A month in: Where are we with COVID-19?

coronavirus politics
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More than 22,000 U.S. deaths have been attributed to COVID-19, which means, what, exactly, in terms of where we are, a month into the national shutdown?

One perspective is that the U.S. is now the global epicenter of the COVID-19 pandemic, which is the narrative you’re seeing splayed in banner headlines across the interwebs today.

Another perspective: the death rate, and more importantly from a public health perspective, the rate of hospitalizations, is down significantly from the original projections that led to the shutdown, which, for some reason, you have to find out about on your own, after doing some digging, despite it seeming to be something resembling good news, or at least a beacon of something like hope, given what we’re facing.

People tend to click on bad news headlines.

Blame the media all you want, but they’re not highlighting those stories if you don’t click.

The bad news was an easy sell early on, when the predictions were projecting a possible U.S. death toll at 2.2 million, and even modeling assuming strict social distancing measures would be put in place put the death toll at 240,000.

Now the models have the projected death count in the 40,000 to 60,000 range, and have us on the other side of the peak nationally, and in Virginia, in terms of peak resource use.

According to the University of Washington Institute for Health Metrics and Evaluation, peak resource use in Virginia is projected on April 26, with COVID-19 cases taking up less than a fifth of overall hospital bed capacity.

The new normal: And the fight that is brewing

OK, so I’ve told you about some positive trends.

I’m not, though, now about to tell you that things are going so well that you’re going to see life return back to what we knew as normal a month ago.

Where we are now is the beginning stage of what promises to be a death match-style national debate over when, and how much, to loosen restrictions.

First, to the when

President Trump seems to be suggesting that he’s going to have some kind of plan in place to open things back up as early as May 1, though the details on that are scarce to non-existent, which means, basically, nothing, in the here and now.

We can guess, pretty easily, that whatever he would end up doing in terms of “opening things back up” would be at most baby steps in terms of the previous normal, in terms of recommendations, and that’s an important point.

Another important point: whatever the president does at the federal level would be a recommendation that would then almost certainly clash with governors in states that have put more stringent measures in place, like Virginia, where Gov. Ralph Northam seems dead set on keeping the state under bubble wrap until at least June 10.

The showdown is almost certainly going to be along partisan lines.

To wit, we’re already seeing Republican governors in Texas and Florida hinting toward wanting to get things moving in the direction of reopening in the coming weeks, whereas Democratic governors like Northam, Andrew Cuomo in New York, Gretchen Whitmer in Michigan and Gavin Newsom in California are strenuously holding the line.

Trump, at the federal level, doesn’t have much in the way of levers to push and pull from above to force action in states, but there’s already a groundswell coming from the other direction, at the grassroots, with Facebook groups opposing the shutdown adding hundreds of thousands of members in several states.

And if you want to get an idea of how effective the grassroots can be in changing the direction of public policy, think Virginia, in December and January, when the Second Amendment sanctuary movement significantly watered down gun control initiatives that Democrats had been throatily advocating for in the Virginia General Assembly.

How much, then, are we likely to see?

Even if Trump were to proclaim “business as usual” beginning May 1, people aren’t going to flock to stores and restaurants as if the past few weeks never happened.

We all know this.

Knowing this, and assuming that we’re also headed where we know we’re headed, the best approach would be one that includes, prominently, elements of what we’re doing now in terms of social distancing, wearing facemasks in public settings, with a new emphasis both in the public and private sectors on thorough, several-times-a-day cleaning of common spaces.

And honestly, on that last point, at least, an emphasis on cleanliness in common spaces needs to be a national priority going forward anyway, and it doesn’t have to be a bad thing, in terms of economic consequences, because thorough and persistent cleaning efforts mean jobs.

Grocery and retail stores and restaurants, when we can go back to dining in at restaurants, will also need to maintain policies limiting the number of people per square foot, at least until we get COVID-19 under control, which worst case won’t happen until we have a vaccine, but that’s assuming we don’t see something significant in terms of the development of treatments that can mitigate broader public health consequences in the short term.

Testing and tracing, as you’re seeing leading public health advocates pushing the past couple of days, will be another key part of the developing new normal.

Also key: extending paid sick leave basically into perpetuity, so that people don’t feel pressure to go to work when they’re sick, basically because they can’t afford to be sick.

This last point will have a positive impact on us for the long term, by the way, because we’re all now much more aware of the impact flu season has on the U.S., claiming 60,000 lives, requiring 740,000 hospitalizations and 26 million medical visits in the 2019-2020 flu season, according to numbers from the CDC.

Paid sick leave will incentivize sick people to stay home.

And actually, if we keep our focus on common-space cleanliness as part of our national lesson from COVID-19, that plus paid sick leave could have a positive multiplier effect that can have a dramatic impact on future flu seasons in the U.S.

Back to reality

I’m assuming here that we’d have people working together to come up with solutions to what we’re facing.


It’s going to get ugly, folks.

The reason is there’s no middle ground right now.

The public health folks and their models are focused on “flattening the curve” with projections extending out as far as two years with no attention being paid to the economic devastation that extended shutdowns will wreak on global society.

The economics folks are similarly working in their silo where the presumption is that we can get back to business as usual without there being any cost borne from what you’d have to presume would be waves of hospitalizations overloading healthcare systems across the country and across the world.

The fight that is brewing resembles everything else that passes as debate in our current environment.

If you’re on the side of the public health folks, any attempt to restart the economy is greedy and shortsighted, focused for some reason on the stock market, and will lead to the deaths of millions; if you’re on the side of getting people back to work, those who say we need to continue the shutdown don’t care that millions who were gainfully employed a few weeks ago are out of work and headed toward financial and personal ruin that will kill many muliples more than the worst projections of impact from COVID-19.

Basically, we’re at another either/or stage, and frustratingly, both absolutes are certain to lead to an almost guaranteed worst possible outcome.

A third way?

Or we could listen to each other, recognize that we still know practically nothing about COVID-19, about what a prolonged shutdown will do to millions on the economic fringes, and try some things that can mitigate the impacts both on public health and the economy.

We could look at what we know now that we didn’t know a month ago, when even the most optimistic forecasting presuming stringent social distancing had us thinking that 240,000 Americans would die, and our hospitals would be overrun.

The fact that, aside from hotspots in New York City, New Orleans and Detroit, the hospitals have not been overrun, is a sign that maybe we can push and pull the levers a bit.

In Virginia, for instance, which will only need about a fifth of its hospital bed capacity for COVID-19 cases on the IHME April 26 projected peak-resource date, you could see some loosening of restrictions on activity, and similarly, in other states where the peak-resource use is significantly below what hospital systems can handle, you could see the same.

Loosening restrictions, again, as described above, doesn’t mean going back to the normal that we knew a few weeks ago, wide open, as it were, but with social distancing still baked in at retail and grocery stores, dine-in restaurants and other common public spaces, the emphasis on cleaning those common spaces, and the like.

You reserve the right, then, as local cases wax and wane, to revisit the levers, to tighten as needed, or to further loosen, as a situation may warrant.

And most importantly, you manage expectations.

No, we’re not going back to baseball games and concerts in packed arenas anytime soon, but we can get most people back to work, and we can buy time for researchers to work on treatments and a vaccine.

We can’t just pretend that COVID-19 doesn’t exist; nor can we pretend that we can wait out a quarantine for years for a vaccine to come online.

It would be great if President Trump, Gov. Northam, other governors, Joe Biden, the rest, could put down their partisan spears and start working together toward solutions.

Because the reality is, we all want the same thing: nobody to die, and everybody back to work.

To borrow from Voltaire, the fairy tale is getting in the way of the good.

Story by Chris Graham

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