Thread by @ShellenbergerMD

Preventing millions of deaths may require 4+ waves of weeks-long social distancing for 12-18 months

Achieving well-coordinated action will require greater public trust in government

Radical transparency is the key

My latest @Quillette — please share!

quillette.com/2020/03/19/win…

The New York Times has published a COVID-19 mortality calculator, which allows readers to adjust infection rates from one to 70%, and a mortality rate from 0.1 to 3%, to estimate various forecasts of total US deaths, from 3,300 to seven million.

nytimes.com/interactive/20…

The actions we take in terms of coronavirus suppression and COVID-19 treatment will determine how many people die, and how massive of an impact our actions have on society and the economy.

The Imperial College scientists propose letting up on radical social distancing and other measures only when local hospital intensive care unit (ICU) cases decline to 50 total, and re-imposing them when they reach some higher multiple, say 100, 200, 500, or more.

Given that COVID-19 victims are likely to exceed hospital and ICU beds in Europe and the US for several more weeks, it could be early summer before ICU cases drop back to around 50.

And we should take these numbers figuratively, not literally. Cities, states, and nations could trigger micro-suppressions, including radical social distancing, at higher or lower ICU bed availability, depending on much and how quickly they can expand hospital capacity.

Many expect, but we do not know for certain, that the spread of the virus will slow in summer and pick back up next fall. Scientists and historians believe that if we relax our defenses too much, the virus will strike back, taking lives that we could have otherwise saved.

“In 1918 many cities imposed restrictions, lifted them too soon, then reimposed them,” says historian John M. Barry. “Covid-19’s average incubation period double influenza’s, so compliance may have to be sustained for months, and openings and closings may also have to be repeated

A radical increase in testing may help societies decide when to let up on social distancing measures. Widespread testing, the tracking of virus carriers, as done in South Korea, and the declaration of some cities as free of the virus, may allow for greater freedom of movement.

However, it is still not clear whether we are on track to produce sufficient tests at a low enough cost to achieve this and, if we are, by when. The Trump administration must do more in this regard to provide transparency into the current and future status of testing.

Around the US, and the world, governors, hospital executives, doctors, and nurses are pleading for personal protective equipment (PPE), and reporting that they are having to make their own masks, re-use masks, and go without proper PPE, thereby exposing themselves to coronavirus

President Trump yesterday invoked the Defense Production Act, but said, “[The] fed government’s not supposed to be buying vast amounts of items and then shipping, you know. We’re not a shipping clerk. The governors are supposed to be, as with testing, doing it.”

But wars are ultimately the responsibility of the federal government, which Trump acknowledged, saying “we’ll help out wherever we can and we can buy in volume.” That’s great news, and the president should clarify what exactly the government is doing and what it is considering.

Vice President Pence told a reporter that 3M is making 35M masks per month, but experts estimate the US will need *3.5B* masks. Including the pledge of five million masks from the DoD’s own stockpile, our total national stockpile sits at around 3M — 1% of our projected need.

Trump must be similarly transparent about what he is doing and not doing to build ventilators. Knowing how many ventilators there are is one of the factors that will determine hospital capacity, which will help determine when local governments should trigger micro-suppressions

Industry leaders want to help. After at first denying the seriousness of the crisis, @elonmusk said he would convert his Tesla factory to make ventilators. Trump must ask Tesla and others to do so, just as Roosevelt asked Ford to make bombers at the beginning of World War II.

If governments fail to maintain adequate supplies of PPE, they will will threaten the entire health care system with collapse

High exposure to COVID-19 has already infected 3k Italian doctors & nurses even though many wore PPE. Without PPE, that number will be even higher.

PPE is not easy to manufacture and so strong federal action is required to replace missing links in the chain. If that requires creating or nationalizing firms, then that’s what we should do. Lives, and the broader society and economy, are at stake.

Finally, President Trump must also be more clear and transparent about what the Federal Emergency Management Agency (FEMA), the national guard, and the US military are doing. It appears that relations between Trump and the governors of NY & Calif have improved. That is great news

With today’s war, there is little need for secrecy. Indeed, secrecy in China allowed the virus to spread while transparency in South Korea saved lives. And secrecy undermines public trust in government, which will undermine public compliance with critical public health measures.

Humankind has proven it is capable of rapid and radical social distancing and thus should be able to carry out Imperial College’s plan for future micro-suppressions, or something similar.

While young people have made headlines partying in Florida, and attending rock concerts in the UK, I believe we will soon see major behavior changes by people under the age of 30 in response to widespread condemnation of such behaviors.

At the same time, as we enter economic recession or, worse, economic depression, individual and collective opposition to social distancing will rise. Workers will need and want to work. Employers will want to make money. Economically desperate people will do desperate things.

Opposition to social distancing could manifest at the individual level as well as politically. People may make the case for loosening social distancing. Already we have seen people ask why they are being required to sacrifice to prevent a few more deaths of the sick and elderly.

Growing opposition to existing and future social distancing will worsen the spread of coronavirus and may even threaten the functioning of society. Popular resistance to social distancing can be met either through social norming (i.e., moralizing) or through coercion.

In order to protect our freedoms as much as possible during this war, the focus of societies and governments must be on the use of as much voluntary, rather than coercive, action as possible.

As people lose jobs, business, and even lives to the economic recession and perhaps depression, some people may argue that we should reduce social distancing, even at the cost of more deaths, to increase economic growth.

Societies are unlikely to decide they want to just “get the deaths over with” and accept COVID-19’s plan to kill millions in return for econ growth, but will set limits on what they are willing to do and spend, either explicitly, through laws, or implicitly, through behaviors.

That means that the focus of societies and governments should be on “no regrets” policies, such as PPE and ventilator production, testing, and sharing information. They will build the trust required for repeated periods of social distancing.

Finally, coronavirus raises important questions about America’s relationship with China, but for now, national leaders including Trump should make clear our enemy is the coronavirus, not China. We will need to work with China for the next 1-2 years to defeat the coronavirus.

The message from President Trump and other national leaders should be that all of humankind has, for now, a single enemy. We need to defeat coronavirus now and figure out the post-war world order later.

The message from President Trump and other national leaders should be that all of humankind has, for now, a single enemy. We need to defeat coronavirus now and figure out the post-war world order later.

The alternative to trust, truth, and transparency is unthinkable. Noted 1918 flu historian Barry, “society is based on trust. Not knowing whom or what to believe, people also lost trust in one another. They became alienated, isolated. Intimacy was destroyed.”

The Trump admin. and other governments are making progress in winning trust. They should keep it up by stating more clearly what they are doing to manufacture the PPE, ventilators, and other equip. doctors, nurses, and others on the frontline of our war on COVID-19 need.

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