Pandemic diary 2020-03-24: Toying with collapse
Lately, the President is talking up the notion that we “can’t let the cure be worse than the problem itself”. He’s toying with relaxing the suppression measures that are, for the moment, our best hope of collective survival.
Let me elaborate on that.
Too often, discussions about COVID-19 are framed in very individualistic terms. What is the true mortality rate? If X people will die, is preventing that worth a tradeoff of Y GDP?
Even on very optimistic assumptions about the mortality rate and pessimistic assumptions about economic cost, the answer to that question should be “Yes”. But that’s not what I want to write about.
COVID-19 is not just a disease that is infecting us as individuals. It has infected us as a society. The financial fallout, the flailing markets, these are the social equivalent of a mid-grade fever, an unpleasant and uncomfortable side effect of the work our society is performing to suppress and defeat the infection. There may be ways of reducing the unpleasantness without impairing the effectiveness of the response, various forms of economic stimulus or monetary loosening as a kind of social tylenol. Maybe those are worth considering. Some have been tried. But nothing would be more stupid, more suicidal, than to suppress the immune response in order to suppress the fever.
That is what ending our isolation now — what sending everybody back to offices, schools, restaurants, beaches, and bars — would amount to. It might well relieve the “fever” short term. The stock market is up this morning! But it radically increases the likelihood that the patient — our polity, our society — dies.
How would that happen? What’s the microstructure of this purported social collapse? How would putting people to work again be bad?
We desperately need people to work. All of us staying home will not save us. But some people’s work is much more critical than others’ to our society’s collective viability. We obviously need medical personnel to work. For them to work effectively, we desperately need the people who are capable of producing and ramping up production of PPE (“personal protective equipment”) to work. Perhaps more desperately, we need our agricultural and food supply chain to be producing the calories and nutrients each and all of us need to get through this. We need grocery store clerks, stockers, shoppers (for delivery and pick-up orders) to work. We need truck drivers a-truckin’. We need Amazon and UPS and FedEx, permitting us to get what we need with minimal opportunity to cough on one another. We need fire departments and police. We need the digital platforms and communications infrastructure. We need people delivering essentials to the elderly. We need the people who can develop and ramp up testing, tracking, and treatment. We desperately need people to work.
But if you are not one of these people, your staying at home — working as much as you can if you can or not at all of you can’t — is not “waste”. It is making a huge positive contribution to our society, by delaying the moment when it will be impossible to persuade a critical mass of these very essential workers to do their jobs, because many of them are sick and the rest of them are too afraid of getting sick.
Whatever the final mortality rate turns out to be in places that retain control and never let the illness rate outstrip the capacity of their health care system, even if it is “only” one percent, if the outbreak proceeds through the population towards “herd immunity” levels, pretty much everyone will personally know someone who dies, like 20 people whose illness is severe enough to at least require supplementary oxygen to keep them breathing, and four or five people who required the incredibly unpleasant ordeal of mechanical ventilation. In a peak that outstrips health care capacity, many more than one of those twenty severe acquaintances will die. They will be dropping like files, all at once. However much you shout that the individual risk for a twenty-something is low, under these conditions, most people just won’t go out. We know people are bad at weighing their risks, fearing a shark attack from an occasional ocean swim more than the much more likely auto accident during a daily commute. People you personally know suffering and dying around you will be much more salient, and much more terrifying, than any risk you have ever experienced. Exhortations by the best and brightest — who would, after all, have permitted this to happen, in whom no great trust by this point would repose — will not be effective. The factories that should be producing the equipment that might save doctors’ will be too understaffed to function, let alone increase production. The trucks will slow to a trickle. The groceries will close.
People will stay in while they can, scrounge out when they are hungry, loot closed stores or their neighbors’ shelves if that’s what it takes to survive. Armed groups will form self-protection militia, or predatory gangs, depending on how you want to look at it, depending how desperate they become. People will be very sad, each and every survivor grieving loved ones, and very angry. People who are ordinarily good will find themselves doing terrible things, because against the backdrop of what has been done to them, it feels justified.
The continent on which the United States sits will endure the pandemic. So will the majority of the population (though possibly a much less overwhelming majority than many people imagine). But the to-some-degree civilized society we have inhabited? The well-oiled economic machine the President claims he wants to save? Democracy and the Constitutional order? The unity of these United States? They may well not survive this event. And at the individual level, the mortality rate will be much much higher than 1%, Wuhan’s 4%, Italy’s 8%.
Those are the stakes.
All of this is preventable. We don’t need to let this happen.
Most of us can stay at home, and be vigilant about social distance. We can buy enough time for essential workers, the heroes of this play, to ramp up PPE, health-care capacity, and testing capacity while keeping us all fed. We can distribute resources — cash, food, however we do it — so that most of us can stay at home without starving.
Once we are prepared, we can test pervasively, and only isolate the people who need to be isolated. We can use IT tools, which even on a voluntaristic, opt-in basis can be extremely effective at tracing contacts when an infection is discovered, as long as infections are infrequent. In two or three months, we can go back to a somewhat slower version of ordinary life, if we can just keep calm and carry in now. And within a period of a six to 18 months, we can expect effective treatments and/or a vaccine to appear, and then we can get back to our ordinary, beautiful, lives. Our perhaps sadder, wiser, ordinary, beautiful, lives.
I love you.
It is also the case that an immune overreaction can cause more damage than an infectious agent. Lots of Covid-19 fatalities are due to the ‘cytokine storm’ of an excessive immune response.
So you’re right, broad isolation measures are part of our society’s immune response, and up to a point, even letting a fever burn is good.
But at some point, any response can be too much, & start doing net-damage to welfare & total lives-lived. So we have to consider: “what are the risk/reward tradeoffs?” – not just punt with “no privation or delay-in-living is too much to pay!”
I’m not seeing policymakers seriously entertain any “no attempts at control” approach, or “send folks back to normalcy right away”. But they are pushing back against the idea we could pause the economy, or have tight mandatory shelter-in-home “for months”, or “indefinitely”. Especially not given the working examples of other nations controlling this with shorter (or no) lockdowns – getting back to living a real life, socializing, and producing for themselves & the world.
We need more info, we need more tests, we need more masks/PPE, we need better treatment options, we need more medical equipment. More of all of these are arriving daily.
A short pause of weeks may be sufficient – if followed with pervasive mask-wearing, tests, & new norms-in-public – to shift from uncontrolled community spread to quantifiable, traceable, declining spread.
Your feared scenario of “social collapse”, “our polity, our society” dying, and so many young people being afraid to go to work that caloric supply chains fail, leading to scrounging, looting, armed gangs strikes me as a hallucinatory paranoid fantasy. Neither current specifics nor historical precedents point that way.
Other nations have already handled this pandemic much better; while the US has sclerotic leadership & career bureaucracies, it also has immense resources to eventually do the right thing (after trying everything else), so we’ll likely catch up with best practices in a month or two.
Historically, cities & nations have weathered far more destruction than this virus’s worst, from the London blitz to the USSR’s losses in WW2, and remained under continuity of culture and leadership. People more often pull together in crises than fall apart.
In the meantime, under either best-case or worst-case scenarios, highly effective or highly inept control, the hardest-hit are the retired: not the key workers in the supply chains you’ve highlighted. Young peoples’ risk estimation is biased towards recklessness – sometimes even triggered by salience of mortality! – not the overcautiousness you describe.
No prior generation of youth hid in their homes in response to war, nuclear-brinksmanship, terrorism, AIDS – so give today’s workers some credit. They’re going to keep calm, wear masks, wash hands, sterilize air/surfaces, & carry on. We of course have to make it as safe as possible as soon as possible. We’ve got got until late April, maybe May 1, to encourage/enforce strict at-home isolation for low-risk people. Then it’s got to be up to localities and free individuals.
March 24th, 2020 at 4:33 pm PDT
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After peeking at the inane ‘national conversation’ since, I want to clarify what I wrote above. I’m in no way advocating any “return to normalcy” after the goofball, halfhearted “15 days” White House-crafted period ends approximately March 31, nor an info-free focus on some arbitrary date like April 12 (Easter) as a focal-point for easing.
Right now, March 25, more places should be tightening – every city, at least, should be in a California-like ‘shelter-in-place’, and most of their adjacent suburbs. Rural places might be OK with extreme social-distancing. And the whole nation should be tighter for at least 2 synchronized weeks, now through the April 7 expiration of Calfornia’s initial period (which may need extension).
But part of selling stronger isolation is its chance to achieve infection-control. We do it harder, and more synchronized, so that it can be shorter. And we warn people that there’s no single magic day of “back to normal”, but a series of data-driven easings, into new norms, supported by new behaviors and replenished testing/masking/disinfecting capabilities.
But we don’t expect leaving the tightest-phase to be “multiple months away” – both because that *shouldn’t* be necessary, and because if it is, it means we didn’t do the intense part seriously enough and took on a whole lot more social/economic/cultural/international-standing damage than we needed to from that unseriousness.
March 25th, 2020 at 11:45 am PDT
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” Lately, the President is talking up the notion that we “can’t let the cure be worse than the problem itself”. ”
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Well, assuming this isn’t the last time something like this ever happens, we’re only one or two more such events away from total collapse.
I mean, you have to admit that it is a little pathetic that two weeks on the couch causes total economic collapse. Don’t the French do this several times every year without such dire consequences? I feel like we should have a better system.
If any US institution has performed admirably during this crisis, I’ve missed it. Talk about group-think. No university, major media outlet, national political figure or esteemed government entity raised the proper level of alarm before it was too late. Not one. Better fix that before trying to sell us peasants on that whole global-government-of-experts scheme again.
Remember when “17 US intelligence agencies agree that Russia interfered with our election?” First of all, we have 17 national intelligence agencies? WTF? Did I miss a meeting? Second of all, what the hell were they doing in January? Dis SpyCon last two whole months this year?
One good thing about Twitter is that it makes it easy to go back in time a bit and see who was willing to risk unpopularity, read between the lines, dig a little deeper and combine some out-of-the-box thinking with common sense and raise a big red flag about that weird virus in China. How about we put some of those people in charge going forward, Left, Right or whatever?
And how about that fella who ran Trump’s campaign toward the end there – the guy who was always banging on about the threat of China, Wall St. bailouts, political/big business corruption and the hollowing-out of America’s manufacturing capacity. Gosh, those things all suddenly seem like a big deal now.
Oh wait, ‘Vanity Fair’ of all places has connected all these dots^^ together for us. Imagine that. Strange times indeed.
https://www.vanityfair.com/news/2020/03/why-some-early-maga-adopters-went-against-trumps-virus-doctrine
March 25th, 2020 at 7:54 pm PDT
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Thanks Steve, I love you too.
March 26th, 2020 at 9:45 am PDT
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Hey – this is Samantha’s friend. A good friend of mine, with similar genius and an ability to research an idea beyond extraordinary found this report. She also looked back in Twitter to find out if anyone had paid attention. I might add her long commentary as well.
Thanks for sharing your thoughts.
March 26th, 2020 at 3:24 pm PDT
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https://www.armed-services.senate.gov/hearings/19-11-20-biological-threats-to-us-national-security
I can’t tell if the link is attached so here it is (again?).
March 26th, 2020 at 3:25 pm PDT
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@Kristen
Yes, assuming that this isn’t the last time we will be faced with an emerging crisis like this, how about we use this current episode as a filter to identify those who grasped what a big deal CV was likely to be, what our greatest vulnerabilities are and how best to prevent/prepare for them. Seems like our current selection mechanisms for institutional leadership aren’t what they should be.
That and we should probably have a national holiday honoring supermarket clerks and the like…
March 30th, 2020 at 6:33 am PDT
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Economy of Post Covid-19- The Next Enlightenment
Before Covid-19, world economic power always greedy to become superpower, super power were attempted capture the globe. The pandemic situation of affect due to Covid- 19 spread forcing the countries get enlighten with the Wisdom Based economics concepts. The urge to fulfill individual greed through the knowledge venture in the guise of knowledge collaborators, the plan to destroy through human community by scientists in the name of fast invention(s) dictated knowledge economy is the worst for human civilization. Covid-19 has killed the knowledge economy, greedy scientists’ economy and greedy chemists’ economy. If greedy man can not enjoy the taste of food because before enjoying tastes they swallow fast then hiccups. This is an universal findings on greedy human’s behaviour.
This has been indicating that the greedy nations those tried to swallow things by even killing the human race will not enjoy the taste of resource. Next course of action will be they would be undergoing medical treatment. Yes, knowledge economy has created good results with a aim to create transformed resource empire. In the light Covid-19 incident, human being has to explore the next global economy. Because, along with knowledge economy human community under the pressure and imagination of global disaster due to nuclear war. The fear of nuclear war will be more severe do to economic reasons only if human being does not change the philosophy of economics and philosophy for existence.
Human being to become humane the economics has to insert the wisdom in crux of all economic decision. Such economists will have global crux of the problem – equity and balanced economy. Let the globe be balanced at all levels. Otherwise there would be no time for destruction to come. Covid-19 has given at least time to resurrect but to correct the human activities. In this regard, the global economics has to neutralize any religions of the world. It is my wisdom.
April 6th, 2020 at 10:38 pm PDT
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