.By Sean Trende - RCP StaffMay 15, 2020
On March 6, Liz Specht, Ph.D., posted a thread on Twitter that immediately went viral. As of this writing, it has received over 100,000 likes and almost 41,000 retweets, and was republished at Stat News. It purported to “talk math” and reflected the views of “highly esteemed epidemiologists.” It insisted it was “not a hypothetical, fear-mongering, worst-case scenario,” and that, while the predictions it contained might be wrong, they would not be “orders of magnitude wrong.” It was also catastrophically incorrect.
The crux of Dr. Specht’s 35-tweet thread was that the rapid doubling of COVID-19 cases would lead to about 1 million cases by May 5, 4 million by May 11, and so forth. Under this scenario, with a 10% hospitalization rate, we would expect approximately 400,000 hospitalizations by mid-May, which would more than overwhelm the estimated 330,000 available hospital beds in the country. This would combine with a lack of protective equipment for health care workers and lead to them “dropping from the workforce for weeks at a time,” to shortages of saline drips and so forth. Half the world would be infected by the summer, and we were implicitly advised to buy dry goods and to prepare not to leave the house.
Interestingly, this thread was wrong not because we managed to bend the curve and stave off the apocalypse; for starters, Dr. Specht described the cancellation of large events and workplace closures as something that would shift things by only days or weeks.
Instead, this thread was wrong because it dramatically understated our knowledge of the way the virus worked; it fell prey to the problem, common among experts, of failing to address adequately the uncertainty surrounding its point estimates. It did so in two opposing ways. First, it dramatically understated the rate of spread. If serological tests are to be remotely believed, we likely hit the apocalyptic milestone of 2 million cases quite some time ago. Not in the United States, mind you, but in New York City, where 20% of residents showed positive COVID-19 antibodies on April 23. Fourteen percent of state residents showed antibodies, suggesting 2.5 million cases in the Empire State alone; since antibodies take a while to develop, this was likely the state of affairs in mid-April or earlier.
State governments have already received a record level of federal aid to cope with the pandemic and now need to shoulder the responsibility to meet their remaining needs with their own resources and necessary cuts in non‐essential spending.
‘There have been as many plagues in history as there have been wars,’ wrote Albert Camus in The Plague, ‘yet always plagues and wars take people equally by surprise.’ So it was this time. The arrival of a new coronavirus blindsided governments of most advanced nations as they reached for a tool that few had ever really considered before: lockdown. It all happened too fast for a proper discussion about the implications. The biggest question — the extent to which lockdown will claim lives as well as save them — is one you can ask at a global level.
We know the national costs. In the United States, there is joblessness on a scale not seen since the Great Depression, with more than 33 million unemployed. The Bank of England forecasts the UK economy will fall by 14 percent this year — the steepest decline since 1706. Similar trends can be found across the industrial world. The global economy is veering toward an economic depression not seen for generations.
The result: One-third of reported coronavirus deaths in the United States, according to New York Times reporting, are of nursing home residents or workers. Nursing homes accounted for a majority of deaths in heavily hit states like New Jersey (52%), Massachusetts (59%), Pennsylvania (66%) and Connecticut (55%), and for 80% of the deaths in otherwise lightly hit Minnesota.
That percentage is much lower (20%) in America's COVID-19 epicenter, New York, but it still leads the nation with 5,403 nursing home deaths -- about one of every 14 COVID-19 death in the country.
Why so many? On March 25, the state health commissioner ordered that nursing homes to accept patients with the virus. It's unclear why he made this fatal decision. Maybe he wanted to keep hospital beds available, or maybe he feared that sick people would be dumped onto the street.
When asked about this policy in late April, Governor Andrew Cuomo professed ignorance. Two weeks later, on May 9, after 46 days in effect, he reversed it.
“A strong currency means that American consumers and businesses can buy imported goods and services more cheaply and that inflation and interest rates will be lower.”
A perfect panacea of economic goodness – so long as the government toes the line. But what line?
The article published in the Economist I quoted above was not written recently, though it does sound like it must’ve been. It was penned instead in September 2003 to slam the Bush Administration for presumably abandoning the strong dollar policy Rubin espoused.
The weak situation and jobless recovery from the mild 2001 dot-com recession was perplexing, leaving both the “maestro” and the President, Bush this time, to grope around for answers. Greenspan kept on lowering the fed funds target even as the bond market beat him to it.
As circumstances have evolved, so has my thinking. We have survived the surge in hospitalized cases and suffered immense economic trauma. The full lockdown made sense weeks ago. But the situation is changing, and more data on the virus are now available to inform our next steps. The choice before us isn’t to fully lock down or to totally reopen. Many argue as though those are the only options.
As a physician, I firmly believe that the primary goal of our reopening strategy should be to maximize the number of lives saved. But virus mitigation can take many forms, ranging from effective to excessive. Extreme forms of mitigation can have diminishing returns. Projections of the death toll produced by the current economic shutdown are often politically motivated, but the effects on human life are real.
The pandemic has brought out the bully in many governors who act as if there are no limits on their emergency powers. A 4-3 majority on Wisconsin’s Supreme Court disagreed Wednesday, and the ruling underlines the importance of democratic safeguards even during emergencies.
On March 12 Governor Tony Evers declared a public health emergency and directed health secretary Andrea Palm to take “all necessary and appropriate measures to prevent and respond to incidents of COVID-19 in the State.” She then ordered all individuals to stay home except for “essential” activities.
Ms. Palm issued another order on April 16 that prohibited all non-essential travel, banned all people who are not part of a single household from gathering, and extended her shutdown of non-essential business through May 26. Violators could be fined $250 and imprisoned for up to 30 days...
“Rulemaking exists precisely to ensure that kind of controlling, subjective judgment asserted by one unelected official, Palm, is not imposed in Wisconsin,” Justice Patience Drake Roggensack wrote for the majority enjoining the stay-at-home order. “When a grant of legislative power is made, there must be procedural safeguards to prevent the ‘arbitrary, unreasonable or oppressive conduct of the agency.’” Two Justices wrote concurrences underscoring how the separation of powers is a bulwark for individual liberty.
SCHOOLS ARE REOPENING in countries around the world in response to a substantial body of evidence that children are largely unaffected by Covid-19 and minimally contagious when they get infected. Experts and policymakers abroad also acknowledge that school closures perpetuate a long list of known harms to children.
Yet, oddly, the US is following a divergent path.
Governors from both parties throughout the United States have already mandated or recommended school closures for the remainder of the academic year, and many districts may not even open in the fall. The chancellor of New York City schools recently put the odds of bringing kids back in September at only 50/50. This approach is all the more illogical given that many states are already starting to reopen workplaces, stores, and other public areas frequented by those who are most at risk: adults.
The precise role children play in both contracting and transmitting the virus is still unknown, and the subject of debate among experts. A recent article in The New York Times asserted that “cases could soar” if schools were to reopen any time soon. The claim (as stated there) rested on two recent studies: an unpublished—and widely contested—analysis of viral loads; and a modeling study based on contact surveys.
Speculations such as these, based on a connecting of the dots, may prove to be correct. But most of the empirical evidence thus far points to the contrary. Not only do American politicians’ insistence on keeping schools closed put them increasingly at odds with other nations, it redoubles the policy’s well-established social costs. As it stands, children appear to be bearing an undue burden for society.
...The good news is that policymakers have an opportunity to strategically reopen the economy, by taking into account a unique feature of COVID-19: its heavy skew toward bad outcomes in the elderly and the near-elderly who also have other chronic diseases. With the proper precautions, and the deployment of tools like contact tracing, self-quarantines, and telemedicine, we can continue to protect the most vulnerable, while returning as many Americans as possible to work.
We will still need to address high-risk populations, like those in nursing homes, rehabilitation facilities, jails, and prisons. Outside of New York, nearly half of all U.S. COVID-19 deaths have taken place in nursing homes and assisted living facilities. But we are persuaded that much more can be done to reopen the economy today, thereby improving the lives of hundreds of millions of low-to-middle income Americans.
After all that, it’s not clear that the paycheck mandate has made a dent in the unemployment rate. The national unemployment rate reached a record high of 14.7 percent, as of May 8, despite the paycheck mandate. While it’s impossible to know what the jobless rate would be if the program didn’t exist, anecdotal evidence suggests the program is undermined by the employee retention requirement.
Another problem is that many business owners have gotten loans approved only to discover they cannot afford to use them, at least not right away. Jodi Burns, the owner of Blazing Fresh Donuts in Guilford, Conn., told the New York Times she was sitting on a $50,000 loan in the hopes she can get a low-interest rate on it and use it pay off bills. She doesn’t know if that’s possible yet because many of the technical details of the loans are still being figured out by regulators. In the meantime, neither her employers nor her creditors are getting paid. “I don’t accidentally want to commit bank fraud,” Burns said.
After the Wisconsin Supreme Court struck down the state's stay-at-home order, which immediately lifted restrictions on businesses and gatherings, some bars opened their doors (and taps) Wednesday night as patrons began trickling out.
The ruling applied to Gov. Tony Evers' statewide order to lock down Wisconsin amid the public health emergency of the coronavirus pandemic. Evers intended to keep the order in place until May 26. However, localities are still imposing and extending their own stay-at-home orders, meaning not all businesses in the state may immediately open.
Photos showed small gatherings of Wisconsinites out at bars and restaurants shortly after the ruling came down, while some establishments posted on social media they were staying closed.
At last we’re getting a debate about COVID-19 modeling. When people finally got to look under the hood of the famous Imperial College study, they found twisted and tangled code. And most of the model’s predictions bear little resemblance to what is actually happening. Some defend the models by saying that their predictions turned out to be wrong only because governments imposed harsher restrictions than the coders expected.
If so, we have a perfect experiment. Sweden did not close borders, shut down schools, businesses, restaurants, gyms or malls and did not issue stay at home orders. So it should be the one country where the models fit. Let’s see.
Maria Gunther and Maria Westholm at Dagens Nyheter, Sweden’s biggest daily, just took a look at two of the most influential models in Sweden, both were inspired by the Imperial College study and published on the preprint server MedRxiv in April. Both were used by critics to argue that the Swedish model would quickly break our health care system — and that we had to make a U-turn into lockdown, as Britain did
Last week, Europe started its liberation from lockdown — and it all feels like a study in national political identity. Belgium took its first step towards ‘deconfinement’ but no one seems exactly sure what that means. France is opting for complexity rather than simplicity. Italy’s national plan for the easing of its lockdown is more convoluted still, but few regions bother to follow it anyway. Spain, goes a national joke, went more slowly and started with a reopening of the siesta. And in Germany, everyone is praising the country’s scientific approach to the pandemic, but as soon as they were allowed to roam freely again, many Germans headed for the beer gardens.
Governments say their approach is ‘guided by the science’. In reality, science doesn’t offer any clear way out of this mess. There is no vaccine around the corner, no answers even to basic questions: how the virus spreads, how many have been infected, why children seem immune. Politics, not science, decides the path out of lockdown. Each country is reopening one step at a time and in its own way, searching for what works in practice, given the lack of certainty. Europe, with all its variety, has become a laboratory experiment in how to end lockdowns.
Here in Sweden, the experiment has involved not doing lockdown at all but instead asking people to socially distance. Gatherings of fewer than 50 are allowed, as are sports events for young people. Church services and dinner parties continue. The distancing has left many of our streets as empty as Britain’s, though, and our economy has suffered. We too have a scandal of too many deaths in care homes. Our guess — and as with everywhere else, it’s not much more than a guess — is that we’re seeing the tail end of it. Our deaths are about average for Europe, albeit higher than the rest of Scandinavia. The virus has spread pretty widely, and we hope it brings immunity in its wake. A study last week suggested herd immunity in Stockholm could be achieved next month, and with an infection rate of 40 percent.
