© Mila Strugatsky/milastrug.comCassandra, Circles of Ruin
When the virus became known outside of China, there were few data points, and the info from China was either incomplete or intentionally misleading. As a result, authorities had to rely on computer models and their projections. These models are only as accurate as the data that are fed into them, and without adequate data, the projections could only be speculative. But the models were all anyone had, and governments can't be blamed (too much) for acting on them. The models predicted mass death and the breakdown of hospital systems under an overload of ICU cases, even with severe countermeasures in place.
As a result, drastic "mitigation efforts" were undertaken in most developed countries. The idea was to "flatten the curve" — not necessarily to reduce the overall death toll significantly (though some lives might be saved), but to space out the cases and prevent hospitals from collapsing under the strain. The nightmare scenario was Italy, where demand for ICUs exceeded the supply and ventilators had to be rationed. Lost in all this was that Italy has a chronically underfunded healthcare system that is prone to shortages and rationing even in normal years, and that the Lombardy region of Italy was in many ways a worst-case scenario because of demographics, air pollution, and a large influx of Chinese workers.
Now enough time has passed to see that the models were very inaccurate. The virus is significantly less lethal than originally believed. No one argues with this. The initial estimate of a 3.4% mortality rate has consistently dropped. Current estimates range from 0.1% to 1% — still a wide range, but even the upper limit is well below the initial assumption. The models have been revised downward accordingly.
Despite fears that viral hot zones would be overwhelmed, no metro area in the US has seen its hospitals so swamped that they cannot provide care, even in the ICUs. New York City constructed a tent city to handle hospital overloads and also had a Navy hospital ship brought in; neither contingency was needed. The city also requested 30,000 ventilators and complained when fewer were delivered, but ended up not using all of the ones it had, and is now sending ventilators to other metro areas, which also don't seem to need them.
In short, the data were incomplete, the models were wrong, and the anticipated overflows didn't happen. And this is true in countries that practiced severe mitigation efforts, moderate efforts, or minimal efforts. It's true pretty much everywhere except in Italy, Spain, and perhaps some less-developed countries like Iran and China, which are not providing reliable data. In fact, by all accounts the flu outbreak of 2017-2018 stressed the US hospital system much more severely than the novel coronavirus.
The intelligent thing to do at this point would be to gradually ease up on the lockdowns. Immediate lifting could well lead to a spurt in new cases, which in turn would trigger calls to reinstate the lockdowns — calls that politicians would find difficult to ignore. Moreover, the public is so panicky about the virus that even if all lockdowns were lifted overnight (not a good idea), many people would not return to work or want to eat out or attend crowded venues.
The worry is that political paralysis will delay the phased-in reopening that's needed. This in turn will have ever more severe consequences for our economy, our national psychology, and possibly civil liberties and civil order. Already we've seen a spike in new unemployment claims that dwarfs any numbers on record and makes the so-called Great Recession following the 2008 financial crash look like a blip on the charts. Some analysts believe US unemployment will hit 20% by the end of this month, a stunning turnaround from the full employment we enjoyed at the start of the year. (3-4% unemployment is considered full employment, because some people will always be changing jobs at any given time.) Small businesses are facing bankruptcy, potentially in record numbers. No amount of stimulus, even assuming that Congress can agree to provide more, will be sufficient to save all these businesses, each of which represents the livelihood of its employees and the life's work of its owners. The ripple effects from these numbers could be catastrophic, as once-prosperous communities see a cascade of business closures and as unemployed or bankrupt people lose their homes. For the moment, foreclosures have been put on hold in many states, but at some point they will resume.
A more immediate concern is the breakdown of the daily delivery of goods. Supply chains appear to be increasingly stressed. Shortages of staple food products are now common in many parts of the country, although these shortages seem to be intermittent for now. The longer the full lockdown continues, the more difficult it becomes to maintain supply lines. Shortages that are temporary could become permanent. Shortages that are localized could become more widespread.
If food starts running out, the next stage in the process is civil unrest. Hungry, scared, angry people are unlikely to sit at home and starve. Authorities will then have to use ever more repressive measures to keep the populace in line. Already some local and state authorities have overstepped their bounds with nonsensical and Kafkaesque prohibitions, which have ignited protests. If the authorities feel compelled to go even further, they will probably trigger more protests, not necessarily peaceful ones.
In short, the situation is volatile. The future I've laid out may be a worst-case scenario. It's possible that supply lines will remain sufficiently intact to prevent more serious shortages, and that civil order will be maintained without unduly authoritarian measures. Americans are resourceful and resilient people, and we may figure out innovative ways to keep our economy running well enough to stave off chaos. The checks and balances of our system may keep any authoritarian tendencies from running too far out of control.
But even if we come through the lockdown period without the crises I've sketched out, there is no way to avoid the psychic toll. Children are locked up in households with abusive parents. Wives are trapped with abusive husbands. People who've lost their jobs may turn to liquor (alcohol sales are way up), opiates, violence, and suicide (some suicide hotlines report record call volume). Anxiety and depression are sure to skyrocket under these circumstances.
The longer-term outlook is not good. The IMF foresees the worst global economy since the Great Depression of the 1930s, though they hold out hope for a relatively quick turnaround. The UN says hundreds of thousands of children will die as a result of a sharp decline in living standards, especially in the developing world, where there is less margin for error. No one can foresee the full ramifications of the worldwide shutdown, but anyone who minimizes them is whistling past the graveyard.
What to do? The lockdown strategy, I believe, was a mistake. It would have been wiser to follow the course set by Sweden, which pursued a more moderate policy of some social distancing (restaurants could not be at full capacity, for instance) while eschewing any general closure of businesses or any stay-at-home orders. Sweden's fatality rate from the virus is in line with rates reported by countries that implemented much more severe measures*, and their economy and society have not suffered to the same degree. But since we did not follow that course, we will have to reopen by degrees, trying to minimize a "second wave" of infections, while intelligently balancing the health risks against the equally real socioeconomic risks. I don't have great confidence in our ability to walk this tightrope. But it's what we can hope for.
This thing has been a clusterfutz of epic proportions, a perfect storm of limited data, unreliable modeling, an impulsive and panicky political class, sensationalistic media, technocratic tunnel vision, and public germophobia. We have dug a deep hole for ourselves, and now we need to stop digging and try to climb out. It will be a long, slow process, complete with much finger-pointing as the dimensions of our economic apocalypse become clear.
That's all I have on this subject. I've prophesied enough doom for a while; my voice is tired. Anyway, maybe I'm wrong, and future generations will look back on this whole episode as a shining example of public policy.
Yeah. Maybe.
*Deaths per million as of April 19:
Worldwide: 21Source: Worldometers
- Germany: 54
- Denmark: 61
- Portugal: 70
- USA: 120
- Sweden: 152
- UK: 237
- France: 302
- Italy: 391
- Spain: 437
Sweden's strategy is to accept more deaths at the onset of the outbreak in exchange for more rapidly achieving herd immunity. Some countries do have markedly lower death rates. Norway's rate is 30, which is seen as something of an anomaly; tentative explanations include more widespread testing and fewer problems with antibiotic-resistant bacteria (antibiotics are used to treat complications from COVID-19).
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