Tuesday, March 24, 2020

Pandemic lockdown must fail: Saving lives without crippling the economy


My most honored readers: This is an unusual blog post for a most unusual time. I have written a paper which critiques the ideas of social distancing and lockdowns as a response to the current coronavirus crisis. It is titled, "Pandemic lockdown must fail: Saving lives without crippling the economy." Below is the introduction to the paper. I provide a link at the end to the full paper. If you are worried about the current response to the crisis and some of the ideas in this paper resonate with your thinking, please pass the paper on.

Larry Hirschhorn: lhirschhorn@cfar.com  267-970-3579


Introduction

The Harvard School of Public Health has released an extremely important study on the coronavirus pandemic in the U.S.[1] I will refer to this study as “HS” in the rest of this paper. It is the result of simulating, at a county-by-county level, the beds we will need to treat all the patients who are hospitalized. The headline: In six months, 99 million people will be infected and 21 million people will need 1.3 million beds. This is the fundamental challenge we face. As the infection spreads and people get sick, we risk overwhelming our healthcare system, threatening patients and healthcare workers alike. Of course, while beds are necessary they are not sufficient. We need more healthcare workers and more ventilators. But without beds we are nowhere.

This is, after all, why we are practicing social distancing. We want to slow the down the infection’s spread, to “flatten the curve” in the current parlance. But as everyone acknowledges, if social distancing—with its associated lockdowns—succeeds, we risk bankrupting many small businesses that are the backbone of our economy and employ 34% of the workforce. Our living standards will be compromised. Failure follows success.

In the following working paper, I want to make a plea for what I am calling a “reverse quarantine”—quarantining people who are over 65 (who number 52 million), before they get sick. We need to complement this policy with federally funded and locally organized efforts to support seniors in place, drawing on the wellsprings of American pragmatism, the capacity to respond in emergencies, American volunteerism, and neighbor-to-neighbor assistance. We can’t turn quarantine into imprisonment. We must work as hard as we can to create a psychological sense of community at a moment when, paradoxically, social distancing is driving us apart. This may be utopian, but in the presence of disaster, hope can be motivating.

Why do this? If the elderly stay in place this will both reduce deaths, as seniors are the most vulnerable, and reduce the number of people who can transmit the infection. We reduce the total burden on the health system. With the burden eased, we can let the virus spread more quickly, knowing that we have the hospital beds and equipment to help them. This would shorten the economic downturn leading to fewer business bankruptcies. After all, within the year, everyone who can be infected will be. The challenge that bedevils and threatens us, should we find no resolution, is to match pacing with the requisite supply of beds. In this note I provide the data and its analysis to back up this argument, to the best of my ability. I hope the latter was up to the task.

This note is organized into six sections. In the first section, I introduce the HS and reproduce within the limits of my Excel modeling tools, their projection. In the second, I argue that social distancing will in all likelihood fail. We will have few of its benefits and most of its costs. In the third, I draw on a long theoretical tradition that connects long bouts of unemployment to deaths. I suggest that if social distancing provokes a long economic downturn, between 28,000 and 68,000 people will die in the years following the crisis. In the fourth, I briefly describe the Chinese and South Korean strategies for coping with the crisis. I argue that their successes are based on their distinctive culture and politics. We can’t use them here. In the fifth, I use a range of data sources, starting with HS, to estimate how many beds are “released” by quarantining seniors. I estimate that we can reduce the number of new beds we must build or re-purpose by over a million if we quarantine the elderly, decrease the length of stay in non-ICU beds, and repurpose current hospital beds. This may be an overestimate—a best case scenario—but I believe that the estimate is within an order of magnitude correct. In the sixth, I outline the rudiments of an American plan for tackling the crisis acknowledging that it may be still-born, with so little time left. It combines a war-economy with local initiative. I end with a plea that we expand the discourse about the crisis beyond the language and frameworks of the public health discipline. We need the voices of engineers, business leaders, economists and project managers. If we ever needed a “systems view,” it is now.

Link to full paper:   

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