COVID-19 Intermission - Halftime Report
To say I'm ambivalent about the current state of affairs would be an understatement. Like many, I'm feeling doubts and anxieties about how this all plays out. And also like many, I have a lot of time on my hands to think about it. We really don't know at this point where this is all going, which is scary for a civilization that thrives on data, predictability, and exercising control over nature to satisfy our wants and desires. Now, a little virus has thrown all of that into doubt.
Anyway, I'm going to take my ambivalence and copious free time and use it as an opportunity for some intellectual self-reflection. For that, I've decided to record some thoughts on where I stand right now in mid-April 2020. I'll leave this article as a record so future-me can return in a year or two when this over and see how accurate or off-base these observations turned out to be.
About those Doubts and Anxieties...
First, I've written a lot about the importance of trusting expertise (here, here, here, and here), especially when it comes to climate change. I remain convinced that we ignore it at our own peril. That means my default is to always provisionally defer to expertise, especially when the experts know more than me. And by the way, that should be the case almost all of the time, not just for me, but for everyone. The point of this approach is to avoid letting personal ideologies and biases cloud reasoning. That leads to sloppy thinking which ends up camouflaged by motivated reasoning.
That's the theory, anyway. In practice, I must confess that I've struggled mightily to apply my own theory this time. I feel my intuitions pulling one way, while my brain is pulling another. It turns out intuitions can be harder to overcome than I thought, a classic case of the tension between theory and practice.
About that intuition: For the last two months, as the situation has deteriorated, my intuition has been telling me not to worry about it. It'll blow over. This despite the increasingly frantic warnings from medical professionals that this was going to be a huge deal for everyone and not just the Chinese in Wuhan. And you know what? Up to now, those professionals have repeatedly been right, and my intuition wrong.
So, duly noted.
And yet...a good portion of the world's economy has ground to a halt, the consequences of which we don't yet fully understand. It's like we all fled to the beach to escape a massive earthquake only to see a tsunami approaching in the distance.
The earthquake is still rumbling, and the wave is coming. Where do we go from here?
We're almost certainly headed into a deep recession, perhaps even a depression. That's what keeps me awake at night. I suspect the 16.8 million Americans (and counting...) who have applied for unemployment benefits so far over the last month are also tossing and turning through some sleepless nights. Where do we go after the pandemic abates? This, not the likelihood of getting the coronavirus, is what troubles me most. Even accepting the expertise of medical professionals to guide us through the pandemic with a minimal of human suffering, we're looking at an economic crisis of terrifying proportions looming on the horizon. I know I'm not alone in that fear. The epidemiologists can't save us from that.
That brings me to the part I've struggled mightily with. The magnitude of the international response to the pandemic (strict confinement and a temporary curtailment of civil liberties) versus the actual numbers of cases we've seen. As of today (11 April 2020), out of a world population of 7.53 billion people, there are 1.76 million infected and around 107,000 deaths. Of course, those numbers are probably much higher, but how much higher? Let's say the actual figures are 10 times higher, say, 17.6 million infected and 1,070,000 deaths. If the world's population is 7.53 billion people, that means around 0.23% of the world's population has been infected and .01% killed. Remember, that's assuming the numbers are 10 times higher than current reporting says.
Look, I understand there are so many variables we don't know yet, so a cautious approach is warranted. We don't know much about the virus. We don't know how long the current outbreak is going to last or how many people will eventually get infected. We still don't know if it's going to come back seasonally. We don't even know yet how many people have actually been infected but not counted. We only know of those cases that required medical attention, so even my inflated numbers may turn out to be underestimated.
Right now, the denominator (number of infected) is smaller than it should be because only those with severe symptoms are seeking medical care and getting tested. Only they are getting counted. The numerator (number of deaths) we know with more certainty, and that will continue climbing until the pandemic ends. It is quite likely tens of millions (or more) end up getting the virus, but are either asymptomatic or only experience mild symptoms. As such, they don't show up on the statistical radar right now.
If that's the case, once we get a better count of those infected with the virus but never counted in official statistics, then the fatality rate won't end up between 2-3.5% as it seems to be now, but around 1% or even lower (Source). That's actually good news. It means that the virus, as infectious as it appears to be, is manageable with a little foresight. We're still looking at a higher fatality rate than the seasonal flu (0.1%), but it's not catastrophically higher.
In fact, the evidence is showing that as we get more clarity on the number of infected, the estimated final fatality rates will continue dropping. Early estimates showing a range of deaths between 200,000 and 1.7 million in the United States have continuously been revised downward, with that latest estimates predicting around 81,000 deaths. I expect (and hope) this number will drop even more in the coming months. This is a good thing but shows that modeling is only as good as the data. We're learning and adjusting in real-time. Another good thing is that the modelers are constantly tweaking their models to reflect newer and better data. This gives us more clarity, which can, in turn, guide our future responses. It also shows how far from the worst-case scenarios we can get by implementing various mitigation strategies.
Can we say the same about the economic impact? A deep recession or a depression that long outlasts the pandemic will bring its own cost in both physical and mental well-being. That's something I think the finger-wagging social distance police on social media don't understand when they're scolding people for wanting to sit in a park on a sunny day.
Yes, regular working folks realize they could possibly get sick and that the illness could possibly be dangerous. They're not blowing it off. Yet that awareness is often countered by the grim fact that many of them are now definitely unemployed and unable to do anything more than sit at home and worry about how they are going to pay the bills. The same goes for small businesses that can't afford to shut down for 6-8 weeks while we sweat out the virus. COVID is a possibility, but economic hardship the reality for millions.
Maybe if America had a more effective and coherent federal response, as I've seen for the most part in Germany and France, then these anxieties could be lessened. Unfortunately, we don't, and there's no reason to think anything's going to change soon. You can't elect officials who despise the very idea of a robust federal government and then expect that same government to function efficiently in a crisis.
We'll have to continue depending on the efforts of state and local governments. Therefore, for millions, the very real prospect of financial ruin outweighs the much more remote possibility of dying from the coronavirus. I know it's taboo to say anything that questions the long-term viability of the current draconian approach, but it's what a lot of regular people outside the Twitter-sphere are thinking, including me.
So, where do I stand after saying all that? Yes, I have doubts, but I'm aware they are the doubts of an average Joe, and so probably not worth two shits. Even so, average Joe or not, the things I'm worried about are the same ones that millions of Americans are also worried about. This will need to be addressed.
In the meantime, I'm going to maintain a stance of skeptical deference to the expertise, working to follow my own sound advice by listening to the experts while reining in my wayward intuitions. Perhaps I remain skeptical about some of the current mitigation strategies, but for the moment, I'm going to give the medical experts the benefit of the doubt that they know what they're doing. They deserve that. They need that. I realize that all the skepticism, all the misgivings I just expressed above could very well be wrong. If that turns out to be the case, I want this essay here to remind me.
On the other hand, if my doubts and fears end up confirmed, I'll know I wasn't crazy for thinking against the grain. I'll be honest, I'd rather be wrong and sitting in a sunny park a year from now than right and living through another weeks-long confinement. I understand we're in uncharted territory right now, and we need to be rowing together to get to the other side as quickly as possible so our lives can return to some semblance of normal.
That said, my deference to expertise is not open-ended, but results-driven. I'm operating under a couple of assumptions.
First, governments will learn from this experience and put in place adequate resources (testing kits, masks, ICU surge capability, expedited vaccine research, etc.) and procedures that both save lives and livelihoods. They should never get caught with their pants down again like they did this time. When an outbreak happens, those resources get deployed and life goes on, albeit at a slower pace.
By incorporating lessons learned, and prepping for future contingencies, future outbreaks should be less disruptive to the economy. They'll have to be. We can't just stop the world for two months every time this virus appears so we can cower in our homes and watch Netflix. If the authoritarian Wuhan lockdown model is going to be the playbook for the next few years, we're going to suffer tremendously both physically and emotionally, whether we get sick or not. There has to be a better way, and I'm confident we'll find it.
At the same time, we need to get more comfortable with risk. It looks like we're going to be living in a corona world for the foreseeable future. We can mitigate and adapt to the virus, but we can't eliminate the risk that it brings. Accommodations will have to be made, balancing our health and economic interests with our civil liberties. Those are all priorities for me, and I suspect they are for you too.
My last assumption is that his first outbreak will be the worst, and that going forward we'll be more ready to deal with it than we were this time. People will die, but far fewer. We won't be able to save them all unless we want to live in a police state under a benevolent form of martial law. We would be alive, true, but not living, not really, and therefore no longer free.
Is that what you want? I don't.
Risk is part of life, and we already live with it in many ways. We could eliminate most of the 39,000 traffic deaths every year by reducing the speed limit to 20 miles per hour. But we won't. Around 38,000 people die from guns every year. Yet we've learned to live with that because we as a society prioritize certain Constitutionally guaranteed liberties. Those deaths are background noise that we don't think about unless they impact us directly.
And so it will eventually be with coronavirus. We'll prepare, we'll mitigate, we'll triage, and we'll adapt, but then we'll get on with our lives as best we can.