Why Are We Acting Like We Only Have Two Choices For Dealing With COVID-19?

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Woman in self isolation using smartphone by window
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A recent paper published by a group of economists from the Federal Reserve and the MIT Sloan School of Management aimed to determine which would be better for our economy regarding the COVID-19 pandemic: lockdown, which would by its nature halt many areas of economic activity on both the supply and demand side. Or, allow the spread while maintaining a level of economic activity, with the assumption that completely halting economic activity would be more catastrophic than the effects of coronavirus itself.

The paper’s authors employed complex mathematical models to analyze the various US cities’s responses to the 1918 influenza pandemic. Their data showed that cities with the earliest and strictest non-pharmaceutical interventions (NPIs) experienced faster and more robust economic snapbacks. An NPI is an action taken by a person or community to prevent disease spread — frequent hand-washing, sheltering-in-place, case isolation, the closure of schools, theaters, and churches, the banning of mass gatherings, etc.

Cities that didn’t react quickly to the 1918 flu pandemic had “substantial economic costs” in addition to lives lost. Cities where NPIs were implemented ten days earlier saw an increase in manufacturing employment by around 5% after the pandemic. Those that maintained NPIs for an extra 50 days increased manufacturing employment by 6.5% after the pandemic.

The overall thrust of the paper was crystal clear, and spelled out in no uncertain terms in its title: “Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu.”

Other economists agree. In a survey issued by the IGM Forum, part of the University of Chicago Booth School of Business, 80% of economists agreed that lifting our strict lockdowns would cause more harm to our economy in the long-run. 93% agreed that the government should aggressively fund coronavirus testing, treatment capacity, the production of more masks and ventilators, and financial incentives for a successful vaccine.

Meanwhile, conservative media outlets argue that, in recommending a prolonged lockdown, we aren’t considering the “despair” that people will feel if they’re trapped in their homes, many without a source of income. This is a fair concern. Some studies have found that the great recession was tied to a surge in suicides, as many as 10,000 more than expected. It should also be noted, however, that more recent studies have debunked this.

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Still, it’s fair to argue that we should be concerned for our collective mental health. It’s also reasonable to be concerned about the economy. It’s rational to wonder whether the cure is worse than the disease. Just, you know, maybe not in panic-inducing all-caps from your presidential Twitter account in the middle of the night.

Is slowing the spread of coronavirus really an all-or-nothing scenario?

I think we’re arguing about our COVID-19 response in the wrong way. Here in the United States, we are so polarized politically that nuance gets tossed out like a baby with dirty bath water in an effort to “choose sides.” But this isn’t an “all-or-nothing” conversation. At least, it shouldn’t be.

The paper discussed above, while scientific and thorough, has several caveats, which the authors list at the end of their paper. We are not living in 1918, and COVID-19 is not the flu. We have technology that didn’t exist in 1918, the ability to rapidly disseminate information that didn’t exist in 1918, and a robust service industry that didn’t exist in 1918.

On the other side, those eager to relax NPIs to get the economy moving often fail to consider the greater economic impacts of an unchecked pandemic, not to mention the impact to our nation’s collective mental health in a future where our healthcare system has been devastated like Italy’s and every single one of us personally knows someone who died of COVID-19. Are they really willing to trade possible suicides for COVID-19 deaths?

There is a middle ground here.

We need to be talking a lot more about testing. It will likely be the key to saving both the economy and lives. Emily Gurley, a scientist at the Johns Hopkins Bloomberg School of Public Health, told NPR, “Everyone staying home is just a very blunt measure. That’s what you say when you’ve got really nothing else. Being able to test folks is really the linchpin in getting beyond what we’re doing now.”

Ashish Jha, director of the Harvard Global Health Institute, agrees. He says we need to mass-produce tests, first testing those who have had contact with confirmed cases, so they can quarantine, then testing “mildly ill” people, and finally, we should test the population at random, to locate “asymptomatic spreaders.”

The New York Times published an opinion piece by Paul Romer and Alan M. Garber, recipient of a Nobel Prize in Economics and a professor at N.Y.U., and a physician and economist and the provost of Harvard University, respectively. They recommend a “targeted approach that limits the spread of the virus but still lets most people go back to work and resume their daily activities.” Again, testing is the key to the “targeted approach.”

Romer and Garber suggest we screen the general public on a weekly basis, and health care and emergency response workers daily. “We do not have the capacity to do this now,” they wrote, “but all it would take to make this happen is for the federal government to make coronavirus testing an urgent goal and to fund it accordingly.”

Some countries, like South Korea, Vietnam, and Germany, have taken rapid and drastic measures with testing, using a “whole government” approach: closing borders, ramping up testing, and isolating any known cases, as well as all their contacts, at the first sign of the disease. South Korea and Vietnam seem to have successfully contained the spread. Germany continues to identify cases but has a low death rate, likely due to the massive scale of their testing.

At the moment, the U.S. federal government doesn’t recommend testing for the majority of Americans. In a White House briefing on Sunday, March 22, Vice President Mike Pence told reporters, “If you don’t have symptoms, you don’t need a test.” This is in line with our current CDC guidelines which, although they offer testing guidelines for healthcare professionals, state that “decisions about testing are at the discretion of state and local health departments and/or individual clinicians.”

Testing will be the key to returning to normalcy and getting the economy moving again.

But if we want to return to economic normalcy, we have to test way, way more than we currently are. We have to identify those who have COVID-19 as well as their contacts, and those individuals need to quarantine.

In addition to testing for the COVID-19 virus itself, we also need serological tests — tests that tell whether a person has antibodies to COVID-19 in their blood. Because of our failure to test early on, we don’t know how many people have had mild cases of COVID-19 or were asymptomatic carriers and now have immunity. Identifying these people could allow a portion of our population to return to work. Testing front-line healthcare workers who may have been exposed to the virus but never developed symptoms (but still must be quarantined) may reveal they are immune and can return to work.

The United Kingdom has ordered 3.5 million serological tests. Germany may use serological tests to issue immunity certificates to those who have survived and are immune to COVID-19.

Testing in the United States is a hot mess.

What the Trump administration is not explicitly telling us is that we have a major shortage of tests, whether we’re talking about testing for the virus itself or antibodies. The FDA is providing funding for private companies to rapidly develop COVID-19 and serological tests, but to date, the U.S. remains far behind other countries in terms of testing rate per capita.

Of course, we don’t need a news outlet to tell us this. We see the problems with testing in our own backyards. In the local COVID-19 Facebook group I’m a part of in Florida, numerous people who are symptomatic have complained that they cannot get tested. One member called the Florida department of health number only to be directed to the county number, where she was then directed to try the department of health number again. No one could help her. Meanwhile, private facilities open up drive-through test sites, but they are costly and the only way to find out about them is by word of mouth or stumbling across a news article.

Dealing with this pandemic shouldn’t be a black-and-white, this-or-that scenario. We shouldn’t have to “flatten the curve” with stay-at-home orders alone. A country as supposedly great as ours should be as able as other countries to implement widespread testing. This would allow us to track the spread of COVID-19 so we could identify geographical areas where spread is contained so people living in those areas can return to work and get our economy moving again. And we should be able to test retroactively — serological testing — to identify those who are immune and can therefore return to work, even in areas where COVID-19 continues to spread.

We need to stop bickering about whether we should or shouldn’t be in lockdown, and start demanding our government provide widespread testing so that we, or at least some of us, can get back to work.

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