Update: This new article largely echoes the one below: it emphasizes the need to get healthy people back to work, which requires more testing, and to provide adequate protection to healthcare workers. Both pieces emphasize fighting the pandemic in ways to minimize long-term damage to our economy caused by extended periods of people staying at home while businesses are closed. As the article notes, “Paul Romer, who received the Nobel Prize in Economics in 2018, is a professor at N.Y.U. Alan M. Garber, a physician and economist, is the provost of Harvard University.”
In the long run, we are likely to have better options — a vaccine perhaps, or effective drug treatments. And at some point, herd immunity, when so many people have immunity that others are unlikely to encounter and fall victim to the virus, will make this coronavirus a far more manageable threat.
But we cannot afford to wait and hope. John Maynard Keynes famously quipped that in the long run, we are all dead. If we keep up our current strategy of suppression based on indiscriminate social distance for 12 to 18 months, most of us will still be alive. It is our economy that will be dead.
David L. Katz (see also here) is a public-health physician and, according to Wikipedia, “the founding director of the Yale-Griffin Prevention Research Center that was founded at Griffin Hospital in Derby, Connecticut in 1998.” I can’t assess his credentials as an epidemiologist, but he’s surely no quack. In an article in yesterday’s New York Times (click on screenshot below), Katz argues that the U.S. is fighting the coronavirus pandemic all wrong. By using a scattershot approach in which everyone is forced to stay home and virtually everything is closed, he argues that we are depriving the most vulnerable (the elderly and immunocompromised) of essential care and equipment, exposing them to younger and healthier people who may carry the disease, and wrecking the American economy by forcing businesses (and maybe schools) to go under.
Yet just today, the U.S. Surgeon General said of America, “This week it’s going to get really bad.” I present Katz’s article because it’s worth thinking about, not to urge people to avoid the guidelines which have been laid down by American authorities, both federal and local.
You should read the article for yourself. I’m sure that many of you, like me, have wondered if mass closures of businesses and requiring everyone, young, old, sick, or healthy, to shelter at home, is an effective way to shut down the pandemic—and also maintain the fabric of our society. Katz argues no: that by getting the healthier population to acquire “herd immunity” while removing the susceptible from exposure to the virus, and by testing only the susceptible for the virus, we could stop the plague without wrecking the nation.
Now I doubt that anybody is going to follow Katz’s recommendations, as the “sequester-everyone-and-shut-down-every-nonessential business” mentality is too widespread and ingrained. Still, have a look at his arguments, which I excerpt below (again, read the whole thing). Katz’s quotes are indented.
The clustering of complications and death from Covid-19 among the elderly and chronically ill, but not children (there have been only very rare deaths in children), suggests that we could achieve the crucial goals of social distancing — saving lives and not overwhelming our medical system — by preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure.
Why does this matter?
I am deeply concerned that the social, economic and public health consequences of this near total meltdown of normal life — schools and businesses closed, gatherings banned — will be long lasting and calamitous, possibly graver than the direct toll of the virus itself. The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order.
Worse, I fear our efforts will do little to contain the virus, because we have a resource-constrained, fragmented, perennially underfunded public health system. Distributing such limited resources so widely, so shallowly and so haphazardly is a formula for failure. How certain are you of the best ways to protect your most vulnerable loved ones? How readily can you get tested?
We have already failed to respond as decisively as China or South Korea, and lack the means to respond like Singapore. We are following in Italy’s wake, at risk of seeing our medical system overwhelmed twice: First when people rush to get tested for the coronavirus, and again when the especially vulnerable succumb to severe infection and require hospital beds.
Yes, in more and more places we are limiting gatherings uniformly, a tactic I call “horizontal interdiction” — when containment policies are applied to the entire population without consideration of their risk for severe infection.
But as the work force is laid off en masse (our family has one adult child home for that reason already), and colleges close (we have another two young adults back home for this reason), young people of indeterminate infectious status are being sent home to huddle with their families nationwide. And because we lack widespread testing, they may be carrying the virus and transmitting it to their 50-something parents, and 70- or 80-something grandparents. If there are any clear guidelines for behavior within families — what I call “vertical interdiction” — I have not seen them.
. . . There is another and much overlooked liability in this approach. If we succeed in slowing the spread of coronavirus from torrent to trickle, then when does the society-wide disruption end? When will it be safe for healthy children and younger teachers to return to school, much less older teachers and teachers with chronic illnesses? When will it be safe for the work force to repopulate the workplace, given that some are in the at-risk group for severe infection?
We all know the pandemic is going to last longer than they tell us, at least based on when schools are set to re-open. But Katz’s alternative: get business back to normal while keeping the most susceptible people out of circulation, and limiting testing to that group or to people who show clear Covid-19 symptoms (my own doctor tells me it’s shortness of breath). Here’s what he suggests (I have to admit it lacks specificity, but differs substantially from what is being done now):
So what is the alternative? Well, we could focus our resources on testing and protecting, in every way possible, all those people the data indicate are especially vulnerable to severe infection: the elderly, people with chronic diseases and the immunologically compromised. Those that test positive could be the first to receive the first approved antivirals. The majority, testing negative, could benefit from every resource we have to shield them from exposure.
To be sure, while mortality is highly concentrated in a select groups [sic], it does not stop there. There are poignant, heart-rending tales of severe infection and death from Covid-19 in younger people for reasons we do not know. If we found over time that younger people were also especially vulnerable to the virus, we could expand the at-risk category and extend protections to them.
However, from what I hear, younger people can die from this virus without any underlying conditions. And if those people are at risk, then “expanding the at-risk category” pretty much means shutting down all schools and businesses—what we’re doing now. Katz doesn’t address this further.
He does, however, make the good points that current policy involves inundating the medical establishment with lower-risk people who don’t need treatment, burdening families with the job of educating and doing extra care of the young while schools and universities are closed, and, above all, forcing susceptible older people to mingle with their younger relatives at home.
One more bit of Katz’s solution:
If we were to focus on the especially vulnerable, there would be resources to keep them at home, provide them with needed services and coronavirus testing, and direct our medical system to their early care. I would favor proactive rather than reactive testing in this group, and early use of the most promising anti-viral drugs. This cannot be done under current policies, as we spread our relatively few test kits across the expanse of a whole population, made all the more anxious because society has shut down.
This focus on a much smaller portion of the population would allow most of society to return to life as usual and perhaps prevent vast segments of the economy from collapsing. Healthy children could return to school and healthy adults go back to their jobs. Theaters and restaurants could reopen, though we might be wise to avoid very large social gatherings like stadium sporting events and concerts.
And there you have it. Of course, this sounds good to those of you who are younger and healthy, as we’re all going stir-crazy, and psychologists warn of an epidemic of loneliness (certainly better than an epidemic of death). But would it work? I do worry, like Katz, that if everything shuts down for months or even longer, we’ll never recover socially or economically, and Katz’s solution deals with that by trading off employment and well-being against the possibility of extra deaths if his policy is implemented. That’s nothing new: we make such societal decisions all the time.
Again, assessing Katz’s recommendations is above my pay grade, and I am not about to tell people that he’s right and it’s fine to flout the regulations. After all, I’m following them, too. But as the months of quarantine draw on, and people start feeling the severe pinch of unemployment, no school, and social isolation, we might wonder whether there’s a kernel of truth to Katz’s arguments.
Please weigh in below.