Will people lose faith when they find out they are expected to get the virus anyway?
Experts now agree the virus’s spread can be slowed but not contained. It will take its place among mostly seasonal respiratory infections. After a time, recurrent outbreaks will be moderated by a large number of potential carriers who have immunity from their last infection.
And then we can ask some questions. The cost to Americans of the economic shutdown is vast. What are they getting for their money? Essentially less excess demand for respiratory ventilators and other emergency care than can currently be supplied.
This demand will come largely from the elderly and chronically ill, who would be competing for these resources with the usual large number of old and ill people already suffering from acute respiratory distress as a result of routine flu and cold infections. A silver lining will be fewer cold and flu victims overall thanks to social distancing to fight Covid-19.
Some number of respiratory deaths will be avoided (really delayed since we all die) but we’ll be spending a lot more than we’ve ever been willing to spend before to avoid flu deaths. Eighty-three percent of our economy will be suppressed to relieve pressure on the 17% represented by health care. This will have to last months, not weeks, to modulate the rate at which a critical mass of 330 million get infected and acquire natural immunity. Will people put up with it once they realize they are still expected to get the virus? Wouldn’t it make more sense to pour resources into isolating the vulnerable rather than isolating everyone? Basically aren’t we really just praying that summer will naturally suppress transmission and get us off the hook of an untenable policy?
But then multiple experiments are under way. China seems to have quashed the spread beyond Hubei province and spared 99.9% of its population from infection—for now. Can China really hold off the virus from being reintroduced or re-exploding during the 18 months it may take for a vaccine to be invented and distributed?
Italy is the test case for being a day late and dollar short in voluntary social distancing—the steps people can take to reduce their risk of contracting and spreading the disease. But Italy may also be the first to emerge from the tunnel, with everyone having had their chance to get sick, and the country being able to get back to work.
Britain is wavering on what seemed a modified, limited Italian strategy. Until Tuesday, it was considering letting its health-care sector absorb as much stress as necessary to avoid a sweeping, draconian shutdown of the economy.
The U.S. may or may not be a test case of a large continental country where hot spots of contagion shock other places into buttoning up and hunkering down, curbing excess local demand for intensive-care beds. But the cost will be astronomical. Essentially we are killing other sectors indefinitely to manage the load on the health-care sector.
Understandably, politicians believe faith in government requires avoiding Italy-like scenes. But turned on its head here is the 50-year-old “QALY” revolution: the idea of measuring the burden of disease and benefit of health care based on “quality-adjusted life year,” typically valued at $50,000 to $150,000. In the present instance, the cost isn’t just medical intervention (e.g., ventilator use) but the cost of an economywide shutdown to limit the number of candidates for ventilation at any one time. I don’t know what the figure is, but the QALY value we are placing on avoiding Italy-like deaths is surely a high multiple of any figure previously considered realistic.
America’s shutdown strategy is interesting because it was not a choice that any one person or authority made. You can’t blame the NBA or Tom Hanks or Congress. Donald Trump is being pilloried for leaning against panic, urging comparisons to the flu, suggesting the stock market is overreacting. Like the bus, another reason to pillory Mr. Trump will come along in five minutes and not one of his critics will engage in soul-searching over whether he might have had a point.
Even the fuss over testing is a bit overdone. Nowhere in the world has there been enough testing to detect most coronavirus cases amid millions of seasonal colds and flu cases. This problem exists in China, Europe and the U.S. A British estimate is that 12 people have the virus for every one found by testing. In any case, testing becomes a tad mootish now if the goal is to isolate even young and healthy people.
There’s a vast gap between people washing their hands, avoiding crowds, shielding the old and using good judgment, and sweeping lockdowns and curfews. Anything government spends now will be a good investment if it prepares the economy quickly to resume its growth and healthy functioning. But there are known unknowns. Elections will be held. Politicians will stake out stands in response to the applause meter, not logic. If I could take out one insurance policy on behalf of the country, it would be this: Joe Biden should immediately name Amy Klobuchar as his running mate so she can step in if the success of his campaign so far is not so rejuvenating of Mr. Biden as it now seems.