Courage? It’s In Short Supply

Will our elected officials ever have the courage to talk honestly about COVID-19? That is the question asked by a reader who despairs over the countless millions of lives being devastated by governments’ shutdown orders:

Here’s one of the crazier features of “expert guidance” as governors try to lay out criteria for reopening their states. With the exception of the Deep South governors (who are taking variable stances), it seems that most governors want to see declining counts of positive cases in the state.

But everywhere we have tested a whole population (a ship at sea, all the women coming in for delivery in NYC, everyone in a Boston homeless shelter), the finding is that a majority (often a large majority) of infected people are asymptomatic. Aren’t “experts” aware of this characteristic of the disease? It has been widely reported for weeks!

What this means is that confirmed cases is hugely problematic as an indicator – it just can’t tell us much about how or where the disease is spreading. If we do more tests, we’ll find more positive cases. We started out only testing the most severe cases and ones with ties to Chinese travel. Now tests are more plentiful, so more people with mild symptoms are being identified as positive. But even if we are picking up modestly more of the symptomatic cases, we’re still missing the asymptomatic cases. Given how many people have mild or no symptoms, that’s most of the cases!

Case counts just don’t provide meaningful epidemiological information under these conditions. Why can’t experts seem to see this?

The original goal of the lockdowns was to bend the curve to bring it within the system’s capacity. That has clearly been achieved! There continue to be empty hospitals all over the country, bleeding money and furloughing staff. So to gauge the status of the situation in their states what governors really need to be looking at is hospital capacity. What is the trend there? Is there sufficient slack for a surge of COVID? Those are the key questions for public policy.

One can think about it in this simple way: the virus doesn’t disproportionately strike nursing homes relative to other institutions. It’s just that when it reaches a nursing home, it has a devastating effect. But the fact that it’s gotten into so amazingly many nursing homes around the country just means that it has gotten into an amazingly large number of institutions and households all around the country. Most of the time the virus’s spread is very stealthy, because it doesn’t make most of those infected very sick or even sick at all. But it is lethal for particular subgroups, especially for frail elderly in nursing homes

What this tells me is that the virus cannot be contained via contact tracing, etc., because it’s too widespread already. We don’t (and won’t) have the capacity to test everyone everywhere anytime in the foreseeable future. We must recognize that the idea that the virus can be stamped out entirely is quixotic at this point. The question should be on how to manage the disease. We have to accept that it is here, part of our environment. We have to figure out how to have a functioning society while we live with it. Will the experts and elected officials ever have the courage to tell people the truth about the situation?

Contact tracing works for sexually transmitted diseases because most people can remember the names of those with whom they have had sexual relations. But it is useless to “contact trace” in the context of COVID-19, or any respiratory virus, by asking people whom they rode the subway with, or who else may have been in the grocery store at the same time they were there.

If you read carefully, you can figure out that all the epidemiologists–as far as I know–say that CIVOD-19 will continue to spread, over time, until enough of us have had it to confer herd immunity. The percentages I have seen range from a low of around 25% of the population to a high of 80%. This is true regardless of how long the shutdowns last. The curve no longer needs to be flattened, so the shutdowns no longer have a coherent purpose, but have taken on a life of their own.

Will the “experts” and elected officials ever have the courage to tell people the truth about the situation? No. And the less said about our hopelessly corrupt press, the better.