Garret Hardin, in his excellent 1985 book Filters Against Folly, How to Survive
despite Economists, Ecologists, and the Merely Eloquent, proposed that one should ask three basic questions
about any proposal: (1) do the ideas make sense? (2) do the numbers add up? (3)
and then what? Let’s apply this to the current pandemic.
The idea (1) is
that we all practice social distancing (close schools and businesses) to reduce
the rate of infection to something that the health care system can manage.
We know some of the
numbers (2). We know the capacity of the health care systems (number of ICU
beds, number of ventilators, number of doctors and nurses, etc). We are beginning
to get some idea of the infection statistics (of identified cases, ~80% are mild,
~20% are severe enough to require hospitalization, and of that 20% about half require
a ventilator for a week or two, and the majority of patients on a ventilator don’t
survive.). We also know that some significant
proportion of cases (current estimates range from 20% to 80%) show no symptoms
but are nevertheless infectious. We also know that the vast majority of fatalities
are among those aged 60 or more and/or who are suffering from health problems
(that includes about 60% or more of Americans, if one counts obesity, diabetes,
high blood pressure, and cardiovascular disease, all identified as risk factors
for CORVID-19), though some younger people die as well.
So what does this mean? There will be a first infection
peak, probably arriving for most hot spots like New York City, Detroit, Los
Angeles, New Orleans, etc, with the next few weeks – say by no later than the
end of May. After that models predict the infection rate will decrease, at
least for those locations that are practicing effective social distancing. Suppose by the end of that peak – say by mid-summer
– we have (worst case) identified 1 million cases in the US. And suppose the
number of unidentified cases is (worst case) ten times that – another 10
million cases. We then have about 11 million people who have recovered from the
virus and are (we hope) immune, at least for a while. But there are about 327 million in the US, so
that means only about 3% of the population is now immune.
So now let’s ask the “and then what?” (3) question. We open
up businesses again so that the economy doesn’t simply crash into a major
depression, though perhaps with as much social distancing as possible. Since
only (best case) 3% of the population is immune, we will almost certainly get a
resurgence of infections. More than that, it will still be highly unsafe for
people 60 and older, or the 60% or more of the population with health problems,
to be in public, exposed to the substantial number of people who are infectious
even though they show no symptoms.
In essence that means either (a) the current lockdown will
need to continue, at least intermittently, until such time as we (hopefully)
have an effective vaccine widely available, which under the best possible case is
still at least 12-18 months from now, but more likely 2-3 or more years from
now., or (b) we have the permanently restructure store layouts and services to
enforce effective social distancing permanently. That presents substantial challenges
for things like theaters, schools, churches, sports arenas, and restaurants, as well as for close-up
and personal services like medical exams and procedures, barbers and hairdressers,
nail salons, massage therapists, and the like.
It’s time to begin to think seriously about the “and then
what?” question.
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