Shifting public discourse about #COVID-19

On March 11, 2020 the WHO declared the Coronavirus a global pandemic. Although the first case was detected in the US on  01/20/20, president Trump skeptically dismissed the threat and waited patiently to take action, naively thinking that it would simply go away. It was not until March 13 that the federal government decided to declare a state of emergency and urge citizens to stay at home in an effort to flatten the curve. The unfortunate result of this decision is that the US is quickly becoming the new epicenter for the spread of the disease. Unfortunately, we are far too deep into this problem to focus on pointing fingers. After all, the virus has spread far and wide around the globe due primarily to how little information was available regarding periods of incubation, forms of transmission and the “unrealistic optimism that is a pervasive feature of human life” (Richard H. Thaler, Nudge: Improving Decisions About Health, Wealth, And Happiness). Thaler goes on to say, “when they overestimate their personal immunity from harm, people may fail to take sensible preventive steps”. This is the primary reason why smokers dismiss statistical probabilities of getting cancer, and helps explain why governments around the world failed to take action until it was too late.

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Title: Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering

Image source: Johns Hopkins University

As of March 27 2019, global counts of the virus have surpassed 500k cases and the spread curve continues to grow exponentially. Most countries around the globe responded to this unprecedented event by urging people to stay home, and in some cases a lock down enforced by martial law. As a consequence, economic activity has slowed down to a crawl and is sure to bring our socioeconomic system to its knees. Based on statistics on the speed of disease spread, it is still unclear if this plan will succeed in containing the virus. However, it has proven to be extremely successful at creating a worldwide recession that has dwarfed the economic downturn of the 2008 crisis in only a few weeks from its implementation. According to a press release published by the US Department of Labor “In the week ending March 21, the advance figure for seasonally adjusted initial claims was 3,283,000, an increase of 3,001,000 from the previous week’s revised level. This marks the highest level of seasonally adjusted initial claims in the history of the seasonally adjusted series”. As a point of comparison, the total unemployment claims reached 665,000 at its peak during the 2008-2009 crisis.

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Title: unemployment Insurance Weekly Claims March 21 to 24, 2020

Source: US Department of Labor Blog

The combination of simultaneous global demand and supply side shock to the economy is unprecedented. Thus, we have entered uncharted territory that will require more than a gigantic stimulus package to dig us out of this global depression. At the current rate of infection, scientist estimate that it is very possible that 25%-50% of the world population living in urban and suburban areas will be affected by the virus very soon. Given that the spread has barely slowed down and the world is beginning to feel the effects of the economic shutdown, perhaps is time to gather what we know and plan for a worst-case scenario instead of hiding at home and hoping for the best. We know what is coming if we do nothing, so let’s shift the focus of public conversation towards brainstorming about alternative plans. Can we start talking about ‘Plan B’ and ‘Plan C’?

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Title: Age distribution of reported corona virus disease on board of the Diamond Princess CruiseShip

Image Source: Eurosurveillance. Europe’s journal on infectious disease surveillance, epidemiology, prevention and control

 

Plan B- if containment fails:  

Based on a preliminary study conducted among passengers on board of the Diamond Princess Cruise Ship that was quarantined due to confirmation of COVID-19 cases, we now know that approximately 50% of those who tested positive for the virus remained asymptomatic after 2 weeks and that only 1/5 of the passengers on board tested positive. Perhaps it is too soon to reach solid conclusions, but these findings justify the grounds for further investigation. Expected percentage of symptomatic cases, across expected age distribution (See Princess Cruise Ship Study link for more details), multiplied by the expected severity percentage (about 3%), and knowing the distribution of at-risk subjects in each county, would allow hospitals to estimate the expected demand for medical equipment.

Furthermore, we have a solid basis for reorganizing our economy around these findings. If we knew the exact distribution of the virus (through mandatory testing) quarantine could be targeted instead of widespread and the economic shutdown, would only be partial. Thus, production of goods could continue, lessening the blow to the supply shock. Furthermore, quarantine of asymptomatic individuals who test positive for COVID-19 could be put to good use if they were isolated with people who are symptomatic. As contagion is not a concern, they can help tend to the sick simultaneously supporting the overwhelmed health system while slowing down the spread. This also benefits university hospitals by reducing the cost of studying both sets of the affected population to find a vaccine. Meanwhile, individuals who test negative can return to work and keep the economy going and ensuring supplies are available until transmission rates slow down or a vaccine is developed. As we can see, who gets quarantined and how it is handled, can make an important difference in the short- and long-term socioeconomic outcome.

Plan C- if it becomes widespread:

Let’s pause to imagine a worst-case scenario situation where the majority of the population is being exposed to the virus. How can we use the data to adjust course and supplement for expected shortages in hospital beds, supplies, economic activity and so forth? Referring back to the percentage of people who test positive but show no symptoms and knowing that the incubation period for those who get sick is 14 days, we can safely infer that economic activity in counties, regions, and states may be disrupted in waves. This means, that a strategy of solidarity (i.e. mobilization of resources to make up for expected shortages) among regions and even countries is not only possible, but far better than the alternative of keeping the world economy on halt for months at the time. This plan would build from the foundational mandatory COVID-19 testing and targeted quarantine from Plan B. Thus, expecting a spike in demand for hospital beds and equipment and a shortage of supplies can be solved by preparing for it. For example: by increasing the number of ambulatory care clinics, providing incentives to increase production of certain goods, coordinating transport where needed and training the population on how to recognize and help manage the symptoms of early pneumonia, so that the total number of severe cases diminishes.

Conclusion:  

These two proposals are only some of the alternatives that can be deployed to manage this global pandemic while simultaneously avoiding an economic catastrophe. A great deal of mind power is currently being wasted in worrying about the problem and focusing too much on a single solution. Meanwhile, billions of human lives remain vulnerable to the threat of death by the virus or hardship by economic downturn. Sixty years of evidence from failed development experiments in third world countries, inform us about the effects of poverty on long term health, education, economic growth and the overall human development indicators. We don’t need complicated equations to figure out that recovering from a global depression will have devastating effects for everyone involved. Perhaps, it will be even harder than recovering from the immediate effects of the disease itself. However, we do not need to aggravate the pandemic by adding another layer of economic hardship. We have more than enough data to be strategic about who should be doing what, when and why. We are not helpless, we have options. Therefore, there is no need to fear what this pandemic will do to us if we begin thinking about how available data and unprecedented global connectedness can help us build resiliency plans. It is about time that we shift the focus of the public conversation about coronavirus towards building positive outcomes even in the wake of failure to prevent the spread.

 

Note: this article presents my personal opinion and does not reflect in any way the views of my employer or affiliated educational institution.


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