Fear and panic in difficult times can cause terrible loss and destruction.
We are in one of those times in America.
The world is in one of those times.
How will we respond?
This virus has disrupted our world. In the United States, there is a credible risk estimate (hopefully much too high) that 100 million people will be infected in the next few months. Guesses at the mortality rate (the number who will die) vary wildly, because no one knows, but one high guess (hopefully it is much too high) is that 500,000 people could die in the United States in the coming months. This is an estimate, and the number of deaths could be much lower. No one knows what will happen, but we have to face the possibility of great risk.
The estimate of as many of 500,000 deaths is based on the assumption that the number of deaths among those infected will be around 0.5 percent. The current rate of death being discussed of 2 to 3 percent is very likely too high, because a lot more people have had the disease around the world than we know. Once that total number is better known, we will have a good idea of the percentage of those who will die from having this virus. South Korea has done the most thorough testing, and their reported rate of death is 0.7 percent. But we have to try to look squarely at the possible extent of the crisis, and considering the possibility of a shockingly high number for deaths is necessary to focus our attention and to be able to respond to the true degree of danger. At the same time, we must remember that all numbers are very speculative at this point, so we must not overreact or be caught up in fear or panic.
If we had acted sooner, following the model of South Korea, Singapore, or Hong Kong—testing extensively and carefully monitoring all detected cases and their contacts—we might have prevented the natural progression of this disease. No one knows if this would have worked here. It might have, but we will never know. Again, estimates vary widely, but there are likely between 100,000 and 500,000 cases in the U.S. at this time, all over the country, with the great majority undetected. Many of these cases are mild, so they will never be diagnosed. Therefore, it is too late to prevent wide-spread infection rates. This disease will continue to spread and will be with us for a long time.
There are only three primary ways to think about how this pandemic will end:
- We get lucky and find a vaccine that can be made widely available in something like 18 months, in time to head off a wave of new infections in the winter of 2021.
- We get extremely, ecstatically lucky and this virus mutates quickly into a much less virulent form (yes, this could happen, we just can’t count on it, for the odds aren’t good).
- Once someone has been infected with COVAD-19 and recovered, there is a good chance that person will have full or partial immunity. Once a large portion of the population has immunity, the disease will still be present, but will operate more like a flu, infecting some people each year, killing some, but nothing like what we are facing right now. One decent guess is that when 60% of a population has immunity, the average new infection from each infected person is less than one, so the spread is contained. Until that time, which could take several years (without a vaccine), we will be dealing with this disease.
What should we do?
If these are the ways this crisis will end, what should we do, for we will be dealing with large numbers of infections and deaths for at least 18 months.
Two things we must avoid: 1) We must not put our heads in the sand and hope it will all blow over. 2) We must not take decisive actions that cause more harm than the disease itself. The wrong decisive actions will be monumentally destructive to our country and to our civilization.
The course our country seems to have set upon in the last few days is to close down and hide away. The medium-sized city I have lived and worked in for many years has had one confirmed case, but in the last week the public schools have closed, the university has closed, the restaurants are closing, the largest mall has closed, and the shops (except the grocery stores, pharmacies, and staple goods stores) are almost empty. Yet there will likely be more confirmed cases in a month, and even more in two months. Are we going to stay closed down for 6 months, for 18 months? This disease is not going away in 2 weeks or 2 months. Yet in 2 months, if not sooner, our national economy will be on the verge of collapse. Tens of millions of jobs are being lost right now. Many will not be easily recovered. In 6 months our economy will be unrecoverable, and our way of life will have been destroyed.
This is how fear is our greatest enemy
Right now, hundreds of thousands of restaurants have closed, with millions upon millions of people who work in that economic chain (waiters, food distributors, dish-washers, all the people who took the risk to open their own restaurants) out of work and without a payday. Many of these people have few savings and nothing to live on. The same is true for all those people who work in the shopping malls and on the shopping streets all over America. Airports are almost deserted; many manufacturing plants have closed; the non-profit organizations that meet so many needs all across America are bracing for funding to diminish, which means cutting services. And on and on. It is staggering to try to estimate the number of people who are not getting their needed income. Can they handle it for 2 weeks? Sure. For 2 months? A lot of people are resilient, and they will get by for 2 months. But 6 months? And what if our supply chains are increasingly disrupted, and our financial systems begin to crumble and fail?
If this goes on for months, our financial system will not survive without enormous chaos and loss. Governments can help for a while. They must, for to help our citizens and our way of life survive is the reason governments exist. But if few people are working, who will pay the taxes to keep the governments operating? City, county, and state governments all over the country are vulnerable to the immediate loss of tax revenue that is happening right now. Massive numbers of municipal bonds will be coming due, and there will be no money for them to be repaid or refinanced. No one will loan these local governments more money. The federal government will try to help by printing money. It will probably print massive amounts. This will allow the federal government to function longer, and it can help the state and local governments for a while. But if tax revenues start falling dramatically, as they will on our current path, printing money will only work for a while, until it leads to other kinds of dramatic problems. (Just look at the history of Germany after the First World War, or ask the people of Greece who experienced it during the Second World War, the people of Zimbabwe in the last decade, and many more.). Ultimately, printing large sums of money leads to hyperinflation, and to economic disfunction on a massive scale.
Maybe we can tax the wealthy to pay for everything? But if the stock market continues to crash, as it will if our economy does not start functioning again soon, much of the wealth that has been accumulated through many years will be dissipated, even that of the most wealthy. And when wealth is destroyed, it will not be recovered quickly. Of course, some wealthy people will be able to hide their wealth away, but the government won’t be able to find nearly enough to solve these problems. There isn’t nearly enough hidden away. And only a police state would be able to make such an effort to find what is there. But if our economy stays shuttered, it could lead to a police state.
I do not say these things as predictions of what must happen, but as warnings of what can happen if we close down our country and our economy in a futile attempt to fight this enemy. We must fight it. This is a war. But we must fight wisely. We might win a few battles with the current tactics, but we will lose the war for our civilization.
Imagine if a new Hitler threatened to kill 500,000 people in America today, and the only option he gave for saving those lives was to close all our malls and restaurants and offices and manufacturing—to shut down our lives—which would destroy our economy and our way of for many years to come. What if he demanded that we shut ourselves in and wait behind closed doors until he lifted his threat? Would we do it?
The British during WWII were threatened with complete annihilation by the Nazis if they did not surrender. They did not, so endured massive bombing and a terrible loss of life. But they fought on, kept doing their jobs, kept their businesses operating and their lives going as best they could, and they won.
This threat is different, of course; it is not as direct, but it is very pernicious. We cannot know the extent of the threat, but we must take seriously the degree of danger. At the same time, we cannot know that, even if we shut down, we will not lose 500,000 lives anyway. Virus diseases, it seems, tend to move in waves, and whatever happens with this first wave, there will likely be another, and another. Will we shut down until it is over? If not, what will be the signal that it is time to begin our lives again? In the meantime, shutting things down and hiding in our homes will destroy millions upon millions of jobs, leading to loss of income for many, many people. Millions of people will not have the money to buy food and necessities. There will be many bankruptcies, and an attendant increase in despair, loneliness, drug abuse, crime, and suicides. Some people will increasingly take their anger and frustration out on each other, on children, on the elderly. My college undergraduate and master’s degrees were in history, and I have been reading history all my life. Throughout history, civilizations that reacted with fear and panic to pandemics did not fare well. And bad decisions in dealing with such crises are one way civilizations end.
China, of course, did shut down a vast segment of their country for over 2 months, and now they seem to be getting ahead of the spread of the virus. But they used massive testing, they relentlessly followed up on cases and suspected cases, they enforced strict observance of severe restrictions, and they accepted a dramatic hit to their economy. But there are many problems with trying to follow this model. First, because we did not organize to do large-scale testing (we should have prepared for this months ago, but didn’t), we are not yet able to do the testing necessary to find out who is infected, and we are not close to having a system in place to follow up all the cases out there and create effective levels of quarantine.
Second, we are not set up to enforce a shutdown of peoples’ lives, and it is highly unlikely enough of us will comply voluntarily for months and months. China has an authoritarian governmental system and had an extensive network already in place to monitor and control their huge population. Further, the vast majority of the people there were prepared to comply with all directives from the government. This way of managing the pandemic will not work in the United States. Rather than attempt to follow this authoritarian model, we must find a creative and effective way for a democracy that values personal freedom to manage this crisis, and hopefully come through on the other side stronger than ever.
Third, considering the hit to China’s economy (they decided to accept a great loss). The people of China, however, have saved and saved over the last 2 decades; feelings of family responsibility are very high and they will extensively share with extended families; their government is well-positioned to borrow and spend now. If our economy does not collapse, they will recover.
But fourth, and perhaps most important for us, their decision to close down for months will cause great ripples of economic impact to spread all over the world for a long time (along with the sharp cutbacks that have also occurred in Japan, South Korea, and other Asian countries). The effect of these massive shutdowns and slowdowns will create great economic difficulties all over the world for many months. In the face of these losses, if the rest of the world keeps going, China and Asia will probably recover in a few months’ time. If, however, America shuts down, and Europe shuts down, there will be a cumulative effect, and the world economy will be reeling for years and years. This will cost millions upon millions of jobs all over the world, and an unimaginable loss of peoples’ livelihoods and wealth.
Plan of action – A brief outline of steps to take
- Mobilize resources for our medical system. Create the equipment, capacity, and supplies they need, the way we mobilized for World War II. Hire extra help. Give bonuses and support. Our medical workers are the front-line troops in this war—give them all the materials and support we can. Fast.
- Mobilize testing nationwide as fast as we can. The federal government should pay for the manufacture and administration of tests, because no one except the federal government is in a position to make this happen quickly. We need to know where the virus is, how it is spreading, and what works to contain the spread.
- Develop a simple set of guidelines about quarantine for those who have tested positive and for those who have been in contact with them. Then, help those people with their lives as they go through quarantine—many of them can’t do it without help and support.
- Make the effort to find a vaccine the highest priority research issue in the world.
- Get our country up and working and functioning again. There will be no signal when it is “safe” to go out. If we wait until it is “safe,” we will not have a viable economy, or perhaps a viable country left. South Korea did not close their restaurants or most of their businesses, and yet they are a large country that has managed this emergency as well or better than any other.
- Save jobs. (One suggestion is for the federal government to guaranty a large number of pre-crisis salaries.) Create jobs. Create a loan program for businesses, large and small, so they can weather this storm. Put in place intelligent conditions for these loans, like requiring businesses to maintain most of their work force and not use the money in certain ways like buying back stock. Perhaps the banks administer the loans. They already have systems in place, and we need to keep them functioning. There are experts who can devise such a plan if we will call on them and listen. The out-going financial team of the Bush administration and the in-coming team of the Obama in 2008 got together and developed a plan for the crisis at that time, and they saved the banking system and other crucial American companies. They made mistakes, but they got enough right to accomplish the crucial task at hand. The same must be done now, but it must be done quickly. If a lot of businesses fail, our country as we know it will not recover.
- Provide assistance to those who have lost their jobs. Help those who need medical care. But we must also be careful about trying to throw money at the problems that will not help solve the long-term issues. I have read many suggestions that spend so much federal money that hyperinflation will be the inevitable result. For instance, providing tax cuts for wealthy people and giving out $2000 checks to everyone. These are unlikely to do anything to solve the long-tern crisis and will only serve to advance the short-term political goals for some politicians. Again, there are people whose lives have been spent trying to understand how to deal with financial crises. Use their wisdom.
- Make sure, as much as possible during this medical emergency, everyone has access to medical care. If people feel they can be tested and taken care of without getting a bill they cannot afford, we will be much more likely to halt the spread of this disease, and each one of us will be greatly benefitted. We are in this together. There is no separate safe place to hide from a virus; there is no location that will keep anyone safe for months and years. And no matter how wealthy you are, if our economy collapses, your world will collapse also. We must learn to manage and contain this together.
- The Federal Reserve, in cooperation with other major national banking systems, must backstop the world monetary system as they did during the 2008 crisis. Probably even more. There is no other organization on the planet that can do this. If they do not do it wisely and rapidly, the consequences will be dire.
- Take care of the elderly and infirm. Help them stay away from risks as much as possible and as much as they choose. Help them meet their needs during this time—including their social human needs. And then keep doing this after this crisis is over.
- Give our young people something to do. So far, it seems like there have been almost no deaths in the U.S among people 0-19 years of age, and there seems to be only about a 0.1 to 0.2 percent risk of death among those 20-44 who are infected. This disease does not seem to be as virulent among the young as it is among those with who are older. People between the ages of 45 and 54 are tending toward a mortality rate of about 0.5 to 0.8 percent, and it starts to rise significantly from there.
In that light, open some schools in intelligent ways. Do we really want to close all our schools for months and months? Will those millions of children be better off for months at loose ends? Being in the same homes with the elderly all day—yet increasingly going out, some of them getting the infection. Won’t they spread the infection to their elders this way? Can we really keep them in their homes for months? What will they do with their time? Will that be healthy for them? And what about their parents? Isn’t there a measured respond to be implemented, depending on how intense the disease is in any given area at a particular time? There is a moral imperative that we not overreact to this threat. Singapore seems to have succeeded in beating back this disease while keeping their schools open. Why can’t we do that? Don’t just kick millions of children and young adults out of school with nothing to do. That will create many other problems. Let’s find a way to give unemployed youth jobs in managing all the things that need to be done during this difficult time.
- Create a clear and simple set of guidelines for safer interactions while this pandemic lasts—without scaring people into being afraid of touching anything in the world or ever getting within six feet of each other.
- Don’t blame or create scapegoats. The human community is in this together, and we will either defeat it together or it will get the better of us (if this disease is not dealt with in Africa, or South America, or anywhere else, it will simmer there and then explode again, over and over, all over the world). And if countries all over the world try to fight it by closing borders, the world economy will be quickly destroyed (the whole American way of life is organized around providing goods and services for the people of the world—think silicon valley, farm goods, financial services, the whole travel industry such as hotels and airlines, and on and on).
- We must understand what “Flatten the Curve” really means, and what it can and cannot accomplish. Flatten the curve means to spread out the number of infections over a longer period of time in order to keep from overwhelming the medical system and keep it from breaking down. This is a good thing to do, but in and of itself does not lessen the number of people who will be infected by the virus, and it does not lessen the number of deaths (except insofar as an overwhelmed medical system leads to a greater number of deaths).
Again, this has value, but it is not a solution to this crisis. Most importantly, no one knows what actions will actually “flatten the curve.” Extensive testing and then follow-up and quarantine of those infected is very likely the most crucial step. If someone is infected and they stay home rather than going into a crowded room, this will very likely flatten the curve. But does closing schools in places that have few infections help? Does closing restaurants all over America? Does closing businesses and manufacturing plants where there have been few infections? There is no evidence that any of these is necessary or effective. Theoretically they might help a little, but we don’t know they will, and doing too many things to flatten the curve will cause disastrous unintended consequences.
For instance, if we flatten the curve and close down the country to keep it flattened, we will be closing down the country for a long time. And that in turn will destroy the American economy, and perhaps the world economy as well. And that will cause the destruction of millions of lives, and over time, many deaths. We have to be wise about what we do, rather than using “flatten the curve” as an incantation that we imagine will solve all the problems. It is one piece of a very large puzzle, and magical thinking around it must not drive our actions. It seems to me we must make efforts to flatten the curve while at the same time getting our economy up and running.
- Develop ways of increasing social interaction while trying to minimize the spread of this disease. We humans are social creatures, and our social needs must be spoken to. A lot of people can “isolate” for a couple of weeks, but trying to get our culture to do that for months could create great harm to our overall mental well-being. Such a path could lead to increased mental illness, greater drug abuse, unhealthy habits, feelings of alienation, and even more suicides. Whatever we do, we must find ways to meet human social needs while dealing with this crisis. Is it too great a stretch to think we might even be able to respond creatively so that we have gains in our culture from finding wise responses to this crisis?
The right plan?
I am certainly not right about everything in this paper. I don’t know all the answers. No one does. But bold, wise actions are called for, much the way Franklin Roosevelt attacked the Great Depression, and Ronald Reagan the Cold War (with the invaluable assistance of decisions by Mikhail Gorbachev). Roosevelt and Reagan were not right about everything they did, but they got enough right to create a positive outcome with a major world problem.
Will all this cost a lot of money. Certainly. But without such a plan, the long-term losses with be much greater.
Will there be loss of life if we follow this plan? Yes. Perhaps hundreds of thousands in the U.S. alone. Maybe even more. But we will have great loss of life even if we shut down our country and our economy. Maybe a greater loss over the long term. We are at war, and there will be significant losses, no matter what we do. We did not choose this war. We were attacked. Now we must fight, but we must fight wisely. In war, the first priority is to win. We cannot prevent the loss of life, but in developing our strategy, we can try to minimize losses but still ensure victory. In war, you risk lives in order to preserve and protect what you hold dear. In this case, we are trying to maintain our freedom, protect the jobs of millions of people, prevent our economy from being destroyed, while at the same time saving as many lives as we can. There will be inevitable losses, just like in any war. We do not have the option of putting this genie, this virus, back in the bottle. The goal now is to win the war while at the same time saving our country, maybe even our civilization. Such things are much more fragile than most people think.
How I will live
This disease seems to be highly transmissible, but not much more than several other viruses. We don’t have to overreact or live in fear. I am 76 years old and thus in a vulnerable group. I will try to be responsible and careful of others. But I also will live my life. If I interact with others, I might catch COVID-19, the disease caused by the SARS-CoV-2 virus (its official name). If I get it, I will either die from it or I will get well—just like many other diseases. Is this any different from making a decision to get in my car and risk death by driving on the highway? Or getting on an airplane and risking a crash? We risk death all the time. I am going to die one of these days. But I refuse to live in fear. Let us not let this enemy drive our decisions or shut down our lives. We are at war. There will be losses, and I might be one of them. That is the nature of life, which no one can change. But we can choose how we will respond to dangers—either wisely, with courage, or with fear.
At the same time, I do not want to harm others. If I have a hint of a cold or flu, I will stay away from other people. I will get tested, if I can. If I have any reason to think I might be a carrier, I will do the same. When the test is widely available, I will be tested just to be sure I am not contagious. If a vaccine is developed, I will take it. I will avoid hugging and shaking hands, and generally keep a greater distance between myself and others than I have in the past. I will wash my hands more frequently and try to create the habit of not touching my face. I will try to eat a healthy diet, exercise, and take vitamins and supplements. And I will go on with my life.
And especially during this challenging time, I will make a greater effort to help others. We can use this crisis to rebuild some of the social bonds that have frayed in our country. I will use this challenge as a reminder of the importance of humility. No one knows the right path. I certainly don’t. But I do have ideas about what seems best, and sharing these ideas seems part of my responsibility to others and to my greater community—all those I have touched and who have touched me in my life. I will use this crisis as a reminder that we each exist within a larger picture, a larger pattern that we do not understand, but which has great importance. I will try to find a way to live in greater harmony with that pattern, whose names are many but whose energy is that of love and compassion. Finally, I will try to find within myself as much inner peace as I can, and share that with others. And maybe even a little joy.
Be well, and as much as possible in this difficult time, at peace,
David
P.S. As I was finishing this essay, I happened to read an article in the NYT by David L. Katz, the founding director of the Yale-Griffin Prevention Research Center. He says eloquently much of what I am trying to say:
https://www.nytimes.com/2020/03/20/opinion/coronavirus-pandemic-social-distancing.html