The Weekly Sift

It’s not going to happen soon or fast, but maybe the process begins by June.

Sadly, any serious article about restarting the economy has to begin by brushing aside the misinformation coming from the White House.

Disclaimers. The economy cannot be restarted safely any time soon.

It won’t happen on Easter (as the President was envisioning Tuesday, but has since backed off of). We won’t even reach the peak daily death total by Easter (as he predicted yesterday). If we’re lucky, we might see the daily new-cases totals peak by then, but deaths trail diagnoses by at least a week. (Italy’s new-cases peak was March 21. Deaths might or might not be peaking now.)

Public health experts agree that certain conditions and capabilities need to be in place before it will be safe to relax social distancing practices, open non-essential businesses, or allow people to start congregating. Those conditions and capabilities aren’t in place now and won’t be for at least several weeks, and probably longer. Trump’s notion that the country will be “well on our way to recovery” by June 1 seems wildly optimistic.

The talking point that shutting down the economy to stop the virus is “worse than the problem itself” (which Trump tweeted a week ago yesterday) is nonsense. COVID-19, unchecked, could kill millions of Americans (which Trump finally admitted yesterday: “Think of the number: 2.2 million people, potentially, if we did nothing.”) The idea that the economy might putter along normally while people are dying in those numbers is just absurd. (I think of this as the Masque of the Red Death theory.)

The supporting talking point that “You are going to lose a number of people to the flu [i.e., coronavirus], but you are going to lose more people by putting a country into a massive recession or depression” is likewise nonsense. Not only won’t a depression kill millions of Americans, the effect usually goes the other way: Lower economic activity means fewer overall deaths, mostly because traffic deaths and heart attacks go down.

We find that in areas where the unemployment rate is growing faster, mortality rates decline faster. So during the Great Recession in the U.S., we saw increases in the unemployment rate of about 4-5 percentage points, so that translates to about 50,000 to 60,000 fewer deaths per year

Smithsonian magazine looked further back and found that “The Great Depression had little effect on death rates.”

Prerequisites. OK, now that the decks have been cleared of some widely distributed bad information, we can start talking sensibly about how the economy restarts

Let’s start with the prerequisite conditions. Dr. Thomas Inglesby of Johns Hopkins listed five:

• The number of new cases starts going down over time.
• The health system can quickly and reliably test people who may have been exposed to the virus, even if their symptoms are minor or non-existent.
• Caretakers have a sufficient supply of masks and other protective equipment.
• Hospitals have sufficient resources: ventilators, ICU beds, etc.
• Systems are in place to trace the contacts of any new cases.

These five conditions are consistent with what Anthony Fauci and other public-health experts have been saying. Together, they paint a picture of a South-Korea-like containment: The virus hasn’t been eliminated, but the public health system has identified and isolated almost everyone in a region who is infected. As new outbreaks happen, they can be quickly found and traced, so that the newly infected can also be identified and isolated. Moreover, public health workers have the means to protect themselves, so that a new virus outbreak won’t break the system.

It should be obvious that those conditions don’t exist now. Even in New Rochelle and Seattle, early hotspots that took early action, the optimistic story is that the rate of increase in cases is down, not that the number of cases has actually peaked. (The curve is being bent sideways rather than bent down.) Some parts of the country, particularly rural areas, have not seen large numbers of cases yet. But their numbers are increasing and none of them have the virus contained in the way the experts envision. Tests are not as rare as they were a week or two ago, but the number needed has grown to stay ahead of the number provided, so they still are not plentiful. Better and quicker tests have been developed, but are still not widely available.

Perhaps the best evidence that ventilators and masks are scarce is that Trump has stopped denying it and started finding other people to blame for it.

It’s worth pointing out what’s not on this list: a vaccine or a magic anti-viral treatment that changes the whole nature of the struggle. Such advances will happen eventually, but almost certainly not in the next few months, and maybe not for a year or more.

First steps. So it’s not happening tomorrow or next week, but you don’t have to wear rose-colored glasses to imagine a time when the prerequisites have been fulfilled. No matter how bad the pandemic gets, the number of cases has to peak eventually. Tests exist and are being manufactured in ever larger numbers. Ditto for hospital equipment. Infection-tracking systems work in other countries and could work here.

So it’s anybody’s guess how long it will take to get there, but we will get there. And what happens then?

Ezekiel Emmanuel envisions how a restarting process might go. He pictures a nationwide shelter-in-place policy lasting until about June (except in places — are there any? — with so few cases that public-health officials can already track them all), during which he imagines achieving more-or-less the same things Dr. Inglesby described:

State and local health departments then need to deploy thousands of teams to trace contacts of all new Covid-19 cases using cellphone data, social media data, and data from thermometer tests and the like. We also need to get infected people to inform their own contacts. It would be easier to lift the national quarantine if we isolate new cases, find and test all their contacts, and isolate any of them who may be infected.

The national quarantine would give hospitals time to stock up on supplies and equipment, find more beds and room to treat people, get better organized and give clinical staff a respite to recuperate for the next onslaught of Covid-19 care. Without these measures, any Covid-19 resurgence would be far harsher, and economically damaging.

Whether all that happens by June or not is debatable. But even with those capabilities in place, the restart happens gradually. Nobody flips a switch or makes an all-clear announcement.

The first people Emmanuel would send back to work are those who have recovered from the virus and provably have anti-bodies to resist reinfection. And even they would need some rigorous training in safe working procedures: frequent hand-washing, avoiding unnecessary contact with others, etc.

Next, low-risk parts of the population could be allowed to congregate, while higher-risk people continue to shelter in place: Colleges might be allowed to hold in-person summer sessions. Summer school, camp, and daycare for K-12 children could be attempted — with ubiquitous testing to spot any viral resurgence.

If that works — it might not, and then retreats would have to happen — public venues could slowly start returning to almost-normal: Offices, libraries and museums, and bars and restaurants could re-open, but with reduced occupancy limits. (I heard a Starbucks executive interviewed on CNBC. He described the gradual reopening of Starbucks outlets in China: First take-out only, then dine-in with one person per table, then dine-in with at most two people per table.)

This is hardly a let-it-rip vision, and I think that it ultimately relies on some kind of treatment or vaccine developing: The economy isn’t completely closed down, but limps along for a year or so until medical developments rescue it.

Herd immunity. Thomas Friedman has tried to popularize a more ambitious opening envisioned by David Katz, who IMO gives way too much credence to the economic-contraction-will-cost-lives theory. The argument here is to focus on protecting the vulnerable (mainly the elderly), while letting the less-vulnerable behave more-or-less normally.

Even here, though, the same ideas show up: A period of lockdown, during which ubiquitous testing and research give us a much better idea of who has the virus, how it spreads, and who the vulnerable really are. (Some young people are dying too.) There is, I think, too much optimism about how quickly this period could be brought to a close. (Katz proposed two weeks, which is already about to expire without the kind of testing availability his plan needs.)

Once the vulnerable are sequestered — how you keep vulnerable parents away from their virus-exposed children and grandchildren is never specified — the virus spreads more-or-less harmlessly among the rest of the population, resulting in ever more recoveries with corresponding immunity. (We’re not totally positive immunity happens or how long it lasts, but it’s a reasonable theory.) The ultimate result is a general population with enough herd immunity that the virus no longer spreads like wildfire. As time goes by, then, more and more of the vulnerable can return to society.

Science Alert’s Gideon Meyerowitz-Katz dissents on this view: Herd immunity requires something like 90% of the population to be immune, and 20% of COVID-19 infections are serious enough to require hospitalization. So if you picture even the minimal overlap, about 10% of the population winds up being hospitalized. That will break the health-care system, even if it manages to save almost everybody — which it probably won’t.

So again, I think some kind of treatment or vaccine has to appear before the economy gets back to hitting on all cylinders.

Summing up. In every re-opening vision I’ve seen, conditions more-or-less like Dr. Inglesby’s have to be met first, and it’s hard to picture that happening much before June. By then, the $1,200 checks the government is sending out will have been used up long ago, so another trillion or two or three will have to be spent, both to keep people eating and to supply the public-health system with what it needs to get through the crisis.

And there’s not going to be an everybody-come-out-now announcement. Re-opening will happen slowly, and probably in fits and starts. Some things will reopen too quickly, start a new outbreak, and have to close again. Some new habits will have to continue for a long time, and maybe we will never go back to washing (or not washing) our hands the way we used to. Cubicle-farm offices may never reopen with the same density. Business travel may never recover. Working from home may become permanent for many jobs, or working-from-home augmented by rare trips to the home office.

When will we be able to pack into stadiums again? Or elbow-fight for armrest-space in theaters? That will probably have to wait for a vaccine, which is at least a year away.