Many commentators have observed that the economic damage of the coronavirus will likely kill more people than the pathogen itself. Too many people then move to arguments like “So let’s isolate only the elderly”1 or “We must therefore minimize damage to the economy.” We’ll turn to Martin Wolf of the Financial Times’ urgings on that front in due course.
The problem is that there are times you can’t have what you want and this is one of them, big time. Our old way of living will never fully come back. And too much fixation on “We need to relax the lockdowns because economy” is bypassing the hard thinking and work that still hasn’t been done enough to help more of us function better before we have either effective treatments that greatly reduce the number of serious cases or a vaccine.2
While China has loosened up on its restrictions, it’s not back to normal due to a combination of some workers reportedly not having returned for duty plus factories not being able to go into full schedules due to lack of new orders thanks to lockdowns in Europe and the US. But there are also rumors that infections have come back. Some countries like Austria, the Czech Republic and Denmark are planning to relax their restrictions in the next few weeks; we’ll have a much better picture a month after that happens of how much reversion takes place.
But the big problem for most countries, particularly the US with its hollowed out health care system and the UK with its starving of the NHS, is that doctors and nurses are already at the breaking point even in locations where the disease has not peaked. Medical professionals are at even greater risk of bad outcomes than the public at large due to potential exposure to large viral loads when exhausted. The lack of adequate PPE is a disgrace and the failure of the Feds to step in, even more so.
There are plenty of clips on Twitter showing the sorry state of hospitals; this is a recent one we featured in Links yesterday:
Shithole kleptocracy pic.twitter.com/MDFBfx3B7h
— Mark Ames (@MarkAmesExiled) April 7, 2020
The National Nurses Union has issued repeated press releases on the lack of preparedness and needed safety protections. Yet the Washington Post showcases Matt Bai putting on an n95 respirator and medical googles (not ski mask made-dos) and other coverings. Not saying that Bai isn’t still taking serious risk, but that the Post is helping propagate the myth that front-line conditions are better than they are.
I am lucky enough to have PPE but it is NOT uniform throughout the NYC hospitals. This has to change… or else more doctors on the frontlines will die. Thank you @MedSupplyDrive @MasksForDocs @patagonia @DBelardoMD @DrJayMohan @MomAnesthesia #CoronavirusPandemic #PPE #COVIDー19 pic.twitter.com/elDwORfJPY
— Dr. Rosine Sarah Rosanel, MD (@DrRosanel) April 5, 2020
This video from the Lenox Hill Hospital in NYC (my old stomping grounds) even though taken outside on a pretty day, still gives a sense of the chaos indoors:
Yesterday, we discussed how the coronavirus is leading hospitals to suspend surgeries and treatments they deem to be postponable, even for cancer. We are now getting reports of cancellations specifically due to the lack of PPE:
Cancer surgery canceled because the hospital doesn’t have enough tests or PPE. This virus is killing people who don’t have the virus. https://t.co/qWaMjgW1gm
— Andrew Yang? (@AndrewYang) April 7, 2020
In the UK, staff at the Barnsley hospital were provided with PPE 19 years out of date
The big point is that a group obviously and seriously exposed to the coronavirus is medical workers. I’ve argued that the big motivation for flattening the curve isn’t just to reduce deaths overall by not exceeding hospital capacity but in particular not to decimate hospital staff.
But as we are seeing from strikes among Amazon warehouse workers and other people who are deemed critical and have to work in close proximity with others, we are risking breakdowns in other now-even-more-essential systems.
And coronavirus is hitting key services where there aren’t many replacement staff, like air traffic controllers. From a late March article in Politico:
FAA personnel at air traffic control facilities from Las Vegas to New York have tested positive in the last week, prompting closures while the buildings were cleaned. The majority of the almost one dozen facilities affected so far have been towers at airports, but two of the incidents have been at centers responsible for controlling airspace over multiple states.
Though the airports themselves remained open, buildings had to be closed temporarily and control duties taken over by another facility, creating delays even in this depressed environment for flights. A cascade of more cases spreading throughout the controller community, especially if it hits several facilities in one region at the same time, could be crippling.
How about the staff that manage nuclear reactors? Sewage plants don’t take as much day-to-day minding, but prolonged staffing shortages could lead to bad outcomes. Readers might come up with other examples of important infrastructure or systems that would have trouble functioning well if a site or sites were to suffer a coronavirus outbreak.
Steve Waldman made the case for enduring the cost of lockdowns in a post last month:
COVID-19 is not just a disease that is infecting us as individuals. It has infected us as a society. The financial fallout, the flailing markets, these are the social equivalent of a mid-grade fever, an unpleasant and uncomfortable side effect of the work our society is performing to suppress and defeat the infection. There may be ways of reducing the unpleasantness without impairing the effectiveness of the response, various forms of economic stimulus or monetary loosening as a kind of social tylenol. Maybe those are worth considering. Some have been tried. But nothing would be more stupid, more suicidal, than to suppress the immune response in order to suppress the fever.
That is what ending our isolation now — what sending everybody back to offices, schools, restaurants, beaches, and bars — would amount to. It might well relieve the “fever” short term. The stock market is up this morning! But it radically increases the likelihood that the patient — our polity, our society — dies.
How would that happen? What’s the microstructure of this purported social collapse? How would putting people to work again be bad?
We desperately need people to work. All of us staying home will not save us. But some people’s work is much more critical than others’ to our society’s collective viability. We obviously need medical personnel to work. For them to work effectively, we desperately need the people who are capable of producing and ramping up production of PPE (“personal protective equipment”) to work. Perhaps more desperately, we need our agricultural and food supply chain to be producing the calories and nutrients each and all of us need to get through this. We need grocery store clerks, stockers, shoppers (for delivery and pick-up orders) to work. We need truck drivers a-truckin’. We need Amazon and UPS and FedEx, permitting us to get what we need with minimal opportunity to cough on one another. We need fire departments and police. We need the digital platforms and communications infrastructure. We need people delivering essentials to the elderly. We need the people who can develop and ramp up testing, tracking, and treatment. We desperately need people to work.
But if you are not one of these people, your staying at home — working as much as you can if you can or not at all of you can’t — is not “waste”. It is making a huge positive contribution to our society, by delaying the moment when it will be impossible to persuade a critical mass of these very essential workers to do their jobs, because many of them are sick and the rest of them are too afraid of getting sick.
The New York Times ran an article on Monday based on interviews of medical experts on what needed to be in place to relax the lockdowns with reasonable safety. Its four requirements:
Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care.
A state needs to be able to at least test everyone who has symptoms.
The state is able to conduct monitoring of confirmed cases and contacts.
There must be a sustained reduction in cases for at least 14 days.
Needless to say, the US is not even close to meeting these standards. From the close of the story:
Gregg Gonsalves, a professor of epidemiology and law at Yale, said: “I’d feel better if we had serological testing, and could preferentially allow those who are antibody positive and no longer infectious to return to work first. The point is, though, that we are nowhere even near accomplishing any of these criteria. Opening up before then will be met with a resurgence of the virus.”
A lot of normally capable policy wonks seem not able to come to grips with the fact that the coronavirus has the upper hand. Sure, we can try reopening for business after we’ve tamped down the infection and death rate with stay-at-home requirements. And maybe the disease won’t propagate quite as quickly because the summer will have a mitigating effect.
But I have yet to see an expert opine that warmer weather will do all that much for contagion rates. And I also know too many people who seem to have convinced themselves that they already contracted it, when the second go-round of the past winter’s flu was nasty and I know personally of only one symptom description that does sound like it was coronavirus. In other words, a lot of people seem to feel the need to tell themselves they aren’t at risk when their personal factoids are far from dispositive.
So what happens to commerce if restrictions are largely or entirely removed, and in a month infections are back on the march? The resulting stops and gos, particularly at different times in different parts of the US and world, would make the production that was happening more uncertain and likely costly.
The reluctance and inability of Federal or even state governments to set priorities and drive resources and support to critical industries and operations, like America’s one cotton swab factory in Maine, is yet another proof of institutionalized incompetence.
With this backdrop, it’s frustrating to see Martin Wolf engage in handwaves. From the top of his article:
What we must do instead is focus on the steps right ahead if we are to avoid falling off our narrow path into mass deaths on one side, or economic devastation on the other. If we do not avoid these calamities in the near future, we risk chaos ahead.
There may be no path through this problem. If you watched the video of the professor who practices at Lenox Hill, he argued for the need to build Covid-19 focused hospitals, all with negative pressure treatment rooms, with the medical professionals in them wearing full hazmat gear, as essential to contain the disease. If he’s right, we are in deep trouble.
Wolf is correct to stress that the economic costs of shutdowns are very high…
….and that the poorest workers and countries will suffer the most.
His next argument:
My view, however, in line with that of health experts and leading economists, is that the lockdowns are necessary to save health systems from collapse and get the disease under control. But they have to be brief. It is impossible to keep people locked up indefinitely, without huge personal suffering and social and economic damage. This is obviously true where governments are unable to offer the costly social protection measures feasible in high-income countries.
Lockdowns must be a short breathing space before we move to what a group of German experts calls a “risk-adapted strategy”. During the lockdowns, governments must do whatever is needed to avoid having to employ such heavy-handed interventions again. They do not have much time to do so: a few months, no more.
Go back to the New York Times’ list. In China, even with its extensive spying technology, it allegedly took 1800 teams of five each to do contact tracing. And it’s not clear that that was a prime defense weapon even outside Wuhan. Please tell me how prepared the Federal government or any state would be to devise such an effort and staff it on an emergency basis.
In most major cities in China, people weren’t allowed out of their apartment buildings if they had a fever (there were monitors at the exits). That form of control is not an option in spread-out America.
Wolf may nevertheless correct about how things will roll even if offices and retail establishments are kept largely closed. A reader in NYC reported that more people were on the street yesterday, wearing masks, apparently of the the view that adhering to the CDC guidance increased safety enough to allow them some liberty. The reality is being outdoors where droplets diffuse quickly is a very different proposition than being indoors or in a vehicle.
So the authorities probably will not have the resolve to keep the lockdowns on even if public health experts mount credible arguments that it’s too soon to go into “Mission Accomplished” mode. Expect a very bumpy ride.
1 In case you haven’t sorted this out: First, models show that isolating the elderly only trivially reduces infection rates. Second, you can’t isolate them. They have to eat, see doctors, go to the bank, get their cars and houses fixed if they live independently or be attended to by younger people if they don’t. Third, younger people are still getting bad cases and dying, and even those who get bad cases and don’t die often do suffer lasting heart and/or lung damage. See this video on how the UK is seeing a lot of ICU cases of people in their 50s and younger:
Fourth, letting the disease rip puts the immunocompromised and those with other morbidities like diabetes at risk.
2 It would be better if I were wrong, but I am concerned that the jury is out on herd immunity. While getting Covid-19 does confer short-term immunity, some experts are worried that it may not last as long as a year.