This is part 2 of my series on the threat of COVID-19 and our response.  In part 1, I reviewed the data and came to the conclusion that the virus is a legitimate threat.  Why would I make that argument while simultaneously believing we should # RestartOhio now?  First, I’ve analyzed the data in depth and believe that it’s true.  But just as importantly, if you want to convince others, we won’t be successful trying to deny the threat.  We’ll have to convince them it’s possible to reopen in a safe fashion.

Let’s start with some good news – social distancing works.  In Ohio’s data, the peak rate of growth in new infections was on March 15 – the same day that restaurants and bars closed in Ohio.  We decelerated dramatically over the next few days with much of the decline in the growth rate occurring *before* additional measures were enacted over the following week and the formal stay-at-home order on March 23rd.  Nearly all of the benefits were obtained before the government policies were enacted.  Let me be clear, I strongly support reopening Ohio immediately, but I have no expectation that we’ll return to exactly what life was like prior to the outbreak.  I expect that business owners and managers will take steps to make the environment more safe for their employees and their customers.  The government is welcome to support that effort with science-based guidance, but everyone involved has incentives to implement cleaning protocols, contactless transactions and a host of other methods to prevent transmissions.  And before you start to argue with me about the risks, a large part of our economy is still open and it isn’t leading to out of control spread of infection.  We don’t see large outbreaks in Kroger, Walmart, Amazon, or any of the other people on the front lines of commerce.

Similarly, Sweden has taken a very hands off approach to combating the virus by banning large gatherings, but otherwise trusting that their population will be smart in their interactions with other people.  Sweden has seen rapid growth in cases and deaths, but their hospitals were not overwhelmed as modelers predicted, nor have deaths counts been as high.  Why not?  The models assume that human beings don’t change their behavior and that they continue with business as usual even as people are dropping dead around them.  As we know, human beings don’t behave like that and the very moderate, non-mandated social distancing measures have the infection under control.

Country Deaths/1M Population Cases/1M Pop
USA 193 3307
Sweden 256 2088

But Sweden has more per capita deaths than the USA already even though their outbreak began later!  Also, Sweden doesn’t have a New York City with crazy population density driving up their numbers!!!  How can you say that this is ok???

I hate it when people die, but it’s a very unfortunate fact of life.  We have to put the numbers above in context.  Since 1960, Sweden’s death rate per 1M population per year has ranged between 11,500 (1985) and 9,100 (2018).  I realize Sweden has a long way to go in this outbreak, as do we in America, but 256 deaths to one cause is 2.8% of the lowest year of deaths in Sweden’s recent history.

But these deaths are preventable if everyone just stays home!!!!!

Not really.  First, we aren’t locked down enough to fully eradicate this virus – it isn’t going away anytime soon.  Second, this is a novel virus.  As I shared yesterday, the virus spreads very quickly when allowed to flourish and it kills about 1% of the people it infects.  It will continue to spread until we build herd immunity or a we develop and distribute a vaccine or an effective treatment.  While there’s been some promising news on the treatment side lately (the drug Remdesivir), there is no guarantees that a vaccine or an effective treatment will be available in the short or medium term.  Even longer term, coronaviruses are notoriously hard to develop vaccines for – that’s why you don’t get vaccinated for the common cold.  That means the only thing we can count on is developing herd immunity, but that requires letting lots of people get infected, potentially as many as 60-80%.  The bottom line is that even with social distancing, most people will probably get this virus over time and the longer we use strong social distancing measures to spread out the infection, the more chance that mutations to the virus will make it take even longer to build herd immunity.  The best course of action is to get people infected quickly, build herd immunity and the virus will die off as it no longer has available hosts (people) to spread too.

Exactly.  Lots of people will die if we do that!!!!

Not necessarily.  What if I told you that Ohio had a group of people totaling 62.7% of our population that was safe from the virus?  One of the best and worst things about this virus is that it doesn’t attack age groups equally.  If you are under 50, you have essentially zero risk of dying even if you contract the virus.  Look at the graph below.  I’ve included the current Ohio case fatality rate based on reported data (which overstates death rates by a lot) and the estimated Ohio infection fatality rate based on our prison outbreaks (which probably still overstates by a little bit).   Of course there will be exceptions.  If you are under 50 and have underlying health conditions, you are probably still at risk.  If you’re 50-70 and in excellent health, you might be ok.

Given that we know social distancing works, we can be smart and protect the vulnerable while allowing the younger and healthier to go back to normal and get to the urgent task of building herd immunity.  When we look at this from a public policy perspective, the only goals must be:

  1. Build herd immunity.
  2. Help protect the most vulnerable.
  3. Prevent the hospitals from being overwhelmed which can cause death rates to skyrocket.

Anything else (which describes Ohio and most other places in the USA) is a massive overreach because of the incredible costs we are collectively enduring right now.  After all, only government could screw things up so badly that HOSPITALS ARE LAYING PEOPLE OFF DURING A PANDEMIC!.  The government can never have enough information about your personal risk situation and a massive blanket shutdown of “non-essential” business overrides any judgment you might have made.

We see the economic costs.  Q1 GDP decreased by 4.8%.  More than 30 million people have applied for unemployment.  Certain industries have been devastated by the shutdown and many businesses will not reopen.

Social costs are just as important, but way underreported.  Families are separated.  Children (who aren’t at risk) are isolated from their friends.  People are prevented from experiencing the sports, hobbies, and activities that they love.  The faithful are not able to worship the way they wish.  People are in pain because they can’t get dental or medical services/procedures done and there will be a long backlog even after they open back up in Ohio tomorrow.  Many of the things that make life worth living are on hold right now and none of it shows up in GDP statistics.

Finally, we have the impact to our civil liberties.  These orders do something that America has never done in any epidemic – we have restricted the healthy as much as we have the sick.  Our constitutional rights at both the state and federal level are being violated by these orders.

All of these costs are massive and yet the benefits are elusive.  Flatten the curve does not mean the virus goes away or that we end up with fewer deaths.  It means we just spread them out over a longer period of time which only increases the costs of our shutdown efforts.

In spite of the risks, we can use non-mandated social distancing to protect our most vulnerable even as we open Ohio and the rest of the country now.  Governor DeWine and Dr. Acton – heed this call, follow the data and get it done.  Open Ohio now.