Day 77: COVID-19 Finding Our Way Out

 

Within the week it will be obvious that places that have been driving the headlines — Italy, New York — will have passed the peak of the epidemic. Sickness and dying have not ended, but the acceleration phase will be over for these places. This realization will create space for reflection, not just reaction. The next steps can be considered, not merely urgently taken.

Economically we are in the wilderness. GDP has or will drop by an estimated 33.5% and our debt has ballooned as government, having idled and choked the economy, is replacing productively earned value with printed money. Our next steps have to be thought through very carefully. We are where we are because we were presented with only bad choices. We can argue later about the choice we made, but for the present we need to find our way out.

But before that just a quick data snapshot:

We lost 900 souls yesterday to COVID-19. And that statistic will continue to partially mark the misery of this plague. We continue to struggle with the manufacture and deployment of personal protective equipment, particularly as the public is now asked to don masks.

So how do we find our way out?

First, we must assure that our health care system does not break. It seems clear now that we do have the capacity to handle future COVID-19 cases. There remain logistical challenges, and mistakes will be made. But we have taken the necessary actions to assure that what can be done is being done. We do know more about the disease and are learning more every day. Information is being shared broadly as things are learned. One thing that we have learned is that testing is no longer the choke point that we earlier thought it to be. Differential diagnosis was always the approach. It’s just now that there have been so many cases of COVID-19, that physicians can reasonably assume its COVID-19 when flu-like symptoms present and initiate precautions, supportive care and whatever therapies are available and appropriate to the specific patient. As we roll forward the value of testing is more in identifying and clearing persons who have developed antibodies as well as gaining more perspective on the course and extent of the epidemic.

Second, we must accept death and poor outcomes. IHME has updated their models to project fewer deaths than initially calculated. They started out at ~84,000 and then revised upward to about ~93,000 and now have gone back down to ~81,000. We are currently at 10,516 so if the model is correct we have another 70,000 deaths to experience. There are debates about the IHME model. Some think it too optimistic; some think it too pessimistic. But it is pretty clear that given the assumptions of the model there is little more that we can do to reduce the number of projected deaths. So we must accept that more restrictions on the economy are not going to avoid deaths.

Scott Adams introduced the concept of “net deaths” in his daily video blog some time ago. In the short term, reduction in economic activity reduce vehicle*, industrial, and other accidents that contribute to overall death statistics. So to some degree, we have only been trading causes of death. In the long term if we have destroyed our economy the resulting poverty will mean more deaths from a variety of causes — e.g., suicides, drug overdoses, domestic violence — even if we eliminate deaths from COVID-19. “Net deaths” will be higher than if we simply carry on with our economy and deal with the epidemic as responsibly as possible.

Third, we will have to adjust our requirements for what has been called “social distancing,” but which has been in practice a shutdown in many places. Yes, for a period of time, we will need to limit crowds and make sure that the numbers of people in places can maintain the six-foot buffer, people will be wearing masks in public, video meetings (including telemedicine) will need to be utilized, and there may be some other sensible requirements that can be done while not restricting businesses re-opening and jobs being done. People who become symptomatic must stay home or be hospitalized as appropriate. Whether we will publicly monitor people for fevers is an open question in my mind.

Fourth, we will be navigating a transition in our economy. Some businesses will never return because the way we live and our consuming preferences will have changed. And that is OK. Our economy needs to reflect the preferences and needs of consumers, not the virtuous future of the ideologues or the entrenched interests of the past. Workers will be displaced, but we need to bear the cost of transition, not regulate a return to the world before the virus. Regulations need to be relaxed even further than before. Barriers to employment through state licensing needs to be reexamined to remove barriers to people promptly seeking gainful employment. In the short term (and I would argue in the long term) progressives need to “embrace the suck” and let fossil fuels do the heavy lifting for our economy that it has done since the dawn of the industrial age.

Fifth, we need to support politically the leadership that is prepared to do steps 1 through 4, above. Freer markets, not social engineering, will save the day and bring us back to the consumer confidence and sense of personal well-being that the country enjoyed in 1 BC (before coronavirus). I don’t know any Democrat that I trust to do this. And, sadly, there are too many Republican politicians that may falter as well. But we need to be in a risk-taking future, just not risking our future with the progressives in charge.

*Just last week we got word that Mrs. Rodin’s mother’s 48-year old cardiologist died in a three-car crash on March 31.

[Note: Links to all my CoVID-19 posts can be found here.]

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There are 33 comments.

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  1. Roderic Coolidge
    Roderic
    @rhfabian

    So it looks like we’re going to get through the worst of this bug without the nightmare scenario the Italians had to face.  

    From what I can glean from models, we’re going to have a long tail of sustained disease activity and possibly there will be a second wave.  It won’t be over until an effective vaccine is distributed.

    I’ll get a pitch in for all hospitals having a stock of re-usable personal protective equipment on hand — cloth masks, gowns, head coverings, etc.  We have seen what relying on disposable stuff gets us at a time like this.  When I was trained the only thing disposable was the gloves, and it all worked just fine.

    • #31
  2. Ray Kujawa Coolidge
    Ray Kujawa
    @RayKujawa

    Are physicians in NY state yet able to prescribe HCQ? The last thing I saw on TV was that the governor had not lifted the ban on filling prescriptions for it there. Is it possible they haven’t been using it at all in NYC?

    • #32
  3. Rodin Member
    Rodin
    @Rodin

    Ray Kujawa (View Comment):

    Are physicians in NY state yet able to prescribe HCQ? The last thing I saw on TV was that the governor had not lifted the ban on filling prescriptions for it there. Is it possible they haven’t been using it at all in NYC?

    It’s a mixed picture. Doctors have been prescribing it but the Governor stepped in and told pharmacies not to fill prescriptions for off label use (the treatment of COVID-19). Of course pharmacists cannot know that a particular prescription is for off label use. Meanwhile New York has set up large clinical trails employing HCG, so that thousands of dosages are being employed.

    • #33
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