The premature lifting of lockdown
How many people will die because lockdowns are lifted prematurely? That’s the first question going through my head as I think about the logic of yesterday’s post on the coronavirus lockdown. No sooner had I written that post predicting that lockdowns would be lifted prematurely than a chorus of people yesterday – including US President Trump – began clamouring for exactly that outcome.
The whole thing makes me uncomfortable. I think it’s a mistake. I think many more people will get sick and be permanently scarred as a result. Many others will die. But I also think it’s going to happen.
Hope and fear
I don’t know how to start this post because it’s not about economics or financial markets. It’s about infectious disease. And I’m not a scientist. And I don’t have any expertise on viral epidemiology.
At the same time, I recognize that the vast majority of Americans are in the same situation. And so that makes all of us dependent on those who do have the expertise in order for us to act appropriately now that we are faced with the Covid-19 pandemic.
Until now, everything I have heard from experts tells us that social distancing, lockdowns and quarantines are the way to go. This buys time by reducing the rate at which the deadly coronavirus can spread, we’ve been told. And that’s important in allowing an effective vaccine to be developed and to prevent our healthcare systems from being overwhelmed. It also helps to combat fear. Fear is a powerful emotion. And if the virus spread out of control, fear would take over. And that could be very destructive as we have seen from hoarding and in so many other ways we can’t calculate. Finally, China has shown us that this method works as they have allegedly stopped virtually all domestically-transmitted cases of the Covid-19 virus.
But, as the economy crumbles, the advice of viral epidemiologists is coming under assault. And that’s because hope is also a powerful emotion. And the hope that we can relax the lockdown and social distancing controls in place comes from a desperation borne out of the crumbling economic environment and the fear that it engenders. Even I used that word yesterday when I talked about the New York Times essay by David Katz. I wrote that:
What makes me uncomfortable is the thought that, in lifting the lockdowns, we would be choosing the economy over human lives. But Katz’s essay suggests that this may not be the right way of looking at the choices. And so that gives me reason for hope.
Despite my hope, I was uncomfortable with what Katz was saying. And so I dug a bit deeper. And unfortunately, having looked at Katz’s position a little closer, I have come to the conclusion, it’s unworkable and a recipe for disaster. But I still think that’s the direction in which we’re going to move. And while I hope for the best, I am prepared for the worst.
Epidemiology and expertise
David Katz is a food scientist. And as a specialist in internal medicine and nutrition, he recommends a holistic approach to dealing with chronic health ailments.
In that capacity, he has written on how nutrition can be a defining part of combatting chronic public health problems in a book entitled, “Jekel’s Epidemiology, Biostatistics, Preventive Medicine, and Public Health“. And, his byline in the New York Times Opinion piece called him “president of True Health Initiative and the founding director of the Yale-Griffin Prevention Research Center.”
So, on paper, to average Joes like you and me, he seems like another viral epidemiologist, credentialed and qualified to give advice on how to respond to this epidemic. But, is he?
The first tell that he may not be was this tweet from the Yale School of Medicine.
David Katz is not academically affiliated with Yale and has not held an academic appointment here since 2016.
— Yale School of Med (@YaleMed) March 23, 2020
Yale was pointing out that Katz may have been “the founding director of the Yale-Griffin Prevention Research Center” but that he was not associated with Yale today. And, the clear inference is that they don’t want to be associated with him either.
This was in response to a tweet by Gregg Gonsalves, who works at Yale “focusing on operations research/epidemiology for infectious disease” as he puts it on his Twitter bio:
An epidemic of armchair epidemiology is happening @NYTimes, first @DrDavidKatz, now @tomfriedman decide to opine on the dynamics of epidemics and their control, when neither of them (nor John Ioannidis) work on these topics. 1/
— Gregg Gonsalves (@gregggonsalves) March 22, 2020
Gonsalves and three colleagues wrote a rebuttal to Katz’s column, saying:
We take issue with Dr. David L. Katz’s suggestion that the global community is overreacting to Covid-19. He favors letting the pandemic run its course, but somehow “walling off” the most vulnerable. He argues that his strategy would preserve the global economy, while stemming deaths from Covid-19. We disagree.
First, it is not yet known who all of the most vulnerable people are. We believe that it is easier, quicker and more efficient to reduce transmission over all than to permit high levels of transmission in the community but somehow keep it from afflicting susceptible people in our highly networked world.
Second, it is likely that more intense transmission among younger people, who Dr. Katz suggests should be freed of most social-distancing restrictions, would result in many more of their deaths, especially as hospitals become overwhelmed.
Third, allowing the virus to spread uninhibited across a wide swath of our country might eliminate any hope we might have of snuffing out viral transmission into a new respiratory virus season next winter.
This is the advice I have been hearing over and over. And so, I can only conclude that Katz is providing a viewpoint that we want to hear but that is not backed up by the scientists closest to the field of infectious epidemiology.
Outcomes
It’s close enough for President Trump. He is going to take that ball and run with it.
WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF. AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!
— Donald J. Trump (@realDonaldTrump) March 23, 2020
Here’s how the Washington Post is reporting this story:
President Trump, under growing pressure to rescue an economy in free fall, said Monday that he may soon loosen federal guidelines for social distancing and encourage shuttered businesses to reopen — defying public health experts, who have warned that doing so risks accelerating the spread of the novel coronavirus or even allowing it to rebound.
“America will again and soon be open for business — very soon,” Trump said at the daily White House news conference. “We cannot let the cure be worse than the problem itself.”
As he watches stock prices plummet and braces for an expected surge in unemployment, Trump has received urgent pleas from rattled business leaders, Republican lawmakers and conservative economists imploring him to remove some of the stringent social distancing guidelines that he put in place for a 15-day period ending March 30, according to several people with knowledge of the internal deliberations.
Also see “Trump Weighs Easing Stay-at-Home Advice to Curb Economic Rout” from Bloomberg News and “Before Trump called for reevaluating lockdowns, they shuttered six of his top-earning clubs and resorts“. The key paragraphs in the second piece are these:
In his unprecedented dual role as president and owner of a sprawling business, Trump is facing dual crises caused by the coronavirus. As he is trying to manage the pandemic from the White House, limiting its casualties as well as the economic fallout, his company is also navigating a major threat to the hospitality industry.
That threatens to pull Trump in opposite directions, because the strategies that many scientists believe will help lessen the public emergency — like strict, long-lasting restrictions on movement — could deepen the short-term problems of Trump’s private business, by keeping doors shut and customers away.
Clearly, Trump feels the economic pain acutely. So, when business owners are telling them that this lockdown is killing their businesses, he understands exactly what they’re saying. And that’s going to pull him away from the viral epidemiologists and toward people like David Katz, who give us hope we can have our cake and eat it too.
Consequences
But, unfortunately, all signs point to this being a fairytale. Italy is the model of what to expect in the US. And given their total lockdown and America’s flirtation with a premature lifting of lockdown, it will likely be much worse in the US. In fact, a WHO official said today that’s exactly what she expects.
The World Health Organization said on Tuesday it was seeing a “very large acceleration” in coronavirus infections in the United States which had the potential of becoming the new epicentre.
Over the past 24 hours, 85% of new cases were from Europe and the United States, WHO spokeswoman Margaret Harris told reporters. Of those, 40% were from the United States.
Asked whether the United States could become the new epicentre, Harris said: “We are now seeing a very large acceleration in cases in the US. So it does have that potential.
“…They (the United States) have a very large outbreak and an outbreak that is increasing in intensity,” Harris added.
My view
Unlike with economic topics, I don’t have a strong view here. I am unqualified to present one. But, I can tell you that everything I am hearing suggests that the lockdown and quarantine approach is the right one. And I am uneasy about lifting it early because what I understand is that it could lead to a mushrooming of cases.
I would use a war analogy here, with Covid-19 as the enemy. The US Civil War was the most lethal in US history. The casualties were horrific. Combat and non-combat deaths are estimated at around 655,000. And that’s in a country where the 1860 US Census calculated that the total population was only 31.4 million. That’s 2% of the population dead.
But, in today’s world, where medicine has advanced, a lot of those people’s lives would be saved. Evidence from casualties in the US wars in Afghanistan and Iraq show this. And that’s good. But, it’s not the whole picture. Someone without his legs or without an arm or with vital organs severely damaged is still a war casualty. And their life is forever altered.
We act like a body count is all that matters in terms of the human toll of this pandemic. But, all evidence suggests many healthy, young adults are developing the virus, beating it, but living with permanently reduced lung capacity and impaired health. Yes, the sick and the old are at much greater risk of death. But, is that the only risk that matters? Again, I am not an epidemiologist. I can’t tell you. But everything I have read suggests we are underplaying the health risk to healthy adults of contracting coronavirus.
Given what Trump has now said about lifting the lockdowns, I think my prediction about backside policy responses yesterday makes sense. We will see lockdowns lifted prematurely and then we’ll have to live with the consequences of that decision, now and next year as well, when the virus may re-emerge.
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