A WSJ article "New Thinking on Covid Lockdowns:They’re Overly Blunt and Costly" reviews recent experience in different countries and regions, trying to find a balance between deaths and economic consequences. New Thinking on Covid Lockdowns: They’re Overly Blunt and Costly - WSJ https://www.wsj.com/articles/covid-lockdowns-economy-pandemic-recession-busines...
They make several points:
"The equivalent of 400 million jobs have been lost world-wide, 13 million in the U.S. alone. Global output is on track to fall 5% this year, far worse than during the financial crisis, according to the International
Monetary Fund. “We’re on the cusp of an economic catastrophe,” said James Stock, a Harvard University economist who, with Harvard epidemiologist Michael Mina and others, is modeling how to avoid a surge in deaths
without a deeply damaging lockdown. “We can avoid the worst of that catastrophe by being disciplined,” Mr. Stock said."
The initial rejection of economic shutdown was reversed by the course of the disease:
"The sight of hospitals in Italy overwhelmed with dying patients shocked people in other countries. Covid-19 was much deadlier than flu, it was able to spread asymptomatically, and it had no vaccine or effective therapy. Taiwan, South Korea and Hong Kong set early examples of how to stop Covid-19 without lockdowns. Their reflexes trained by SARS in 2003,
MERS and avian flu, they quickly cut travel to China, introduced widespread testing to isolate the infected and traced contacts. Their populations quickly donned face masks. "
Other countries including the US, and states within the US responded in different ways. The goal of minimizing the spread or R value was weighed against "flattening the curve" to minimize impact on healthcare systems.
“There have been few attempts to truly define the goal, and partly it’s because policy makers and epidemiologists haven’t thought well enough about the vocabulary to define what they mean or want,” said Dr. Mina, the Harvard epidemiologist."
And it is fair to say that starting with the President of the US, some attempted to deny that any definition of the problem was needed at all.
"In mid-April, his health advisers issued guidelines for when states with lockdowns should reopen, including 14 days of declining cases and the ability to test and trace anyone with flulike symptoms. “The predominant and completely driving element that we put into this was the safety and the health of the American public,” Dr. Fauci told reporters. But that same day Mr. Trump made it clear his priority was the economy: “A prolonged lockdown combined with a forced economic depression would inflict an immense and wide-ranging toll on public health,” he said. Within weeks he was praising states that had reopened despite not meeting the guidelines and was tweeting “LIBERATE” to supporters protesting lockdowns."
This political split interferes with any effective intervention strategy and reflects the denial and economic interests of elements of the government which disregard danger to human life. This excerpt from WSJ references a paper on staged reopening, but ignores two major points: 1) the president denied the epidemic and tried to block control measures because he imagined this would protect his economic interests, and 2) voluntary participation is not assured, for example, by churches refusing to close down.
(This is the clearest example of how failing to isolate leadership from personal economics is dangerous for the country. The president and his family's major holding are in the hospitality industry most likely to be impacted, which certainly influenced his decision to deny the significance of the disease. That other Republican leaders followed suit instead of a more measured response is unfathomable.)
Closing some businesses over others based on risk interferes with “fairness” free enterprise. The WSJ article reflects the typical confusion that the issue is a
choice between economy and lives. The economy will collapse under the fear
of contracting the illness as it did in the 1918 flu or 1970 flu.
Trump’s strong denial message could not eliminate the surge of deaths in
NYC and the fear it induced. Giving the public clear boundaries to
define protection is better than an inconsistent response with emphasis
on economy above all, or the one of safety over all. This is not a political issue but a scientific one.
A simple model for addressing a balance between deaths and economy can be built:
1) Strong isolation of high risk individuals to lower death rates. 2) Quarantine and contacts quarantine for those who are symptomatic and test positive. Testing and reporting to government health agency is mandatory. The loss of work is compensated as “illness” or “sick leave”.
3) All major “super spreader” events are eliminated until the rate of infection in the local region goes below R = 1 or so.
4) Some businesses are inherently “super spreader” in nature, including those with crowds like performances or sporting events, air travel in commercial airlines, business meetings in large groups, cruise ships, Vegas style casinos, and most large hotel/hospitality venues. (Most of the Trump businesses are of this type, making the impact especially negative on his holdings.) These must be treated in the same fashion as “super spreader” events.
"Research by Dr. Mina and others has shown that “super-spreader”events contribute disproportionately to infections, in particular dense indoor gatherings with talking, singing and shouting, such as at weddings, sporting events,religious services, nightclubsand bars. Bars and restaurants accounted for 16% of Covid-19 clusters (five or more cases) in
Japan; workplaces, just 11%. Bars, restaurants and casinos accounted for 32% of infections traced to multiplecase outbreaks in Louisiana."
5) Businesses with significantly high rates of positives must close until positive testing abates. This is compensated by (how?) and is enforced by mandatory penalties.
6) Casual social interaction is not eliminated but mask and distancing guidelines are encouraged, favoring families and close friends and avoiding “super spreader” events. A strong public awareness program encourages compliance.
7) Schools pose a special dilemma. The rate of serious complications is lower in children and teens, but their potential to spread to other family members is high. The social contact in most schools makes them “super spreader” locations. Children and teens including college students have a strong tendency to ignore social distancing making the problem more difficult. This is also complicated by the difficulty in distance learning for many children, and the financial issues in higher education.
8) It is also necessary to prevent temporary migration to nearby low intensity regions. The NYC migration is typical of this, and mostly available to the wealthy, spreading infection to all.
Freedom of action and assembly are abridged in this model, which has serious constitutional problems. This might be mitigated by enacting laws to support the program, which would likely have to be state by state. The sequence of emerging disease state by state has made it difficult to get a national policy. Without enforcement, it appears that a significant proportion of the population is unwilling to adhere to even the least restrictive “mask and distance” recommendations as intolerable loss of liberty. (This is sometimes ascribed to Trump's attitude, but I think it is the reverse: his attitude reflects a significant component of the society.) The model has a more serious problem: the US is not willing to commit to increasing in testing and contact tracing. Trump feared testing would reveal the extent of infection and undermine his denial. Poor voluntary participation and no national commitment to testing and tracing are two major factors increasing the severity of impact on the US.
The scientific problem can be stated as: “what combination of mitigating behaviors, including isolation and limited restriction of commerce, will produce the best ratio of limiting deaths while preserving economic function”? It is assumed that a vaccine distributed to the entire society would solve this problem immediately. It would certainly simplify the situation, but the likelihood of such a “magic bullet” is at least months or years away. And the results of the influenza vaccine indicate that it can reduce the overall risk, but not eliminate it. The current situation does not have scientific evidence to support a clear strategy for balancing death and disability with economic preservation. An approach this minimizes death and dissemination is definable in epidemiological methods, but one that also minimizes economic impact at the same time is not available. This leaves each region to find its own solution by T&E and different regions have had differential success as indicated in the article.
No comments:
Post a Comment