[Disclaimer: I want to have a thoughtful discussion here on the policies/economics/disease and I realize that this is the appropriate forum for it. This post is not intended to flame or troll, so please give me the same respect. I want to do my best to show my work, so I apologize in advance for the long post.]
Hypothesis: The "shape" of the backside of the coronavirus curve will determine how robust the economic recovery is in the US/World, due to it's implication on buyer confidence in resuming activities that do not require social distancing.
My prior assumptions and understanding:
I believe that the virus has mostly acted the way that experts told us it would act in late February, early March.
What now? The three scenarios for the backside of the peak:
Now that we are at/beyond the peak natoinally/locally, I think views have begun to diverge dramatically on where do we go from here, even amongst people who can agree on the above priors:
1. Curve "Flatteners" believe that the only intent of sheltering in place was to flatten the curve to reduce demand on hospitals and give us time to prepare. That has been done, so life must go on.
2. Curve "Destroyers" want to pursue policies that can lead to the eradication of the virus in the US, similar to what has been done in South Korea, via test/trace/isolate. They would support sheltering at home until the spread of the virus is low enough that the testing/tracing capabilities (which grow monthly) are large enough to be effective.
In weeding my way through the various positions, I have considered the following 3 scenarios and what the various outcomes would likely be.
Scenario 1: We resume activity to some level that allows R0 > 1, which allows the virus to regain exponential spread. This feels unlikely for a sustained period due to the heightened awareness of the virus, but if it did happen it would be disasterous:
Scenario 3: We socially distance long enough and effectively enough, while simultaneously investing heavily in testing/tracing capabilities to go on South Korea-like test/trace/isolate programs which can destroy the curve to near-0 levels.
My conclusion: As painful as it may be in the short term, there is a larger long term payoff for stretching to Scenario 3 than the alternatives.
In closing: I think that the model for the best response for the virus has already been established, and it's not Sweden. It is and always has been South Korea, Taiwan, etc. Veterans of previous Chinese-borne outbreaks, they managed to destroy the curve and resume something much closer to normalcy than their peer countries/states such as Italy. It's hard to recall how South Korea and Italy had similar rises in cases/deaths early in the global outbreak, given how dramatically they diverged. I do believe in American exceptionalism, which is why I believe we should be able to do it better than all of them.
Hypothesis: The "shape" of the backside of the coronavirus curve will determine how robust the economic recovery is in the US/World, due to it's implication on buyer confidence in resuming activities that do not require social distancing.
My prior assumptions and understanding:
I believe that the virus has mostly acted the way that experts told us it would act in late February, early March.
- The spread of the virus is exponential when unchecked on a level we have not seen in recent years in the US in major epidemics.
- The virus is deadlier than the flu by some magnitude. While the "case fatality rate" was calculated to be 3.4% back in March and is 6.9% now, it was understood that there was a large amount of mild/asymptomatic cases that would lead to an eventual "infection fatality rate" of somewhere between 0.5% - 1.0%
- The shelter-in-place orders did work by halting the exponential spread of the virus and exponential growths of the deaths. New York City is a very robust example -- they have the hardest situation in the country to prevent spread due to their population density, reliance on public transportation, high level of immigration and international travel/tourism. I think that, as expected, places that were farther along in their outbreak than others experienced higher peaks than those who sheltered early in the outbreak.
- The hospitalization rate was initially way overestimated. This is being attributed to the data in Italy/China early in the outbreak showing much higher hospitalization rates than what we are currently seeing. In NYC, there is 3.5 hospitalizations for every death. Early estimates were 2-3 times that amount and had to be adjusted down after new data came out of the US. If you go back to nawlinsag post from March 25, you will see he states a 14% hospitalization rate and a 5% critical care rate. If you assume 80% of patients who receive critical care die, you get 14% hospitalization / 4% death = 3.5 hospitalizations per death. Texags knows stuff. I would hope part of the reason our rates are lower is that we have better doctors and better treatments. As a esult of overestimating our hospitalization early, many localities predicted doomsday scenarios that never came to pass. Lombardy was strained to the limit, but not many other places to the same degree.
- There is no proven vaccine, cure or treatment. We do have some treatments (HCQ, Remd., IL-6 Inhibitors, etc) that are now proving to be somewhat effective at reducing the severity or duration of the virus, but still nothing yet that resembles a knock-out punch. However, it does seem like some time in the next year we could have a vaccine available.
- Age and comorbidities have a large effect on outcomes with CV infections.
- The most effective way to break the curve is testing, tracing, and isolation, which requires a volume of resources beyond what we currently need at our daily infection levels.
What now? The three scenarios for the backside of the peak:
Now that we are at/beyond the peak natoinally/locally, I think views have begun to diverge dramatically on where do we go from here, even amongst people who can agree on the above priors:
1. Curve "Flatteners" believe that the only intent of sheltering in place was to flatten the curve to reduce demand on hospitals and give us time to prepare. That has been done, so life must go on.
2. Curve "Destroyers" want to pursue policies that can lead to the eradication of the virus in the US, similar to what has been done in South Korea, via test/trace/isolate. They would support sheltering at home until the spread of the virus is low enough that the testing/tracing capabilities (which grow monthly) are large enough to be effective.
In weeding my way through the various positions, I have considered the following 3 scenarios and what the various outcomes would likely be.
Scenario 1: We resume activity to some level that allows R0 > 1, which allows the virus to regain exponential spread. This feels unlikely for a sustained period due to the heightened awareness of the virus, but if it did happen it would be disasterous:
- There would be renewed calls for resuming restrictions, which would destroy the theoretical V curve of recovery and add uncertainty to the next year.
- Consumer confidence would be shattered. Many (not all) people would avoid crowds even if the government had no guidance
- Certain localities would go under healthcare strain with the same issues regarding testing, ppe, etc.
- ~250,000 deaths by Aug 1
- We wouldn't be overloading our health system
- Even if the government gave no guidance, the awareness of the situation will modify behavior for many.
- As a population, consumer confidence and spending would still be lower overall than the baseline. Vunerable people and people in regular contact with vulnerable people would still avoid crowded situations.There would be a dark cloud of fear for many. ~1,000 deaths per day would be like a 9/11 event happening every 3 days or Pearl Harbor happening every 2.5. Conferences, major sporting events, etc. would have to be adapted or eliminated entirely.
- ~160,000 deaths by Aug 1
Scenario 3: We socially distance long enough and effectively enough, while simultaneously investing heavily in testing/tracing capabilities to go on South Korea-like test/trace/isolate programs which can destroy the curve to near-0 levels.
- Even vunerable people would not have be afraid of normal interactions
- Large gatherings could resume, as 1-10 new cases per day is infinitesimally small risk, especially when any new cases' contacts can be traced back two weeks and tested.
- Consumer confidence could go back to normal.
- ~100,000 deaths by Aug 1
My conclusion: As painful as it may be in the short term, there is a larger long term payoff for stretching to Scenario 3 than the alternatives.
- The economic rebound will be more robust and long lasting
- Some tens of thousands of lives will be saved
- If you believe in our ability to make a vaccine in the next 12 months, >100,000 lives would be saved over the course of the virus.
- We have spent trillions of dollars in economic recovery, but not nearly enough in testing and tracing resources. We should be unlocking every bottleneck nationally and enlisting and training as many people as possible to destroy the curve. It would be better for the economy to spend $500B on a testing/tracing national program than it would be to shelter at home one more month.
- Small measures like mask-wearing, which may have only incremental value to R0, can have huge economic impacts.
In closing: I think that the model for the best response for the virus has already been established, and it's not Sweden. It is and always has been South Korea, Taiwan, etc. Veterans of previous Chinese-borne outbreaks, they managed to destroy the curve and resume something much closer to normalcy than their peer countries/states such as Italy. It's hard to recall how South Korea and Italy had similar rises in cases/deaths early in the global outbreak, given how dramatically they diverged. I do believe in American exceptionalism, which is why I believe we should be able to do it better than all of them.