Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, said Sunday that Americans must prepare to “hunker down” to avoid a worst-case scenario with the rapid spread of the Chinese coronavirus. Nevertheless, plenty of skeptics are asking if coronavirus is “something” or if it is “nothing.” That’s the wrong question to ask. And asking the wrong question leads you to the wrong answers.
Of course it is something, but what is it? That’s the question we need to answer.
I know that people reading this will fall broadly into two groups. The first group, which is strongly represented among political conservatives, maintains that coronavirus is nothing or, if not precisely nothing, then it is asymptotically approaching nothing. For them, it is as real as the Fusion GPS dossier on President Trump.
Then there is the other group. These are people who are concerned that an outbreak in one or more American cities that goes undetected and thus uncontained for too long could cause a repeat of the Wuhan or Northern Italy scenario. Those scenarios followed roughly the same pattern: the virus went largely undetected due to a lack of testing capacity and soon became widespread before public health officials could act.
This led to a surge in hospitalizations that overloaded existing resources and spiked the number of fatalities as well as the fatality rate. That’s why the delay in increasing testing capacity in the United States until the past few days has been a cause for concern. The Wuhan virus should not have a high mortality rate, but when left unnoticed and thus unchecked it can spread and lead to deaths of people who would be able to recover if they’d had proper treatment.
The scenes from Italy have been horrible. By Sunday, Italy had nearly 25,000 confirmed cases, more than 1,800 deaths—and 368 of those deaths came in the prior 24 hours. That single-day death toll exceeds the worst day China ever reported.
And the Italian situation appears to be worsening. Mauro D’Ambrosio, a nurse at Fatebenefratelli Hospital in Milan told Euronews that ICUs are dangerously overburdened. He says the average stay in ICU for a patient who has developed COVID-19 as a result of infection with coronavirus is 15 days compared with an average ICU stay of 5-6 days. Another nurse, speaking on condition of anonymity said that “Anesthetists—despite them playing it down a little bit on the media—have to choose who they attach to the machine for ventilation, and who they won’t attach to the machines.” And Dr. Roberto Cosentini told the Italian newspaper La Repubblica, “If this new wave does not subside, the health system is heading towards collapse: triggered by what we can compare to a natural catastrophe,” he said.
When there are more patients than resources, for example, more patients who require intubation and a ventilator, than there are ventilators, then doctors have to choose who gets a treatment that under normal circumstances would be available to any and all who needed it. And then the fatalities shoot up.
That’s the situation we’re trying to avoid. The way to do that is to slow the spread so that the virus is either arrested or makes its way through the population slowly rather than quickly. This video created by the CDC is a helpful illustration.
It does us no good to make comparisons about deaths from the seasonal flu or deaths from auto accidents. That’s beside the point. Taken even at face value, the “it’s just the flu” argument points to a dangerous scenario. The United States has averaged over 400,000 hospitalizations from the flu every year. And in a country with very little excess hospital capacity adding another 400,000 hospitalizations from a second virus—which is what the “it’s just another flu” scenario implies—would over-tax the system and lead to more deaths from conditions that would normally be treatable. As a point of comparison, the United States has 2.8 beds per thousand while Italy has 3.2, China 4.3, and South Korea, which has done an excellent job containing their outbreak, has more than 12 beds per 1,000.
That means that we must be honest about what type of threat coronavirus really is. Data to answer that question is emerging every day. What we’re learning is that coronavirus is not a highly contagious form of SARS or MERS that will kill tens of millions. That horrific scenario—conceivable, if unlikely, during the first weeks of the outbreak in Wuhan—is off the table. But it remains a real public health threat that doctors and scientists are trying to quantify.
In America, we are fortunate, as we have been throughout our history, to be separated from Europe, Asia, and Africa by two large oceans. They are a buffer that, in this case, means we are dealing with our outbreak after Asia and Europe so we can learn from their experience.
Dangers and Opportunities
At present, coronavirus presents three main threats:
- The potential for a public health crisis that leads to mass fatalities. For example, this particular coronavirus becoming a second, additional virus in our population causing as many or even more hospitalizations and deaths than the seasonal flu. At the moment, our system isn’t built to take it.
- An economic contagion that causes a significant systemic breakdown or long-term destruction in a particular industry, region, or worse, the whole country or globe. This is likely to be the most widespread consequence of virus and the responses to it. But a slowdown, even a major slowdown, while painful, is something from which we will recover if not hampered by bad policy or mass death. If history is a guide, the former is more of a threat than the latter.
- Bad policy. There is an almost irresistible temptation for policymakers to “do something” and many of the incentives combined with the preexisting condition of bad ideology will militate toward bad policy. We do not, for example, want the government to create a “temporary” surveillance commissariat to monitor everyone’s body temperature or anything like that which could become a permanent fixture in American life. Think of the prospect of an agency equivalent of the TSA but patting you down every time you venture into public. Its logo would be a fist encased in a latex glove.
Each of those threats requires a distinct, discrete response, but they are also so intimately intertwined that policymakers and the people who advise them need to be aware of unexpected correlations and unintended consequences.
There are also opportunities, which I will address at greater length later, but they relate to rebuilding our manufacturing base, rationalizing our supply chains, becoming more self-sufficient and thus anti-fragile as a nation, reforming work and education to allow for more of both from home, and the necessity of solutions to this and future viral outbreaks based in new science and technology.
Avoiding the worst-case public health scenarios means two things: slowing the spread and increasing the availability of mass testing to identify infection clusters and contain them. This plays into the economic impacts. Uncertainty is a killer, both literally and figuratively. When doctors can’t make a decisive clinical diagnosis it makes it harder to treat and harder for public health officials to make good decisions. So what do they do? They err on the side of caution.
That’s one of the reasons we’re seeing mass closures of, well, just about everything. And people become hesitant to go out or even to make plans for the near future. That’s a big hit to the economy. But with more certainty, people can make better decisions and start to resume their normal lives. Fortunately, new tests became available at the end of last week that will begin to make an impact. Most important of these is the test developed by Roche that increased the nation’s testing capacity by a factor of at least 10. To illustrate the importance of testing, consider that Italy has nearly 25x the dead compared to South Korea which did 9x more testing than Italy. Korea learned a hard lesson from the 2015 MERS outbreak that temporarily tanked their economy.
The big economic news of the past few weeks has been the massive sell-off in the stock market. But bear in mind that stocks had been on a 12-year bull run, a portion of which was the result of a lack of sound money exemplified by the massive amount of liquidity pumped into the economy by the Federal Reserve which has nowhere to go except into financial assets. The lack of better investments than financial assets is a subject for another time, but holders of those assets can take some solace in the fact that when the coronavirus is brought under control—and it will be—the world’s central banks remain committed to printing massive amounts of currency and they will, as night follows day, find their way back into financial assets and the people and industries that benefit from the Cantillon Effect will continue to do very well.
Reasons to Take Heart
In the meantime, we should not treat the Wuhan virus as a death sentence as some of the media’s breathless, overhyped coverage—for instance dramatically releasing daily increasing tally numbers of confirmed cases—seems to suggest it is. It’s not. The caseload is useful information and newsworthy, but bear in mind that in 80 percent of the cases they’re reporting are of people with a mild cough and a fever who will fully recover in a week or so. How about also reporting with equal alacrity the number of recovered patients?
More than anything, we should take heart. Mankind is strong, resilient, and endlessly resourceful. Our bodies are wonderfully made and adapt to viruses and build immunity over time. And when that is insufficient, we use our God-given reason to create other solutions like vaccines and therapeutic drugs. Remember that the bubonic plague killed something like 30 percent of the population of Europe. It now kills less than a few hundred worldwide every year.
Whether one thinks this virus is especially nasty, contagious, and deadly, or is an overhyped version of the flu, realize that time is on our side. And while the world takes an unexpected, unwanted pause, use that time wisely.
Kids are home from school. Concerts and sports and movies are canceled. People are keeping to themselves. Don’t let this time be a waste or even a burden. Enjoy the time with family even in spite of any additional burden it may create. If you’re home from college, do something. Anything. And check in on folks you know who are lonely. Facetime them, they’d love to hear from you!
A friend who grew up in Beirut during their civil war has been very encouraging. He says he remembers huddling in shelters with his family while bombs were falling sometimes for days, with no water except what they had filled in containers and bathtubs. There was no electricity and food was scarce. But they encouraged one another, they played board games, and they prayed. They continued to live.
We are, mercifully, far, far from that sort of situation. We should remember that—and we should learn from their example.