A very difficult balancing act

President Trump is getting a lot of criticism for his promise yesterday to reopen the country by Easter. It looks, at first blush, like he is simply ignoring the warnings of the health professions. It looks, at first blush, like he is on a different planet than the rest of us. But clumsy as his approach is, I think fundamentally he has a point. We simply can't keep the country closed down for as long as the epidemiologists would like us to.

Here is the dilemma: epidemiological models predict, if we don't keep the country locked down, that even under the most wildly optimistic assumptions, if only 20% of the 327 million Americans get infected, and if the fatality rate is only 1%, as many as 654,000 Americans might die. It is more likely that 50% or more of Americans will get infected eventually, and if we don't sustain social distancing for many months perhaps 1.5 - 2 million Americans will die.  By contrast, a really bad influenza season, like the 1957 season, kills about 70,000 Americans. The 1918 Spanish influenza killed about 600,000 Americans from a much smaller population of about 103 million (that would be about 1.8 million deaths with today's population).

On the other hand, economic models suggest that keeping the country locked down as tight as it is now for 3-4 months or more may well bring on a depression worse that the Great Depression of 1929, with as much as 30% or more of the nation out of work, more than were out of work at the peak of the Great Depression. In the end that might cause even more deaths, from depression, suicide, alcoholism and disease caused by poverty and inability to afford health care or decent meals.

So here is the dilemma: how to balance what the health services need with what the economy needs to survive. I suspect the Imperial College report is correct: we will need to tighten up until we bend the infection curve down, then loosen up enough to get some economic recovery going, then tighten up again when the infection curve starts to climb again, rinse, wash and repeat. And do this for a year or two until, hopefully, an effective vaccination is widely available. Or perhaps we can do this cycle regionally, or just around current hot spots.

This will be a difficult balancing act, and the President and state governments will get incessant criticism when they loosen restrictions, and then when they tighten them again, which will make it all that much harder. But those who are arguing for reopening the economy have a valid point, and we need to not dismiss them out of hand.