In my novel, The Cendovian, Professor Richard Nelson and Dr. Pari Kallalaprakesh-Francis seek to the power for humanity to escape into a digital world in the event of something like an unstoppable pandemic. While such fictional digital transcendence capabilities do not exist today, nor is the current coronavirus pandemic one that will wipe out humanity, I feel compelled to ask what are we doing to ensure the long-term sustainability of humanity.
We as a world are taking extreme measures to combat this novel coronavirus. And we all hope that these measures are successful. I sure do. But what constitutes success? I have not seen a lot of discussion of this in the news or social media. I think it’s time we define this. If we do not, we could end up sheltered in place with many people out of work for months or even years.
We risk pushing ourselves into the Second Great Depression if we lack a long-term strategy. As Americans, we have become accustomed to being in a long, protracted war with no end in sight. But unlike our military wars, which the public largely forgets in their daily lives, this battle with covid-19 is unavoidably at the forefront of everyone’s minds. So let’s make sure we have a way out.
When do we reboot?
The world has engaged in a massive shutdown. So, when do we start rebooting the world? Here are some possible answers:
1. Reboot only when covid-19 has been completely eradicated?
I don’t believe this is a realistic answer. As much as I would like to believe we can quickly eradicate covid-19, there is no precedent in human history for quickly eradicating a disease that has caused a pandemic. In theory, if everyone in the world voluntarily self-isolated for the incubation period of covid-19, 14 days, and then anyone with symptoms continued to self-isolate until recovery, we could eliminate the disease. Complete isolation would eliminate all means of transmission. However, such extreme isolation in a world of nearly 8 billion people that depend on each other is practically impossible, not to mention possibly more harmful than covid-19. So, if our strategy is to wait for complete eradication to reboot the world, then we will be waiting way too long.
2. Reboot only when we have a cure?
If a widely-available cure arrives quickly, then great, we reboot the world. And while we should invest in seeking a cure, look at how many diseases we have been attempting to cure for decades without success. Don’t expect a quick cure to arise. At least, our strategy should prepare us for a very long road towards a cure. And while I’ve advocated for minimally invasive measures such as self-isolation for those who can do so to work from home and washing your hands, its the highly invasive measures that we have taken that are not sustainable without major impacts to many peoples lives and livelihoods. Will we keep schools virtual for all of 2020? Or until we find a cure that may never come? Will all countries close their borders permanently until we find a cure? I don’t think we should wait for a cure to start rebooting the world. That is too extreme. If the mortality rate was like ebola, around 50%, I might think differently. But the covid-19 mortality rate is much lower.
Some may think I’m making a heartless calculus. Some will say we should do whatever it takes to save every life. And while I wish for no one to die, as a world we have not operated this way in the past. We have not “done whatever it takes” to eradicate any other disease. Why? Because largely unknowingly we make these cold calculations in our choices all the time. We have to accept the world has trade-offs. Pretending these trade-offs don’t exist is not a strategy. Unfortunately, this is why economics is called the dismal science. The sooner we accept this harsh truth, the sooner we can move forward with devising an effective strategy. We have to seek optimal trade-offs.
3. Reboot only when we have a vaccine?
A vaccine may come sooner than a cure. But we are hearing from the CDC that the best case scenario is about 18 months. Now what if it turns out that covid-19 is not seasonal like the flu? Do we keep the world shut down for 18 months? How many will suffer because of these measures? How many lives would we save? And how much suffering of others are we willing to trade for those lives? It’s impossible to know the answers, but we have to make our best guesses in a world of imperfect information when devising a strategy. My belief is that if we keep the shutdown we have in place for 18 months, we will enter the Second Great Depression and billions will suffer.
But if we return to normal, how many more will die? This is where some will raise the concern of exponential growth rate of the number of infected. This is a valid concern. We talk of flattening the curve. Well, I can assure everyone the curve will flatten. Exponential growth distributed among a finite population cannot sustain exponentially. Assuming those who recover gain immunity, once the whole world gets infected, the curve will necessarily flatten. There will be no one left to infect.
Of course, when people say flatten the curve, they mean flatten the curve at a low number and quickly. We have seen this happen in China, although they fear a second outbreak. And flattening of the curve will likely happen in the next few months in many more countries before infecting their entire populations. All of these curves will become S-curves.
Now suppose it is seasonal. We might get a break during the summer only to have the coronavirus blossom in the fall. Do we then return to the global shutdown? If that is our long-term strategy until we have a vaccine, we could face many years of seasonal global shutdowns. This long-term toll on the world economy will lead to great suffering, most especially for those on the margins. To the dismay of the utilitarians, there is no way to objectively measure this suffering. But in my judgement, this suffering would be greater than the number of additional deaths.
So, I don’t think the criteria for a reboot should be the arrival of a vaccine. I also don’t think it’s a dichotomous decision. We have more choices than either a complete worldwide shutdown or an immediate full return to the old ways. We can return with some changes in place, some compromises.
4. Reboot when we have a treatment that brings the mortality rate to an acceptable number?
This is more practical and what we do for every other disease. Yes, covid-19 is more contagious and lays dormant longer than many other diseases. But still we must ask, what is the acceptable mortality rate for covid-19? It’s a horrible question to have to ask. As I certainly, no one wants anyone to die. But people die every day and the world keeps going. It’s sad, but it would be sadder if the world did not keep going.
I don’t know what the acceptable mortality rate for covid-19 should be. But it’s what we should be discussing as a society in order to devise a collective, worldwide strategy. Perhaps the answer is less than one percent.
5. Reboot when we have sufficient medical capacity to address surges in cases?
I completely understand taking some extreme short-term measures involving self-isolation and changing behaviors in order to help our hospitals and medical system deal with massive surges in cases. If my staying home reduces the opportunities covid-19 will have for transmission, and that in some small way helps hospitals avoid being overwhelmed, I’m all for that. And as many of us do this, all of these small contributions add up to a large contribution.
But I am fortunate that I work in software development and completely do my job from home. Not all are as fortunate. So our long-term strategy should involve putting preparations in place for spikes in cases to allow our medical system to keep up. This means having enough reserves of supplies readily available, and plans for transferring reserves to areas most in need. The supply challenge, while hard, is still probably easier to solve long-term than having enough hospital space or personnel. And in the end there will never be infinite capacity. So, some spikes will overwhelm local capacity.
Ideally, we would have pre-defined criteria for each local health system that triggers emergency measures in each area. For example, we could say that once hospitals are running at 85% capacity during an outbreak, we institute phase 1 of containment practices (perhaps cancelling large gatherings). If we hit 95%, we institute phase 2 of containment practices (perhaps making schools virtual). I’m not proposing any specific here, as I’m not an expert in this area. But I know that our strategy should have these pre-defined reactions in place. It seems instead like we have been winging it with each local government making judgement calls using different criteria, criteria that was often not defined in advance. That doesn’t necessarily they made the wrong calls, but it means that it’s harder to instill confidence with the public that we are prepared and are following our well-thought out strategy to deal with epidemics.
My Suggested Reboot Criteria
For our public discussion, I suggest that our strategy involve rebooting the economy as soon as we have reached the acceptable mortality rate. We need to as a society start discussing what is an acceptable mortality rate. This is not an easy discussion. But if you say it’s zero, that is a hard position to defend in light of how we treat all other causes of death. Perhaps we should look to the flu as a reference. The mortality rate is estimated to be somewhere between 0.04% and 0.16% in the US this season so far, resulting in 23,000 to 59,000 deaths as of March 14, 2020. The CDC doesn’t have perfect data, so their estimates have wide ranges. https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm
Our strategy should also detail at the local and national level how we will respond to surges in cases, including preparing for indications of upcoming surges. The latter is particularly important when faced with diseases like covid-19 that have long incubation periods. Small numbers of cases might still be predictors of rapid impending local surges.
What does a rebooted world look like?
I think it is likely we will have to accept covid-19 becoming an endemic in all nations. Covid-19 is unlikely to go away anytime soon. Like all diseases, we will have to find our best way to limit its spread and limit its impact, while also keeping the world running. There will be compromises. Right now we are making drastic compromises in the short-term. But the compromises will need to be less drastic for the long-term sustainability of humanity.
Maybe more people will work from home as the norm. Maybe we will all do a better job of washing our hands. Hand shakes might become less frequent. Social distancing might change some of our norms. Of course, humans are social by nature and we want human contact and human closeness. So, like changing any habit, sustaining changes will be hard.
Even if we find a vaccine or cure, just like the flu, covid-19 could mutate into a different strain. So we still need to prepare a long-term strategy for dealing with these types of outbreaks. We need a strategy that limits their spread and limits the total human toll.
How do we accomplish a reboot?
The world’s central banks have rushed in firing nearly all the monetary policy tools they have. Federal governments of many nations are throwing fiscal stimulus at the coronavirus problem, drastically increasing the debt burdens in a way that cannot be done every year. Yet, I still don’t think it will be enough to fully cushion us from the economic toll. Perhaps, it won’t be anywhere close to enough. Time will tell.
State and local unemployment systems will be overwhelmed by a spike in jobless claims. We are already starting to see this. There are just too many sectors impacted by this global shutdown. I’m not opposed to bailouts with the right terms or even to direct payments to those in need. These can help to some degree if done effectively. But even if done optimally, they can’t do it all. The economic impact is just too big.
Those less impacted will have to help reboot our local economies. And many are doing this already by ordering food for takeout or delivery so that some restaurants can keep paying their employees. Much more of this will be needed for the rest of the year. Private initiatives will be needed to supplement public initiatives in order to get us back on our feet.
Thankfully, I live in the U.S.A., one of the most philanthropic nations in the world. We rally together in times of crisis and we help our fellow men and women. We will need to do this again. For all those posting #StayTheFuckHome and #FlattenTheCurve, I hope that you will with equal fervor support the efforts to #DefineTheCovid19Strategy and to #RebootTheWorld in both word and deed.
