How To Think About Re-Opening

If each infected person is contagious for a month and infects just one other on average, the health care system can cope.

People will keep dying of COVID at the rate they now are — which is awful — but if you need to access the health care system, whether for COVID or some other reason, it will be there for you.

If, on average, each infected person person infects two others — as early models imagined might be the case — then it quickly becomes a nightmare.

Think of it like money.

A dollar growing at 0% interest a month remains $1.  It never goes away, but it doesn’t grow, either.

That same dollar growing at 20% a month — 1.2 people infected instead of just one — grows to $8.91 in a year.

A dollar doubling every month — two people infected by each infectious carrier — grows to $4,096.

So that’s quite a difference — $1 versus $8.91 versus $4,096.

Staying away from people if you’re infectious — or because they might be — is how we keep the virus from spreading.

(Also: wash your hands after you touch anything an infected person might have touched.)

If the whole world could do this perfectly for a month, only bats would be left with the virus.  (More or less.)

Look how well Israel is faring.  The same population as New York City, but 116 deaths versus 12,000.  Responses matter.

Those who mock cautious doctors and governors for raising alarms about “the health care collapse that never happened” — New York may never need anywhere near 40,000 ventilators — should imagine 4,096 times as many hospitalizations.  Or even 8.91 times as many.

So it’s easy to say, “we should all pack the churches for a big Easter celebration,” but that is leadership akin to leading lemmings off a cliff.

“Follow me!”

It’s equally dumb to say, “we must all shelter in place until we have a cure or a vaccine.”

For one thing, we’re not doing that now — ask any nurse, grocery clerk, or UPS driver.

For another, it doesn’t take into account the costs of doing that.  An economic collapse can cause death and misery as well.

(The good news: at least one treatment, Remdesivir, already does look promising.)

Angela Merkel (here) and Andrew Cuomo (every day around noon) are right to stress the need to keep the rate at which the virus is spreading at or below one infection, on average, for each infectious person. (A dollar shrinking at 20% a month for a year, it should be noted, becomes just 7 cents.)

You and I, I think, should be stressing this, too.

The question is . . . what sensible steps can we take while we await the cure and the vaccine to strike an optimal balance?

Can we take sensible steps even while we await the criminally-overdue availability of testing?

(Trump was right to say “the tests are all perfect, like the letter was perfect” because yes, the tests were all perfect in exactly the same way as the letter.  Which is to say grossly, wildly, impeachably, obviously-on-their-face not perfect.)

One step is to do everything we can to isolate and support our most vulnerable populations — in nursing homes and senior communities, to take the most obvious example, where nearly half the deaths are occurring.

Why are we sending $1,200 each to tens of millions of people who haven’t lost their jobs?  This must be the largest-dumbest single expenditure the government has ever made.  (Maybe not the largest or the dumbest, but surely the largest-dumbest?) Why not use that money to help those who need help?  (Not to mention Trump’s  taking credit for ameliorating a situation his own negligence caused, as we move slowly from democracy to strong-man rule.)

Another step might be to send as many vulnerable essential workers home — older grocery clerks, those with diabetes, etc. — and while keeping them on payroll but temporarily replacing them with folks at very low risk of anything more than a mild to moderate illness if they become infected.  (And/or replacing them with — of course — people who’ve recovered from COVID and are thus likely immune.)

A third step urgently to be considered is to open the schools and summer camps to children not living with grandparents or high-risk adults . . . to be taught by teachers who are young, healthy, and willing.  School employees who feel they’re at risk should be kept on the payroll while they teach from home children who also need to stay home.

These discussions need to be thoughtful and expert-led.  (I am not an expert!)

Joe Scarborough — with whom I mostly agree and for whom I mostly cheer, but who like all of us is not perfect (and who must suffer permanent sleep deprivation, so it’s a miracle he does as well as he does) — led off yesterday’s show berating a TV doctor who cited a study that suggested opening schools would increase deaths by “only” 2%-4%.

Joe misheard that to mean deaths among children would be 2%-4%.

How — he marveled and ranted and ranted — could anyone even contemplate allowing 2% of our school children to die?

But that’s not what the study said.  Experience has shown that, happily, it is the rarest of exceptions for an infected child to die of COVID.  Opening the schools would lead to no children dying, let alone 2%. (A difference worth noting, no?)   And experience has also shown that if the teachers and cafeteria workers who chose to come back to work were only those who are young and healthy — as many are — almost none of them would risk anything worse than the equivalent of the flu.

That said, people of good will can still argue that schools and summer camps must stay closed in all cases, everywhere.  I think they’re wrong but they should be listened to . . . just as I hope people who argue the opposite should be listened to.

Shouting at each other as if we were fools to pause the economy — which we were not! — or as if we are fools to inch our way, carefully, toward restarting it — which we are not! — helps no one but Vladimir Putin.

I have a brilliant young friend so bought into the argument that we have over-reacted to the crisis (is it even really a crisis, he asks, or just a moral panic?) that he focuses only on examples of empty ER rooms and hospitals going broke from a lack of patients . . . the drop-off in elective surgeries . . . somehow not crediting the endless stories of stress and heroism (and in some cases deaths) of the nurses and doctors on the front lines.

He’s not an uncaring person; but what he sees as the illogic of our over-reaction has actually driven him to complain about “all that noise” every night at 7pm when people cheer out their windows for health care workers.

And you’re saying to yourself: “This is the worst person I have ever heard of.  How can you even call him a friend?”  And I am telling you: “No, he is actually a wonderful person, who’s been made crazy by the 100% focus on the benefits of shutting everything down with no explicit examination of the costs.”  Like the cost in child abuse, the cost in alcoholism, the cost in suicide.

“Here’s a shocking stat,” he writes me: “Since March 17, eight children have been admitted to Cook Children’s Medical Center for injuries related to child abuse. Three of those children died. To put that number in perspective, Cook Children’s typically sees six child abuse deaths a year.  In other words, we have now lost more children to child abuse at one children’s hospital than we’ve lost to COVID nationally.  At-risk children are literally being ordered to sacrifice their lives in the battle against a virus they aren’t vulnerable to.”

Is it heartless to weigh costs and benefits?  I’d rather characterize it as heartbreaking.

Not trying to make the least-bad trade-offs, that cause the least human misery and death — hard as it is to weigh these things — I would characterize as deeply irresponsible.  Immoral, even.

Should we be spending precious resources to bail out the shareholders of cruise lines or airlines or perhaps any other industry!  No!  Airlines used to go bankrupt all the time.  They kept flying.  The only change?  The bondholders became the new owners.  And some, like Trump Airlines, changed names.  The planes didn’t disappear.

You can make a good case for liberal bridge loans to corporations, to avoid bankrupting them all — but that’s lending, not spending, and almost all those loans would be paid back, with interest.

At the end of the day, I think my wonderful young friend (hereinafter MWYF) is right that we need to have really logical, thoughtful, on-going discussions of the trade-offs . . . and to do so virtually every day, as more data becomes available, and as circumstances change. (Imagine the difference an effective treatment will make!  Imagine the difference “certified immunity” will make once we can all be tested for antibodies!)

But because $1 becomes $4,096 at the end of twelve months if each infected person infects, on average, two others rather than one, I think MWYF is wrong to be mocking leaders like Andrew Cuomo and Angel Merkel and so many others around the nation and the world who are rising to the challenge in the way one “leader,” in particular, has grotesquely not.

Have you seen this chart that was also shown on yesterday’s Morning Joe?  Anybody who reminds you how many people die of car crashes each year — or cancer — should take a look, to help inform his or her view.  (She or he should also note that car crashes and cancer are not contagious.)

Have a great weekend.

And remember: this too shall pass.

What a wonderful world.  (Thanks, Alan.)