantly revising their prediction and behavior prescription models. The “facts” are very misleading. The daily numbers of infections and deaths due to Covid-19, which we follow with a zeal once reserved for political polls and baseball box scores, are based, not on the actual population, but on persons tested. The tests are not at all a random sample but are overwhelmingly given to persons who show symptoms or work in high risk occupations or are exposed to them.

Early on, Coronavirus deaths in the US were predicted to be a million. They have been revised downward, one analysis from the University of Massachusetts, Amherst in late March predicting 195,000. As of May 17, the actual toll is 89,000, with about 33,000 or them occurring in New York and New Jersey.

Even the utility of facemasks to protect the wearer from disease has been in dispute. Early on government experts believed it was pointless, even harmful, for ordinary citizens to use them. (The conspiracy theorists among us might believe that advice was designed to keep the limited supply available to hospital workers and first responders.) It seems at least that masks on the infected reduce the chance of passing the disease along.

The generally approved response of our Federal, state and local governments has been to separate people from each to control the spread of the virus or, as the experts put it, to “flatten the curve” of people becoming ill. There was concern about our hospitals becoming overwhelmed and unable to handle vast numbers of those requiring inpatient treatment, particularly Intensive Care. It is important to note that no one has suggested that this separation would prevent infection altogether or even reduce the number of infections over time. It was merely to spread the infections out to make hospital admissions easier to manage. In this, the strategy has largely succeeded.

The strategy has included various forms of “shut down” and “stay-at-home” government orders to keep people apart and at least delay their infecting each other. There are many activities, however, that cannot be shut down. First responders and emergency medical care have had to continue, as well as treatment of critical cases of Covid-19.

Food supplies and distribution must be maintained. Farm production has continued but crops and meat go to waste while shortages exist at the consumer level. Our freight transportation system has heroically continued unsung but bottlenecks have arisen at meat and other food processing plants due to Covid-19. These must be managed urgently.

There are catastrophic costs to the “shut down” strategy. As we consider how to return to a “new normal,” it is necessary to consider not just the medical and scientific advice, the best we have however uncertain, but also economic and other costs and how they are to be balanced against the risk of illness and some shorter lifespans. Cost analysis is a tough business in the context of that kind of risk.

Countless businesses have been closed and their employees left without work. Without some exposure to risk, the great economic engine that sustains most of our lives will be ruined, if not permanently, a least for a long time. Government checks to a large portion of the population cannot be long maintained. Poverty shortens life too.

Ironically there have been massive layoffs of nursing and other medical workers as non-emergency and Covid-19 medical care has been shut down. Cancer and heart screenings and other preventative care go unperformed with definitely unfavorable consequences on health and lifespan.

The full “shut down” and “stay-at-home” strategy cannot continue indefinitely. No one has suggested that it will eliminate the virus. Short of a vaccine which can be broadly distributed and unless the virus turns out to be seasonal, the only solution is “herd immunity” the theory that when a sufficient number of the population have gotten the virus, it will disappear for lack of easily available hosts.

Re-opening the economy is necessary but entails risk. It is highly likely to produce another surge in infections, hospitalization and deaths. If it is handled correctly the hospitalizations and deaths will be minimized by confining the surge in infections, as much as possible, to those willing to take the risk and more likely to avoid serious illness and death.

The problem is greatly complicated by our incessant noisy politics. Politicians and their partisans on social media let no opportunity pass to gain advantage from the tragedy. Even the wearing (or not wearing) of face masks is taken by some silly people to be a political statement. Here’s some advice: if you hear people say, “The Republicans want to reopen because they care only about money and not human life” or “The Democrats want to ruin the economy to hurt President Trump’s re-election chance,” ignore them. They are all partisan idiots – part of the problem, not the solution.

A popular meme going around argues, “If you want to open the economy, who do you want to die? Go ahead, name the people.” The answer to that is, they will pick themselves. People will decide for themselves the measure of risk they can bear to achieve what is important to them. Also, as I point out above, there are shortening of life effects from denial of “routine” medical care and poverty itself.

President Trump and his worst enemies seem to agree on one thing. “It’s all about Trump.” They’re both wrong. While he has been omnipresent at the daily briefings, he has had little effect on what has happened. He was predictably criticized in January as “racist” or “Xenophobic” for halting flights from China. That seems to have been a good idea, although the virus generally moved from China to Europe and then from there to the United States. Different leaders around the world have taken different approaches. With exceptions any variations in results have been more due to the availability of testing and medical equipment than political approach. It is easier of course for more autocratic regimes to manage their populations’ behavior but a by-product of such a regime is lack of transparency in disease statistics.

The Federal government can collect and distribute information and develop models and guidelines but it is state Governors and local leaders who must be in the lead on reopening the economy. One single plan will not fit Idaho and New York. In larger states, different parts of the state present different situations to which leaders must adapt. But we must reopen the economy. The cost may be high, but will be higher still if we do not.

There will be unmasked fools packing reopened bars. If you know people like that, stay distanced from them. Offices and factories, businesses and stores will operate under different rules and conditions.

Schools need to reopen. The risk to children from the Coronavirus is negligible, statistically insignificant. A new inflammatory disease, affecting children and theoretically associated with Covid-19 is also extremely rare. The loss of learning to a whole generation of children, at the time of life best suited to learning is incalculable.

If you are older and/or have one of the “underlying conditions,” you should self-quarantine and take careful precautions when you must go out. I am 76 and have COPD, so I place myself in that category. I don’t expect the younger, healthier part of the population to ruin their lives and futures to eliminate any danger to me. That is up to me.

If you can bear the risk, go carefully about your life. Our country must too.

4 Comments Add yours

  1. bob.k.sheridan@gmail.com says:

    Well said. A necessary cerebral timeout.

    Sent from my iPhone

    >

    Like

  2. Carla Blakley says:

    Great and then some!!!!!

    Sent via the Samsung Galaxy, an AT&T 4G LTE smartphone

    Like

  3. Paul Mahoney says:

    Great article Brian.

    Like

  4. Laurie Toner says:

    A pleasure to read. Numerous points well stated.

    Go Pats

    Like

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