It’s A Long Road Back To Normal
For the next month or so, the peak of hospitalizations and deaths from COVID-19 will roll across the country. Hopefully, sometime in May we will finally see cases reach a relatively manageable level for an already exhausted medical system to deal with. But when and how we can emerge from stay-at-home orders and social distancing is still an unknown. It is hard to imagine, however, that it will be a quick process.
Even South Korea, which has been by far the most effective country in containing the virus, is still seeing around 100 new infections per day. They have managed to do that with extensive and sustained testing that included the asymptomatic, impressive contact tracing, an effective quarantine system, and social distancing. Despite holding new infections at around 100 for the last three weeks, the government is still asking its citizens to stay at home and encouraging social distancing. Worryingly, the number of infections has spiked up a little in the last few days, possibly as a result of Koreans tiring of the social distancing requirements. Presently, schools are still closed until April 6 and that deadline is almost certain to be extended. And the government is still working on plans for how to bring the country back to something resembling normal. The fear, of course, is that eliminating the current precautions too soon will simply produce another outbreak with numerous hotspots and a restoration of the stay-at-home recommendation and social distancing requirements.
It seems clear that any return to normalcy will require the strategy that South Korea has already employed, but on a continuous and massive scale. Testing must be all-encompassing and nearly continuous. Contact tracing for those newly infected must be intensive and thorough. Those newly infected and their contacts must be forced to isolate. And social distancing would still probably need to continue, with any kind of mass gatherings out of the question. Masks may possibly be required when outside of the home. One potential important addition would be a blood test to check whether an asymptomatic person has already recovered from the virus and is immune for at least the near future. Another potential hope is finding a treatment that would mitigate the deadly effects of the virus. This would not be a vaccine or a cure but would ease the strain on the medical system and reduce the number of deaths.
All of the above would require a monumental effort in both production capacity and manpower. The availability of a test that provides a result in less than 15 minutes is a huge step forward. Certainly having that be available at medical facilities for those who believe they might be symptomatic will certainly be better than what we have now but will still only have limited effectiveness in stopping any spread of the virus. By now, most people are already self-isolating at the first signs of infection. Far more important is the ability to easily identify presymptomatic and asymptomatic individuals and get them to quarantine. That requires massive testing on a regular basis and the manufacturer says it will only be able to produce 5 million units of the test by the end of April.
The problem of mass testing is compounded by our dysfunctional health care system. With a predicted 30% unemployment rate at its peak, that implies that potentially more than 20% of Americans could be without health insurance. That creates an enormous, gaping hole in any public health delivery system, especially one that needs to do extensive testing. The government has promised that testing will be free but we already see cases where individuals are being charged for costs associated with the tests. For the millions unemployed, taking the test runs the risk of being quarantined and losing another few weeks to actually get a new job. There are similar issues for the millions who do not have health insurance and fear the tests will lead to incurring medical costs they can’t afford. In addition, if masks are required when being out of the home, that implies a massive increase in production and distribution, again bringing into question how those costs will be borne.
Contact tracing is yet another huge issue. It is an incredibly labor intensive project. China sent in nearly 10,000 epidemiologists to the city of Wuhan alone to do contact tracing. South Korea used security camera footage, credit card records, and GPS data from phones and cars in order to trace an individual’s contacts. That may prove much more difficult for the US with its current civil liberties laws and privacy protections. One tactic that could be somewhat replicated from the South Korean experience are the almost immediate cell phone notifications to citizens whenever new cases are discovered in their area, sometimes with specific details about the infected person’s travels and the locations where the infected person has been, including street addresses. Again, such granular information is critical to get potential contacts to self-report but also runs up against privacy protections.
Finding infected individuals and their contacts will be hard enough. Getting them to self-isolate will also be difficult. South Korea required quarantined individuals to put an app on their phone that would track their movements and fine them for violating their self-isolation. Again, that might be difficult to implement in the US. Additionally, it is hard to imagine that contacts who show no symptoms are going to be willing to also self-isolate for two weeks, especially if they are one of the millions of the currently unemployed who have successfully found a job again as the economy comes back to life.
In addition, effective decontamination systems will have be in place in lots of workspaces. We are already seeing that the low-wage workers who keep the supply chain that we all rely on to eat and live are demanding greater protections. Amazon, Whole Foods, and Instacart workers are all taking action to demand their companies do more to prioritize their safety. Those kind of protests will continue and probably grow as more of the economy comes back on line.
Our federal system is yet another impediment to some kind of return to normalcy. It is the governors who have actually determined the social distancing and isolation policies dealing with the pandemic. Some states have done better than others. Some states are farther along the infections curve than others. Even if one state manages to bring the number of new infections down to reasonable levels, it will be hard to maintain that position without some relatively intense restrictions on out-of-state visitors. We are already seeing individual states restrict out-of-state travel into their states. That will apparently continue as states begin to try and return to normal. But that will also restrict commerce and slow down the economic recovery, especially for those states that rely on tourism.
Lastly, we can be sure that the pressure from the plutocrats to restart our economy as the number of infections begins to fall will be enormous and Trump will certainly be on that bandwagon. But without those measures described above – mass testing, thorough contact tracing, and effective isolation – restarting the economy too soon will not just make it more likely that new hotspots will develop with increasing infections and associated deaths, it is almost guarantees it. At the same time, the political and economic pressures for governors not to re-implement renewed stay-at-home orders and social distancing measures once they have already abandoned them in order to keep the economy moving will be enormous. The mantra that some deaths are “simply the cost of doing business”, which has already been floated by business leaders and Republican politicians, will become the norm as infection rates drop. Similarly, as one state does begin to come back to normal, the pressure on neighboring states’ governors, who may not be as far along in dealing with the pandemic, will increase.
The bigger question is what kind of economy we can even return to. The world will be in recession. The collapse of demand will be an enormous drag. And the longer that drags on, the more likely it will be that smaller firms, especially those in the service economy, will collapse, further extending unemployment and the recession even without any restrictions in place because of the virus.
Obviously, everyone’s focus right now is simply getting through the next month or two by keeping the death toll as low as possible. And that is entirely appropriate. But I don’t think the American public is prepared for just how long getting back to anything resembling normal will actually take. It would be nice to think that the federal government is planning for this post-peak world and is preparing to deal with it, but that seems naive at this point. To effectively bring the economy back to anywhere near normal will take a massive effort in the production of necessary equipment and implementation of complicated logistics that the federal government has already been shown to be unwilling or unable to make. It will also take lots more federal dollars to help support state public health efforts. It does not help when the President constantly engages in happy talk and apparently only sees the crisis as a way to boost his electoral fortunes in November while punishing blue state voters. We are so focused on getting over this looming mountain of infections and death that we are seemingly unprepared for just how dangerous the other side of the mountain will still be and how long the road ahead still is to return to anything approaching normal. If we only had a real leader to guide us.