This is what is going to happen with COVID-19 going forward.

CDC surveillance of COVID-19

The economic cost of staying in the shutdown is too painful to continue. The big argument is over when to open up, not if. The CDC and other major medical agencies would like us to stay in social isolation mode until testing can ramp up to where everyone can be tested on-demand. They would like the rate of new infection to be low enough that contact tracing becomes possible.

Given the near universality of cell phones, we can contact trace large numbers of people quickly through automated systems, assuming people are willing to participate. Some won’t, most will. But even with high tech solutions, contact tracing is still impractical until the high rate of new infection we see drops to some specified level and testing climbs to some specified level. Testing is crucial because of the large number of asymptomatic carriers.

The other side says that the economic hardship is already too great and we have to open up sooner rather than later. There is also an indication that the number of deaths caused by social isolation itself is climbing. Suicide and death due to alcohol and drug overdose are spiking.

Calfornia is $60 billion in the red and the Federal government has tacked another 6 trillion dollars onto the deficit.  We have unemployment in some areas as bad as the Great Depression. How long do we keep this up?

On the positive side, if 20% of workers are unemployed it means that 80% still have jobs.

There is also fear that special powers granted the government to fight the epidemic can result in a permanent loss of freedom – and it certainly feels like new powers tend to never be revoked. I consider that a legitimate concern but note that nobody in the US is attempting to assert any special powers that weren’t already recognized in the 1918 influenza pandemic. Other countries aren’t so restrained. Hungary, Turkey, Brazil, and others may use pandemic concessions for permanent power enhancement.

Different strokes for different states.

Sweden took the approach of doing very little to flatten their curve. (If you read nothing else in this post, please click on the link!) Initially, that was what medical experts in Britain had advised Boris Johnson to do. (He wasn’t just being a dork.) Britain changed boats in mid-stream after the situation got worse than expected.

In exchange for a potentially higher death rate, the infection will pass through Sweden, saturate the population, and burn out. Social distancing is voluntary. Citizens are expected to use their judgment. (Unheard of in most countries and downright subversive!) Personal responsibility and mutual trust replace government orders. That’s the opposite of what most countries are trying to do.

It may work. Sweden has a much stronger medical infrastructure than most countries. The population is well educated and affluent. The people trust the government to backstop them if they get ill and cannot work. Most important they trust each other to do the right thing. There will be more casualties but the country as a whole will not suffer economic disaster. Years from now, Sweden may come out ahead even if it is hurting more now.

Most countries are not Sweden.

The US has managed to “flatten” the curve a bit, even if we are behind other countries. There is really no Federal regulation, only CDC suggestions. It is unclear how much ability the Federal government would have to impose social distancing restrictions but under the Interstate Commerce Clause, there is some authority.

Nationally, we are not much like Sweden. We lack the extensive social safety net and have a far more diverse and argumentative population. The executive has been asleep at the switch in terms of resource allocation. And instead of exhorting the people to civic virtue, the bully pulpit has become a source of misinformation. Really stupid misinformation at that.  Congress’s supporting legislation is mostly directed at large businesses more than ordinary citizens. Even hundreds of millions in small business loans went to big businesses.

Exactly what I’d expect. It is what it is. Heavy sigh!

Individual states have taken different approaches. Some have opted for very few controls but the closing of “nonessential” businesses, wearing masks, and prohibition of public gatherings is the heart of it for most states. Individual cities and counties may be more restrictive than states. LA County will stay in “lockdown” mode until July.

I am supposedly in “lockdown” but I am still free to go anywhere I want outside of a closed business and do anything I want as long as I wear a mask and keep my distance when others are around. I use gloves when touching a “public” surface and wash my hands frequently, tho that is not legally required. It is not a true lockdown like some other countries. I am glad of that. I am willing to manage my risks in exchange for a bit of freedom.

“Flattening the curve” is not a cure.

Remember that flattening the curve does not mean fewer people will become ill. It means that the casualties will be spread out over a longer time so that infrastructure doesn’t become overwhelmed. Just as many people get sick but fewer die because they can get better care.

The pandemic is far from over but we can handle it better than a couple months ago. Industrial capacity for production of PPE and medical support equipment has spooled up to where we can now start exporting such to other countries. There is a surplus of hospital beds as old facilities expand and new ones are created. We have an understanding of how the virus works and ideas on how to fight it. Since our ability to fight the disease grows better over time, those who get sick later will have the advantages of therapeutics and protocols that did not exist at the beginning.

The US expects to see 3000 deaths per day in June and then slowing down after most restrictions are released. It will continue until herd immunity is established, a brilliant therapeutic is devised,  or a vaccine is developed. Such a vaccine has reached stage 2 clinical trials in the US but will not be available in 2020.

Even if a vaccine is developed there will be people who cannot take it for medical reasons. There will be those who get vaccinated and still do not get immunity.  There will be those who refuse. There will be reservoirs of the virus in less developed countries.

Consider that except for these things, measles would be as extinct as smallpox.

I’m not going to hold my breath on a vaccine. Some vaccines may go into human testing in the near future. Even the most optimistic projections say that it will be into 2021 before general availability.  My hope is that a really effective therapeutic is developed before then. Remdesiver and convalescent plasma are better than nothing and I expect better products will be developed.

Perception and a “new normal.”

Welcome to the new normal.

There is one other way for this epidemic to “end” besides herd immunity and that is for it to become “endemic.”  Epidemics are changes from the status quo. If it becomes “normal” for a certain number of people to be infected by COVID-19 then it is no longer an epidemic. The term would be reserved for areas with unusually high infection rates.

People catch all kinds of nasty diseases all the time. These illnesses and deaths subside into the background noise of life. If we don’t get an effective vaccine, if exposure does not confer long term immunity, that is the ultimate fate of COVID-19. It will become just another reality of life, no different than traffic fatalities, cancer, heart disease, and natural disasters.