Lock-Down... Yes, For 18 Months... No!
So many are taking an absolute, extreme view of what is happening and why. Based on my review of online opinions, the sentiments are either close everything down forever and crater the world economic dynamics or do nothing and get back to business as usual and let the old people die. These are extremes that only incite fear, confusion, and, eventually, anger.
Up To Date Covid-19 Data
First, if you want data, here is an article with a lot of up-to-date data compiled in one spot: https://medium.com/six-four-six-nine/evidence-over-hysteria-covid-19-1b767def5894. I am not going to regurgitate everything, so if you want to understand the global trends, please read it.
Overall, the author does a good job of distilling and interpreting the raw data; however, there is some data from very suspect sources, there are some big leaps in his conclusions, and the author fails to provide critical context (or data) for some of his anecdotal support information (more on this below).
Regarding the raw data, the bottom line is Covid-19 is here; it's spreading, and if left unchecked it will infect many and overwhelm our hospital system as it has done in many European countries. If we do not address the spread, many communities will be waiting on the military -- or some other task group -- to bury bodies in mass graves.
Managed Infection Rate
There is no reasonable scenario where we stop all deaths from Covid-19. People will die, and, statistically, the majority of them will be 60+ . This is a fact we must accept. Contrary to what some may think, shutting down the World -- or the US -- to stop the deaths resulting from Covid-19 is not the goal. The goal is to carefully manage critical care cases so our healthcare system (and broader social construct) does not crumble.
Many have seen the generic 'flatten the curve' graphic, but the study completed by the Imperial College COVID-19 Response Team (found here: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf), which underpins that generic graphic, includes the graphic below.
As you can see, many people will get critically ill in every potential response scenario. However, in the response scenario that includes case isolation, household quarantine, and general social distancing measures (the light orange line), peak case load is not expected until the fall. Why is this expected, and why is it important?
This profile is expected because Covid-19 is not heat-resistant and is expected to naturally die off as the warm weather arrives, but this also means there will be another large spike in infections when the cold weather returns in the fall.
So, the logical (and seemingly prevailing) strategy is to manage the infection rate until weather becomes our friend and prepare for the impending infection surge in the fall.
What's The Gap?
One may ask, "if we are all going to get sick anyway, why not just get it over with?" The short answer is time. The solid red line in the graph above (critical care bed capacity) is not static. It is the number of critical care beds in the United States, currently. We can change this number, so we can meet the need driven by Covid-19, but we need time.
According to an American Health Association 2015 annual survey (dated, I know), the United States had 540,668 staffed beds and 94,837 ICU beds (14.3% ICU beds/total beds). Of those ICU beds, 46,490 were medical-surgical beds, 14,731 were cardiac beds , 6,588 were other beds, 4,698 were pediatric beds, and 22,330 were neonatal beds.
Given, ~27,000 ICU beds are for children and infants (not useful for the average Covid-19 patient), and the fact that a hospital operates at ~70% capacity, today, the United States can absorb ~20,000 critically ill Covid-19 patients nationwide.
With a population of ~330,000,000, the United States needs ~400,000 to 900,000 critical care beds to treat the expected number of critical Covid-19 patients nationwide.
Addressing The Gap
Two days ago the President of the United States enacted the Defense Production Act, which allows the government to commission private companies to build and supply products for federal government efforts. Without having a part in the administration's discussions (and having no 2nd, 3rd, or 4th hand knowledge of the discussions), one could resonably assume a large part of the reason for enacting the DPA was to address the critical care bed gap mentioned above.
Ensuring the nation's hospitals have the space and equipment to treat the inevitable number of Covid-19 patients is critical to staving off panic and true fear.
Below is a modified version of the graphic from the Imperial College COVID-19 Response Team that was show above. In this version, there is a gradual step-up of the critical care bed capacity over time.
TO BE CLEAR, the modification below is not based on actual manufacturing capacity assumptions. This is my attempt at a visual for the strategy being employed and the rationale behind it.
I suspect the United States can ramp up capacity a lot more quickly than my graphic shows. More than that, it seems reasonable to conclude that once a 60 to 90 day lock-down is completed, the healthcare system would be in a position to allow the rest of society to "get back to normal." Normal does not mean no more Covid-19 infections, it just means we have the capability to handle the resulting critical care cases.
Buying Time: Brute Force Or Finesse
In the Medium article provided above, the author likens the US response to that of China and suggests another way to arrest the rate of infections is the strategy of South Korea, which did not close businesses and social gatherings.
While I agree (a) China and South Korea deployed two seemingly different approaches to reducing the rate of infection and (b) both can be effective, the author left out some key context and information of the actions taken by South Korea.
First, China was able to stop the initial rates of infection by quarantining millions of its citizens in a drastic way. Millions of people were locked in their houses/condos, and those that did not obey were effectively isolated by jailing. Obviously, isolation is effective, and it is the strategy being used by the US and many other countries.
If you want to understand the South Korean strategy, here is a great article: https://thebulletin.org/2020/03/south-korea-learned-its-successful-covid-19-strategy-from-a-previous-coronavirus-outbreak-mers/. If you are like me and question informational sources check out the publications board; they are serious nerds -- said with love and respect. Also, here is a wiki profile on the organization: https://en.wikipedia.org/wiki/Bulletin_of_the_Atomic_Scientists.
Fundamentally, the South Korean strategy was a finesse strategy that focused on understanding and controlling people flows, instituting widespread testing, and leveraging vast surveillance capabilities. In addition, South Korea learned from the (MERS) epidemic and instituted systems and task forces, based upon their learning. Bottom line, South Korea was/is prepared and equipped to address and epidemic.
To be fair, while China instituted strict lock downs in the initial hot spot of Wuhan, there is considerable evidence China moved to a more finesse strategy in other areas, as they became more aware of the infection rates, symptoms, and Ro values.
Why Is The US Following China's Brute Force Strategy?
So, if there are two effective strategies, why is the US employing the more draconian strategy? The short answer is that it's the only strategy available right now. In the US we do not have the notoriously widespread surveillance that is employed in South Korea. Even more, our government does not have the authority to use domestic surveillance to track specific individuals, except in very specific instances.
Aside from the surveillance aspect, the US has failed at deploying widespread testing, and without it, we cannot begin to manage people flows on a micro level. So, that leaves the only option as managing people flows on a macro level , i.e. statewide and nationwide lock-downs.
The United States CANNOT use the same strategy as South Korea because the infrastructure isn't in place but, more importantly, our constitution prevents it.
So What Now Does All This Mean?
Flattening the curve is vital, and the only strategy available to the US is lock-down -- we aren't setup to do what South Korea did. Lock-down is only to buy time to to build up our critical care bed capacity. Based on the results in China, lock-down should't be required for longer than 60 to 90 days.
Until we build up our infrastructure AND deploy widespread testing, we are stuck in a nationwide timeout.
Keep in mind, if the strategy taken by our federal, state and local governments is effective, lock-down will feel like a big waste of time! That is what we should all want.
Want to Read More About What I Think?
Here are my thoughts on how the Government can facilitate a 60 to 90 day lock-down: Covid-19 - What The Government Should Do.
Curious what you should do during a lock-down? Take a look at my post here: Covid-19 -- What You Should Do.
Have a business and want some ideas on what to do during lock-down? Here are my suggestions: Covid-19 - What Companies Should Do.
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MORE INFO:
Covid-19 - Historical Perspective
Covid-19 - Why An 'Only Quarantine Seniors' Strategy Will Not Work