What Lies Ahead in the Pandemic?

The first great wave of the COVID-19 pandemic is either peaking or past its peak in China, parts of Asia, Europe and the U.S.  What lies ahead?

What does it mean when people say, ‘the worst is over’?  It means that the explosive growth of the pandemic in a particular city or nation is over, that the healthcare system is no longer stretched beyond capacity, that the number of new cases each day is not getting larger.

But it does not mean that the contagion has stopped spreading.  There may still be more new cases each day than cases that have been resolved.  New people will go into the hospital.  New people will need intubation.  New people will die.  There will still be large numbers of people who walk the streets in either a pre-symptomatic or asymptomatic state.

The only way to completely stop the spread of COVID-19 before a vaccine is available is to test universally and constantly, and track and quarantine all infections, efforts that very few countries will be willing or able to mount.

But there is no doubt that human beings will attempt to return to a more normal life and be willing to take on a certain level of risk to ensure that total economic collapse and all of its attendant consequences do not occur.

So, what will life be like in this interim period, before vaccination but after total shutdown orders have been lifted?  Knowing that there are still significant numbers of infected people in public, will people be willing to fly on airplanes?  Will they go to bars and restaurants?  Will they attend sporting events, concerts, plays or theater?

This will partly depend on the level of contagion in any specific area.  And that level will probably ebb and flow much like the tides and any other cyclical phenomena.  COVID-19 is highly contagious, so if the social distancing measures are completely abandoned it will return with a vengeance. 

Will a more relaxed social distancing policy, with people generally wearing masks in public and trying to keep their distance from others, be enough to keep the virus at bay?  Will the mortality rate be lower if we keep the contagion at a lower level and allow our healthcare providers to work in an optimal manner?

The unpredictable nature of the COVID-19 sickness may have a sobering effect.  Even young, healthy adults can end up on a ventilator and ultimately die.  Will this fact cause much more conservative behavior, or will people be willing to take that relatively small risk and resume their normal lives?

Clearly, elderly people and those with pre-existing health problems will be very reluctant to risk exposure as long as there is a significant level of contagion present.  This is a growing portion of our population and a group that contributes heavily to our economy.  Their isolation and sheltering will certainly be a brake on any real recovery until there is a vaccination available.

One possible short-term aid would be the development of a treatment that stops or significantly reduces the so-called ‘cytokine storm’, the medical event that seems to herald the rapid demise of patients and is responsible for the death of young and healthy victims.

It is impossible at this point to accurately predict the future of this contagion.  But I believe there is enough evidence to support the argument that any true return to normalcy is many months away.  There may be an improvement in economic activity once the strictest shelter-in-place restrictions are lifted, but it is likely we will endure many months of a seesaw response.  We will simply have to do our best to adapt to each new situation and, most importantly, avoid desperate moves that pit state against state, country against country, rich against poor.  Our humanity is being tested; we must all do our part to meet the challenge.

Why Was COVID-19 A Partisan Issue?

It is not hyperbole to postulate that partisanship and distrust of science in the U.S. is responsible for thousands of unnecessary deaths in the COVID-19 pandemic.  It is a lesson that we have paid heavily for in the last month, but hopefully it will have beneficial long-term effects that could save lives and suffering in the future.

When the spread of COVID-19 first became obvious to the world outside of Wuhan, scientists and physicians were nearly unanimous in warning of the potential for a pandemic.  There was sufficient data from Wuhan to make it clear that COVID-19 had a much higher reproduction factor and mortality rate than influenza.

The Trump administration was cavalier about the danger from the start.  The primary reason for their reluctance to acknowledge any risk was the possible impact on the stock market and the economy, which Trump saw as the key to winning a 2^nd term in November.  This led the administration to interpret any pressure from politicians or the science and health communities as attempts to create a panic situation and bring down the ‘Trump stock market’.  Trump and various right-wing pundits and news shows even went so far as to deride these warnings as hoaxes.

By constantly comparing COVID-19 to the annual seasonal influenza, Trump and his allies showed both an astonishing level of ignorance and a cynical willingness to gamble the health of Americans on the hope that somehow the virus would indeed be relatively harmless.  This hope was not based on any science or data, but on the ‘instinct’ and so-called ‘common sense’ that seem to be the only basis for Trump’s decisions on every issue.

Because of this incomprehensibly stubborn refusal to listen to reason, Trump wasted weeks of time when the nation could have been preparing for the onslaught of the virus.  Testing could have been accelerated, a large-scale national effort to make personal protection equipment and extend hospital facilities could have been initiated. 

The time lost during Trump’s selfish attempt to save his own fragile economic legacy has had devastating effect.  Thousands more will die than would have died had he acted aggressively in the nation’s best interest rather than his own.  Compare his administration’s response to that of Germany and you will see the difference between the leadership of a vain, petty demagogue and a true selfless, determined humanist.

Trump’s disdain for science and data has set us on a course for disaster, and not just in this pandemic.  There is an even more catastrophic highly probable natural disaster awaiting us in the near future with climate change.  We can only hope that all of humankind, and particularly the science-ignorant public in the U.S., will draw a lesson from this pandemic and understand that science informs us about the dangers ahead, but politicians must take action.

We are learning through this pandemic that the earth is a single, fragile organism in many respects.  There have been numerous noble gestures and empathetic responses across the globe.  The sacrifice and dedication of health care professionals worldwide stand in stark contrast to the woeful actions of our President.  We must unite in our determination to defeat this current pandemic, heal the economic wounds, and then use that unity to face the certain challenges that lie ahead.

Making a Killing in the Stock Market During a Crisis

Perhaps I am naïve and too idealistic, but I find it repugnant that people take advantage of a crisis to make money in the stock market.  If you decide to sell stocks before the crisis hits when the prices are high and then purchase them again at lower prices once the full impact of the crisis has been felt, then you are basically stealing from other people.

Recent news reports have publicized multi-million-dollar sales of stock before the fall of the stock market by very wealthy senators and representatives.  After these sales generated public outrage, these so-called leaders denied any specific advanced knowledge and made the excuse that their financial advisors made these stock sales independently.

I find it reprehensible that leaders of our country would allow their financial advisors to pursue profit at a time when our financial system and economy are clearly at great risk.  This is a highly unethical decision.  Any profits made from these sales are not due to companies doing well or generating profits, they are simply the result of the COVID-19 crisis and the broken nature of our financial markets.  The money these people make is money that was lost by others who were not as keenly aware of the coming chaos.

I know that the stock market is as much a gambling casino as an investment vehicle.  In normal times I would begrudgingly give the devil his due and acknowledge that one person’s mistake is another’s good fortune in many transactions and that the market cannot be designed to prevent that type of zero-sum win/loss.

But in a time of world crisis, when people will be losing jobs and income on a massive scale, it is the very height of greed and callousness to knowingly and actively benefit from others’ financial misfortune.

Time To Open Up the Wallets America!

The first order of business for the world is to contain COVID-19 to the greatest extent possible.  The second is to find a vaccine or significant treatment regimen that will curtail or eliminate the threat. The world must be united in these quests.

In parallel, we must be energetic and radically generous in our efforts to support those whose livelihoods and lives have been dramatically damaged by this pandemic.  It will not be enough to provide unemployment pay and loans.  By the time this is over, there will be widespread poverty, hunger, despair and chaos.

There are vast resources of funds that could be used to keep people safe and secure during the pandemic and rebuild the economy once it has ended.  Let’s start with the wealthy and even the well-to-do.  It is time for all of us to extend our hands and open our pocketbooks. 

But there are many institutional pots of gold that could be re-directed to resuscitate a desperate world.  Public and private universities have absurdly large endowments that could be used to stimulate the economy and lessen the suffering.  Private universities have over $339B in endowment funds and public universities have over $153B.  I know these endowments augment the universities’ programs, but there is a new set of priorities in this world and having bigger and better athletic centers at universities is way down on the list.

There are legions of private foundations that also have rich endowments and use the income to support their programs.  There are untold billions of dollars in these foundations (just the top 40 listed in Wikipedia total more than $300B).  Now is the time for these foundations to dig deep into their funds to keep this world from disintegrating.

Make no mistake.  This pandemic will not be over in a few weeks and may not be over in 6 months.  I am sure we cannot yet comprehend the damage it will wreak.  Human beings are resilient creatures and we will survive and eventually prosper again.  But it will require some new thinking in terms of the way we share resources.  It is time to open the wallet.

Preppers and Saints in the Time of the Coronavirus

It is difficult to find words for the disgust I feel for the prepper mentality that has proliferated in the wake of the coronavirus pandemic.  People are hoarding vital supplies, stocking up on guns and preparing for the apocalypse.  The prepper world is flourishing.

Meanwhile, millions of medical professionals are risking their lives to help those who have contracted the disease.  Millions more are donating time and resources to help those whose businesses or livelihoods have been destroyed as a consequence of the pandemic.

In times of crisis there have always been saints and villains.  Humanity is a strange mix of selfless nobility and craven self-interest.  When put to the test, each human being must decide.  Will I be a person who tries to assist others by some means, who is willing to risk and potentially sacrifice resources or health for the general good?  Or will I seek to shield myself and my family and retreat from society, hoarding whatever supplies and resources I can get my hands on, regardless of the impact on others?

We are currently facing a unique challenge that crosses national borders, racial and ethnic lines and even economic class.  How we respond to this challenge will determine whether the human race can survive in the coming years of potential pandemics and climate catastrophe. 

The costs in terms of life and commerce will be staggering no matter how we respond. But if we are optimistic and work together in good faith, we will make it through this period with a heightened sense of our common humanity. We may even discover that our civilization becomes more united and empathetic, and that we can make further progress on other daunting problems such as war, genocide, refugees, immigration and climate change.

There are many saints among us who have chosen the high road.  In this time, it is the doctors, nurses and other health professionals who are most worthy of our gratitude and respect.  We also are grateful for the people who risk infection in their jobs of  keeping essential services and resources available But all of us can contribute in some way, whether it is donating generously to worthy organizations, keeping our social distance, or helping out neighbors in need.

The preppers and the hoarders are the vermin of society.  They have lost their humanity and they have somehow convinced themselves that a solitary, end-of-world existence is worth their stockpiling of resources and effort that could otherwise have been put to good use in our common need.  Shame on them!

The Nature and Dilemmas of Pandemics

The current coronavirus pandemic has re-emphasized the complex nature of health decisions.  Medical science informs our decisions, but the science is not exact, or at least our current capabilities to model and understand these phenomena are not at a level where we can be completely confident in our analysis.

Some people are outraged or indignant about the precautions currently being implemented.  Part of this is political in nature, as all things seem to be lately in our society.  But part of it is basic ignorance of how small uncertainties and differences can play a huge role in the progression of a pandemic.

Many argue that we should treat this like a flu epidemic, since flu epidemics spread rapidly and kill tens of thousands of people each year.  They don’t understand why we should view this disease any differently.

However, there are several factors that can play a dramatic role in a pandemic, and the coronavirus appears to be just different enough from the flu to make these factors very significant.

The first is the basic reproduction number - Rₒ, which is an estimate of how many people a contagious person will infect.  The flu typically has an Rₒ of between 1.1 and 1.6.  COVID-19 appears to have a much higher number, around 2.2.

This is a huge difference!  After 20 cycles of transmission the flu, with an Rₒ of 1.4, will infect about 136 people.  When a virus has an Rₒ of 2.2, twenty cycles will infect 137,000 people!!  

The second major factor is the mortality rate.  The flu generally has a mortality rate of 0.1%, meaning that 1 person in a thousand who get sick will die from the flu.  COVID-19 appears to have a much higher mortality rate, anywhere from 1-2.5%.  This means that 1 to 2.5 people out of a hundred will die.  This is a very big difference.

There are other important factors – the incubation time and how long the person is contagious are examples.  All of these factors are estimated from data collected.  We have years and years of data from the flu and understand the threat quite well.  The exact opposite is true of COVID-19.  We are learning in real-time and having to make decisions based on limited data.

Another key aspect of managing the pandemic is the ability of healthcare services to treat people with the disease.  Hospitals and healthcare providers are not prepared to respond to huge surges in sickness.  They make heroic efforts, but they simply do not have the beds, the equipment (respirators, etc.), the qualified people, or the quantity of drugs necessary to deal with massive increases in infected patients.

We have seen what the combination of high Rₒ, high mortality rate, and limits on healthcare facilities can do in Wuhan, Italy and Iran.  The mortality rate in these places rose well above the expected mortality rate because a triage situation occurred and many patients who could have been saved were abandoned because of the overwhelming number of desperately ill people. Those examples make it clear what can happen when little is done to defend against the spread of the disease. 

The tricky thing is that there are really no half measures that one can employ to control contagion.  The usual recommendations of washing hands and covering your mouth when you cough are simply not enough to limit the spread of something with such a large Rₒ.  And the risk of creating a situation like those mentioned above is too high.  The only real solution until all of the cases are known and tracked is isolation and social distancing.

The sad fact is that these extreme measures, though certainly justified and necessary, will necessarily cause widespread hardship.  A world recession of unknown depth and duration will certainly occur.  I hope that it will bring out the better angels in our human nature and teach us to care for one another and this fragile earth.  Perhaps it will be the wake up call we need?

Economic Effects of the Coronavirus Pandemic

With much of the world taking dramatic measures (lockdowns, travel restrictions, social distancing etc.) to prevent or temper spread of the virus, there is no doubt that the economic impact will be significant.  Obvious victims will be the travel industry (air travel, hotels, cruise lines, tourism businesses, etc.), restaurants, bars, sports events, gyms, entertainment venues – pretty much any activity where people gather.

Many businesses will ask or insist that their employees work remotely.  But most businesses do not have that flexibility.  It is difficult to do a construction job remotely, or landscape work.  Most blue collar or service jobs will either continue to be done as before with whatever risk that entails, or the work will be suspended with the consequent layoffs and loss of income.

Initially, the worst damage will occur in the businesses mentioned in the first paragraph.  If the restrictions stay in place long, this will cause many of these businesses to at least temporarily lay off personnel.  Additionally, there will be many small business owners whose businesses have had their revenue dramatically curtailed.  All of this will have a negative feedback effect of causing less spending in general.  Once consumption rates start to fall, all businesses will feel the effects, as consumer spending is what drives the economy. 

It is difficult to predict how far all of this will go.  It will depend primarily on the length of time that extreme measures are in place.  However, what is clear is that the first negative effects will not be felt uniformly across the populace.  Those who have guaranteed salaries, and especially those who can continue to work remotely, will essentially be untouched initially (other than having their stock portfolios temporarily reduced!).  But people who work an hourly job or whose small business depends on the normal circulation of people, will be hit hard.

It would be wise for congress to target any aid packages to the people who are hit early and hardest, and not to institute a general stimulus like a payroll tax.  Unemployment pay, sick leave and outright tax reductions to those who are either laid off or those whose businesses lose money should be the first priority. 

Bailing out industries like the airlines, cruise lines, and other major industries with political clout should be done very carefully as they are in a position to recover better and more quickly than individuals or small businesses.  They will pass their woes onto their employees through layoffs with little hesitation, and their losses will typically only temporarily inconvenience their shareholders and lower their stock price.

The fair way to manage this crisis would be for those of us who are not impacted financially to share our good fortune with those who suffer significant effects.  Ideally, this would happen through generous, non-governmental transfer, however, there is no good way to accomplish this and it is unlikely to happen.  The next best way would be for the government to institute a higher tax on high incomes for a short duration and find a way to identify those who have legitimate claims (perhaps by comparing taxable income year over year or employment status) and make the funds available to them.