...Archive for March 2020

Pandemic diary 2020-03-24: Toying with collapse

Lately, the President is talking up the notion that we “can’t let the cure be worse than the problem itself”. He’s toying with relaxing the suppression measures that are, for the moment, our best hope of collective survival.

Let me elaborate on that.

Too often, discussions about COVID-19 are framed in very individualistic terms. What is the true mortality rate? If X people will die, is preventing that worth a tradeoff of Y GDP?

Even on very optimistic assumptions about the mortality rate and pessimistic assumptions about economic cost, the answer to that question should be “Yes”. But that’s not what I want to write about.

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.

Whatever the final mortality rate turns out to be in places that retain control and never let the illness rate outstrip the capacity of their health care system, even if it is “only” one percent, if the outbreak proceeds through the population towards “herd immunity” levels, pretty much everyone will personally know someone who dies, like 20 people whose illness is severe enough to at least require supplementary oxygen to keep them breathing, and four or five people who required the incredibly unpleasant ordeal of mechanical ventilation. In a peak that outstrips health care capacity, many more than one of those twenty severe acquaintances will die. They will be dropping like files, all at once. However much you shout that the individual risk for a twenty-something is low, under these conditions, most people just won’t go out. We know people are bad at weighing their risks, fearing a shark attack from an occasional ocean swim more than the much more likely auto accident during a daily commute. People you personally know suffering and dying around you will be much more salient, and much more terrifying, than any risk you have ever experienced. Exhortations by the best and brightest — who would, after all, have permitted this to happen, in whom no great trust by this point would repose — will not be effective. The factories that should be producing the equipment that might save doctors’ will be too understaffed to function, let alone increase production. The trucks will slow to a trickle. The groceries will close.

People will stay in while they can, scrounge out when they are hungry, loot closed stores or their neighbors’ shelves if that’s what it takes to survive. Armed groups will form self-protection militia, or predatory gangs, depending on how you want to look at it, depending how desperate they become. People will be very sad, each and every survivor grieving loved ones, and very angry. People who are ordinarily good will find themselves doing terrible things, because against the backdrop of what has been done to them, it feels justified.

The continent on which the United States sits will endure the pandemic. So will the majority of the population (though possibly a much less overwhelming majority than many people imagine). But the to-some-degree civilized society we have inhabited? The well-oiled economic machine the President claims he wants to save? Democracy and the Constitutional order? The unity of these United States? They may well not survive this event. And at the individual level, the mortality rate will be much much higher than 1%, Wuhan’s 4%, Italy’s 8%.

Those are the stakes.

All of this is preventable. We don’t need to let this happen.

Most of us can stay at home, and be vigilant about social distance. We can buy enough time for essential workers, the heroes of this play, to ramp up PPE, health-care capacity, and testing capacity while keeping us all fed. We can distribute resources — cash, food, however we do it — so that most of us can stay at home without starving.

Once we are prepared, we can test pervasively, and only isolate the people who need to be isolated. We can use IT tools, which even on a voluntaristic, opt-in basis can be extremely effective at tracing contacts when an infection is discovered, as long as infections are infrequent. In two or three months, we can go back to a somewhat slower version of ordinary life, if we can just keep calm and carry in now. And within a period of a six to 18 months, we can expect effective treatments and/or a vaccine to appear, and then we can get back to our ordinary, beautiful, lives. Our perhaps sadder, wiser, ordinary, beautiful, lives.

I love you.