About 10 years ago, I was on a telepresence meeting at Amex in one of our conference rooms, meeting with people from another Amex office. After the call, I was told that a colleague had been diagnosed with H1N1 which we were still calling Swine Flu. He had been sitting right next to me during the meeting, trying to scoot away as he coughed into his fist. He was quite visibly ill, and we all urged him to go home. While I didn’t catch it, none of us did, it was probably my closest known encounter with a pandemic.
A week ago today we were flying back from SLC where we had intended to do a campus tour of UVU with our graduating daughter during her spring break. While guided tours were cancelled, self-guided tours were still possible, so we opted for that instead. The campus office gave us a map, some brochures, and some swag, and socially-distantly sent us out to walk around the empty campus. We had flown up the prior Saturday and aside from our campus tour, restaurants (which were still open at the time), grocery store stops, and seeing family, remained mostly quarantined in our airbnb during our stay. The country was not yet in full lockdown mode, and the information changed every day. When we left home, the airport parking lot was mostly full. When we returned, it was only about a third full. Our car looked lonely in the parking lot surrounded by empty spaces.
Every day feels like a month in terms of the information unfolding and the mood changing due to the Covid 19 pandemic. While we’ve experienced pandemics as a country, this is the first time we’ve had a widescale effort at social distancing. There are two stresses under discussion that partly run counter to one another:
- Health. Saving as many lives as possible through social isolation to “flatten the curve” to reduce incidental deaths due to hospital and equipment capacity gaps and unnecessary exposure.
- Economy. The longer we shut down commerce and force people out of work, the longer it may take to recover, and the more small businesses will permanently close (leaving their employees jobless).
In essence, the shorter the lockdown, the less the overall impact to the economy, but the higher the death toll due to overcrowded hospitals. Different countries have tried different solutions:
- China quarantined known hotbed areas in Hubei province (population 58.5 million). As a result of these measures, China has only had 56 cases per million citizens, and only 2.3 deaths per million. (Italy has had 100 deaths per million and over a thousand cases per million by contrast). China has also weathered through much of the crisis (or at least the first wave) as only 6.3% of their known cases are still active. (In Italy, 79% of cases are still active as of March 23. In the US, 98% of our known cases are still active–we are just at the beginning, meaning that known Covid patients have mostly not resolved yet).
- South Korea got ahead of the curve using very early broad testing of the population and tracking and linking cases to limit further exposure. It is too late to implement this approach in the US as they started this well ahead of us in their pandemic curve. We are already in the middle of it, particularly in densely populated areas.
- Some countries wanted to quarantine only those vulnerable, the elderly or those with a compromised immune system; however, there are many vulnerable populations, and some who don’t know they are.
- Some have suggested just lifting restrictions and letting the disease run its course. The problem is that there will be many incidental deaths as hospitals are overrun.
Our current response is to do a halfway lockdown, encouraging people to be socially distant (usually defined as 6 feet away from others, no groups larger than 10 people–unlike what is modeled in press conferences, BTW), letting people make their own decisions, and letting state governors make their own decisions about enforcement and guidelines. On some level, state oversight makes sense; each state is almost like its own country to some extent in terms of population density, reliance on public transportation, etc. Epidemiologists warn that this halfway approach will prolong the time the pandemic lasts and will stretch out the negative impacts to people and businesses. Trump seems convinced that after 15 days, we can go back to normal life, but the data show that we will still be very much in the grip of the pandemic in 15 days, and social distancing keeps too many from getting sick at once, but people will still get sick, and the curve will rise again if we increase social contact.
Some states, particularly with larger metropolitan centers are taking a much stronger stance on lockdown. Some are calling this a liberal state approach. Some are saying it’s an overreaction. When you watch how senators and representatives use social distancing, it appears that there is a partisan divide in how seriously these individuals are taking the pandemic. Conservatives tend to feel the response is overblown, and liberals tend to feel the response is recklessly insufficient.
What would I do if I were calling the shots at a national level? Here are my initial thoughts.
- Extend Medicaid for all immediately. Having employment tied to healthcare in this type of crisis is untenable and inhumane. People are literally losing their jobs due to the pandemic which means they are also losing their insurance at the exact same time. That’s a moral failure.
- Randomly test populations to determine asymptomatic infected rate. This is one I haven’t heard many people talking about, but it makes a lot of sense to me. We don’t know how many asymptomatic people are out there, infecting others because they do in fact have Covid 19. Some reports state that up to 70% of us will get it with 80% of those infected being either mildly symptomatic or asymptomatic. This information is vital to know how much social distancing and isolation will be required. I would randomly identify people, similar to how jurors are selected, and have 300 people in various locations tested as well as surveying them about any possible symptoms (fever, aches, respiratory, appetite, etc.) That information would inform policy decisions about increased lockdown.
- Use schools, churches & hotels as temporary hospitals. While schools are suspended or moving online, we have buildings available to be used as temporary hospitals. These are already property of the state. Churches can be requested as voluntary spaces for the same, given that it is humanitarian work, and vacant hotels can be “leased” through a stimulus bill that covers the costs.
- Immediately uptrain “medical adjacent” people and other volunteers to assist in care. Here I’m thinking of people like dentists, veterinarians, pre-med students, etc., who are willing to perform the semi-dangerous work of caring for those with Covid 19. I would identify and train them to handle the more routine care aspects to free doctors and nurses up to handle the work that only they can provide. At bare minimum, we can also train students and others to do the lab work to get the tests done on a wider scale. As I’ve said elsewhere, I’m surprised some enterprising South Korean company hasn’t already created a quick-turnaround spit kit to sell to Americans to test for Covid 19 for $20 a pop. People would pay for that!
- Create rapid manufacturing channels for medical protective gear. This could be done by various businesses and be pretty easily replicated across the country if we got a template, created a local quality control process, and obtained correct materials for the manufacture (or distributed requirements to the state level to oversee). States could use federal funding directly to those businesses willing to manufacture these items, which offsets some job losses as well. This type of work could be done in the home, following set guidelines and using approved materials.
- Create rapid manufacturing channels for respirators. If this is a war, we need to be in the business of manufacturing the weapons of war immediately. Pay companies who can build them to build them. Get a clear number we need based on expert projections (which require bullet #2 to get to, IMO).
- House all homeless in now vacant hotels. Several states are attempting to do this quickly as the first person to die of Covid 19 in CA was homeless, and this is a much higher risk population due to exposure, lack of access to handwashing, and lack of insurance coverage. As part of any stimulus package, I would have the government literally buy out hotels which would help that industry, but would also provide housing that states can convert to housing for homeless (requiring staff to support the same).
- Direct significant research money toward a cure. This is one that Trump seems to feel is the most critical. It’s certainly the best narrative he could stumble upon: the US innovated its way out of a crisis. It makes our country’s health care system look like the best. It makes him heroic. It literally saves the world. That’s not the same as spouting off about drinking aquarium cleaner as a cure, which is obvious to most of us (but apparently not Trump).
- Keep schools and churches closed until we can clearly see that the pandemic has passed. Both of these can be replaced with online options in the near term, at least for the remainder of the school year, and possibly longer if necessary. I was intrigued that so many of the cases in Asia originated in Christian churches! That’s largely due to the way a Christian church service happens with a group of people all together sitting side by side with others. Not a great option for social distancing. Who among us has never been coughed on at church (or passed the bread tray down the aisle which might as well be eating off the same plate with 50 people)? 
The economic funding problem is incredibly difficult to solve. Some ideas:
- Fund businesses directly for up to one month if they are unable to operate due to Covid 19 impacts, under the condition that all employees remain on payroll for that time. They would have to provide proof of revenues and payroll to make that work. It gets complicated pretty quickly. However, many people have already been let go.
- Send everyone a check for $1000 every month this continues. The problem is that businesses will still fail because people aren’t making the same types of purchasing.
- Reimburse businesses for the cost of moving to telework. This was how we spent all of last week, buying laptops and headsets that work with laptops, and then hours on the phone with Cox troubleshooting the routing issues to get the calls to go to their various homes.
Let’s hear your thoughts:
- What would you do to get the pandemic under control if you were in charge?
- Where do you fall on the economy vs. health scale?
- How long do you think we can maintain social distancing as a society?
- What do you predict going forward? When will schools and churches resume? When will restaurants re-open? 
 Kudos to the Church for a quick response in canceling church services. I know in my ward people are locked down like it’s the zombie apocalypse, which basically it is. They are willing to leave groceries on someone’s porch, but that’s it.
 I predict Trump doesn’t have the stomach or the will to maintain even this level of lockdown as long as necessary. He’s hinting at lifting restrictions on Easter already.