“Social distancing” has become a common part of the American vernacular in recent days, as people across the U.S. hunker down in an effort to slow the spread of the coronavirus — sometimes by government mandate, sometimes voluntarily.
Just about all the things that Americans enjoy have been canceled. There are no festivals, no sports, no concerts. Theaters are closing. Vacations are being canceled.
Virtually every school in America has closed or soon will. Bars and restaurants have been ordered closed in a growing number of states and municipalities. Others are taking it upon themselves to at least scale back. On Monday, a host of national chains announced plans to close their dining rooms, including McDonald’s Taco Bell, Chick-fil-A and Starbucks. Others will follow.
Millions of Americans have stopped going to the office and are working from home. Hundreds of thousands more have already been laid off or are on the verge of unemployment as the economy slides into recession as a consequence of “social distancing.”
Most Americans — though not all — are adapting to these abrupt changes without too much resistance. The nonstop ringing of alarm bells by the CDC, the White House and other authorities has helped convince many that it’s absolutely necessary to intervene.
But what if you were told that you would have to maintain this new way of life for a year and a half in order to fully mitigate the dangers of COVID-19, the disease caused by the virus? Would that change the way you feel?
It seems like fear-mongering at its best. But that’s exactly the stance taken by a group of epidemiology experts at London’s Imperial College. In a paper published Monday, the college’s COVID-19 response team, consisting of professors, doctors and others, said that for the disease suppression strategy currently being employed in the U.S. and the U.K. to work, the guidelines would have to remain in place until a vaccine becomes available — which means another 12 to 18 months.
Lest you think this is just a random research project by a random group, it is believed that the study — an advanced copy of which was provided to the White House — is central to President Donald Trump’s increasingly serious tone with regard to the threat posed by coronavirus.
Most people infected by the coronavirus experience only mild symptoms. But, for some — primarily the elderly and those with underlying medical conditions, the virus results in serious illness and it can be fatal. The goal of America’s current suppression efforts — which are also being employed in much of the developed world — is to slow the spread of infections so that the health care system will not be overwhelmed by too many sick needing access to finite resources at the same time. It’s what scientists call “flattening the curve,” a phrase heard so often in recent days. Flattening the curve doesn’t necessarily mean the outbreak stops. It simply means that the infections are spread out over a longer period so that, hopefully, deaths and infection rates can be reduced.
How long will that take? No one really knows. Fifteen days is a number that’s been tossed about a lot. President Donald Trump said Monday that Americans have 15 days to stop the crisis. But that simply means the U.S. has 15 days until it is where Italy is now — 15 days until its health care system is overwhelmed if action isn’t taken. Anything beyond that is uncharted territory. The best-case scenario, the outcome that is presumed by most Americans, is that students start returning to school after that 15-day period, bars and restaurants reopen, families start rescheduling their vacations, the Major League Baseball season begins. Life returns to normal.
But what if 15 days isn’t the end? What if 15 days is just the beginning? At his press conference on Monday, President Trump mentioned that this situation could persist into July or August. Anthony Fauci, director of the National Institute of Allergy & Infectious Diseases, later said the 15 days are a “trial” period for the new guidelines and that they might not necessarily be in effect until July even if the outbreak lasts until then.
But what if they are? Trump administration officials have hinted that they will be extended beyond the current 15-day period.
And what if July or even August isn’t the end?
China and South Korea have been very successful in showing that short-term suppression of COVID-19 is possible, though each nation implemented measures far more draconian than the U.S. government would ever consider — more stringent than the American people would ever accept. As bad as the outbreak was in China, it could’ve been significantly worse.
But it’s too soon to know if rates of infection will bounce back in those nations as the measures put into place are relaxed. Wuhan is slowly returning to normal, so we may know the answer to that soon. If new cases start to bounce back, the Imperial College paper will suddenly start to look more credible.
That brings us back to the Imperial College paper. Can you imagine 18 months without sports? Without eating at your favorite restaurant, or any restaurant? Without going to a movie or a concert? Without going to church?
The authors of the Imperial College study warn that “a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members” will be needed — potentially accompanied by school and university closures — until vaccines become available, “given that we predict that transmission will quickly rebound if interventions are relaxed.”
For the record, the Imperial College team doesn’t say that social isolation measures would have to be constant for the next 18 months, but does say they could only be “relaxed temporarily in relative short time windows.”
But would America be willing to continue these draconian measures for that length of time, even if it means saving lives? Would the rest of the world? Should America and the rest of the world be willing to head to the bunkers for a year and a half? The impact on the global economy would be devastating, on a scale that would make the Great Depression seem like a field day. The toll on mental health would be significant. Chaos would ensue. It’s not hard to envision scenarios where our social order dissolves, or where our supply chains break down.
Is it worth the risk?
There’s no doubt that COVID-19 poses a very real threat. Critics who remain unconvinced of the disease’s severity point out that 80% of patients experience only mild symptoms, and that’s true. But when you’re talking about the potential for millions to be infected, the remaining 20% represents a substantial number. Those critics also point out that the virus has killed fewer than 100 people in the U.S. thus far, which is far fewer than the 22,000 killed this year alone by seasonal flu, or the tens of thousands who died in the H1N1 pandemic in 2009. But this outbreak is just getting started. The number of fatalities in the U.S. is increasing each day, and will continue to increase.
If no interventions were taken, experts estimate that 81% of the population in the U.S. would eventually be infected. Based on current fatality rates, the result would be 2.2 million deaths in the U.S. Or, to illustrate it as I prefer to, since so many people fall back on the flu statistics from this year: This year’s strand of seasonal flu is carrying a death rate of less than 0.1% in the U.S. Yes, it’s killed 22,000 people, but that’s out of 36 million people who have been infected. If the same number of people were infected with COVID-19, and if we assume a death rate of about 1% (which seems pretty safe, based on the thoughts of various experts), the final death toll in the U.S. would be somewhere around 360,000. Obviously, the Imperial College team is estimating that far more people are sickened by the coronavirus, which is not an unsafe assumption, since it has been shown to transmit much more easily than the flu.
The next argument is that COVID-19 “only” impacts the elderly and those with underlying medical conditions. The callous nature of that argument aside, it’s true to a point — but not entirely. See the 46-year-old paramedic from Italy who just died. He had no underlying medical conditions. And while he eventually recovered, the so-called Patient 1 in Italy was a man in his 30s who was otherwise healthy, and he wound up spending three weeks on a ventilator.
Yes, COVID-19 disproportionately affects the elderly and those with pre-existing medical conditions … but it isn’t as though those with pre-existing medical conditions are necessarily people who are already knocking at death’s door. Risk factors include high blood pressure, a group that includes millions of Americans. Another risk factor is type 2 diabetes, which includes millions more.
As for the claim that the vast majority of people experience only mild symptoms that are more in line with seasonal flu or even the common cold. Again, that’s true to a point. But it’s still a significant risk to the elderly population. Consider this: while only 1.2% of people in their 20s need hospitalization due to COVID-19 sickness, that number jumps to 10.2% for people in their 50s, and all the way to 27.3% for people aged 80 or older. Of the patients who do require hospitalization, greater than 10% require intensive care treatment if they’re 50 or older. Greater than 70% require intensive care treatment if they’re 80 or older. The overall death rate for those aged 80 or older is 9.3%.
So it’s a deadly disease, one that poses a much greater risk than H1N1 or any other pandemic of our lifetime. It is on the same scale, as far as unmitigated threat, as the Spanish Flu pandemic of 1918-1919. In fact, the only way you can seriously claim that the coronavirus pandemic isn’t on the same threat scale as the 1918 flu outbreak is if you’re biased towards ages. The Spanish Flu primarily killed younger Americans (99% of the 500,000 or so victims in the U.S. were younger than 65), whereas COVID-19 primarily kills older Americans.
There’s no way to sugar-coat the threat posed by the coronavirus. Everything that the WHO is saying, everything that the CDC is saying, everything the White House is saying — it’s all true.
But if the only way to truly combat it effectively is to remain holed up for 18 months, at what point do we start to consider compromise solutions?
I could be wrong — fear is a powerful motivator, after all — but my guess is that if the current restrictions are extended beyond the current 15-day window, Americans will be ready to talk about compromise solutions.
It’s not a pleasant scenario to think about. It’s not quite as uncomfortable as the situation doctors in Northern Italy are being placed into, where they have to decide who they’re going to let live or who they’re going to let die; there, they’re dealing with real faces and real names that are attached to the options in front of them. Here, we’d only be speaking in terms of hypotheticals. But it would still be an itchy place for a governor or president to find himself, saying he’s going to lift restrictions even though it’s inevitably going to cause some people to die.
Still, if the alternative is an 18-month economic shutdown, it’s safe to say that the cure will be far worse than the virus could ever hope to be. We know, because of the modeling by these scientists who are much smarter than you or I, approximately how many people we can expect to die from the coronavirus. But what we don’t know is how many people would ultimately be overwhelmed by an economic recession that could perhaps be the greatest the world has ever known.
Already, the economic fallout from what we’re experiencing today is going to be harsh. A recession is inevitable. Many small businesses are going to close, because they cannot withstand losing their cash flow for even a few weeks. Hourly workers who are living paycheck-to-paycheck are going to find their world turned upside down. And that’s to say nothing of the social chaos. Social distancing doesn’t come without a cost. We will see domestic violence increase, we will see suicides due to financial ruin, we will see wholesale increases of depression and anxiety to the point of an epidemic in and of itself.
Now imagine multiplying that a few times.
A lot has been said in the past week about “tough decisions.” Actually, the decisions that have been made thus far may have seemed like tough decisions at the time, but chances are they’re about to pale in comparison to the decisions that lie ahead.
Let’s hope for better news that makes all of this seem like a really bad joke. Australia researchers claim to have found two drugs that will stop coronavirus in its tracks — one of them used to treat malaria and one used to slow the progression of HIV to Aids. Clinical trials could begin in a matter of weeks. That’s a start. Let’s see if more good news follows. This nation, this world, could use some right about now.