Competing Considerations

It’s evident that at least some of the optimism I have expressed in recent posts was premature. The virus now looks likely to last longer and cause more pain – both directly via illnesses and deaths and indirectly through economic dislocations – than I had expected. I remain quite optimistic in some respects, but am distinctly more concerned in others. Separating out the reasons for optimism and worry is vital to weighing likely outcomes and preferred policy approaches.

How quickly is the virus spreading (and can it be effectively contained)? Most of our current efforts (the new social distancing and partial lockdowns in California and New York, in particular) are designed to slow its spread. Based on this article (, which asserts that the number of cases in the US has been doubling every 1.75 days, it would appear that given the numbers of people who presumably already have the virus, containment efforts have largely failed – and that everybody is likely to be exposed to it in fairly short order.

Even in this most-pessimistic-scenario, the present containment efforts are important as a means of “flattening the curve”, i.e., slowing the onrush of new patients into an overburdened emergency medical system, and thereby saving many lives that could be saved with proper care. This leveling of medical demand and the prospect that in time the medical community will come up with better treatment protocols and eventually a tested-and-approved vaccine are, effectively, the justifications for shutting down much of the US economy to slow the virus’s spread. And there is every evidence that better protocols and vaccines are on their way.

Meanwhile, estimates of the lethalness of the virus appear to be falling quickly. This ( brief publication from The Centre for Evidence Based Medicine from the University of Oxford asserts that the likely CFR (Case Fatality Rate) for those who have the virus is only .14%, with virus-caused deaths concentrated heavily among elderly males with pre-existing health conditions (“comorbidities”). If this estimated CFR, which is based in part on educated guesses about how many people have the virus but are asymptomatic and have not been tested, proves to be even approximately correct, the coronavirus will come to be understood as not meaningfully more lethal than the flu.

Which, even if true, wouldn’t mean that our current efforts at containment are an overreaction. The tsunami of very ill people now engulfing our medical system in New York and California, and maybe coming soon to a place near you, is no less real for the fact that only a miniscule proportion of the general population is likely to die from the disease. Think of it this way: if half the people in critical care for the virus die (a data point from the University at Oxford study), and everybody in the US gets the virus more or less simultaneously due to the disease’s rapid rate of spread (which nobody expects, but go with me on this), that would mean that about .3% of the US population – or about 1 million people – would need critical care at the same time – far, far exceeding the medical system’s capacity to provide such care. Effectively, we would have a traffic jam – with lots of fatalities from the jam itself – at the nation’s hospitals.

Nobody wants that, and even the young, who are largely impervious to the disease, presumably don’t want grandpa to shove off prematurely (and I write that – hopefully – as a grandpa), so the American public is presently all for aggressive containment efforts. This consensus won’t last.

The non-medical factor that is increasingly becoming acute is that the containment efforts are causing severe economic damage – and that damage will become ever more severe as the lockdowns continue. The stock market has lost roughly a third of its value over the last month, reflecting fears of the economic chaos that will follow the now-likely bankruptcies of many small and midsize businesses and changing consumer patterns that will threaten large companies in several sectors of the economy. These might sound like immaterial, paper losses, but their effects on millions of Americans are already being felt via layoffs and completely unexpected economic insecurity.

Even as I write, the government is figuring out how to effectively print lots more money to help those in the most need; this (like the containment efforts) is an entirely understandable policy response, but it’s at best a band aid. People need jobs, more than one-time hand-outs – and jobs are being lost.

We all hope that the curve will be flattened enough through the lockdowns, better hygiene and social distancing so that the medical system can get through the present rush of severely ill patients without underserving those most at risk, but irrespective of the magnitude of the immediate medical system crisis, the economic imperative of keeping the economy going will force us to open for business again soon.

The show must go on.

M.H. Johnston          

3 comments to Competing Considerations

  • Dcs  says:

    I’m not sure that there is a consensus even now for the containment efforts. I’ve encountered lots people who think the threat is overstated and the response is overblown.

    What are your thoughts on what will happen once whatever consensus there is starts to unravel?

    Is civil unrest a possibility? How might this all influence the election?

    • M Johnston  says:

      Civil disobedience will grow by the day, but I see that as quite different from civil unrest. I have no idea how it will affect the election, though I must say that I find it hard to believe that the American public will seriously consider electing Joe Biden.

  • Anonymous  says:

    Lovely optimism that there might still be an election

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