Cautions On Reopening

Yesterday I ran two posts that were mostly the work of others, both of which focused on the pandemic. AG Bill Barr, in his interview with Hugh Hewitt, spoke to the need for a more targeted response to the pandemic--we can't shutdown forever. We need to come up with some strategy for managing the undoubted risks of "reopening" the country. Ways for managing the risks on an individual level--but with implications for society wide risk management--were discussed in Saving Your Health, One Mask at a Time. The good news is that practical precautions are available, but the caveat is that if those precautions are not taken we could face highly unpalatable alternatives.

Today I offer articles that highlight the serious nature of the Wuhan virus, lest we forget that the risks we need to manage are very real risks.

The first is from The Atlantic:

Why Some People Get Sicker Than Others

COVID-19 is proving to be a disease of the immune system. This could, in theory, be controlled.

The article does get into a fair amount of detail about the more technical medical aspects of the fight against the virus. Here I want to use the more anecdotal, impressionistic, general excerpts to lead you to read the rest. To begin with, the author offers a personal account to remind us that "recovery" from COVID-19 is neither smooth nor rapid--because this isn't just an ordinary disease:

The COVID-19 crash comes suddenly. In early March, the 37-year-old writer F. T. Kola began to feel mildly ill, with a fever and body aches. To be safe, she isolated herself at home in San Francisco. Life continued apace for a week, until one day she tried to load her dishwasher and felt strangely exhausted. 

Her doctor recommended that she go to Stanford University’s drive-through coronavirus testing site. “I remember waiting in my car, and the doctors in their intense [protective equipment] coming towards me like a scene out of Contagion,” she told me when we spoke for The Atlantic’s podcast Social Distance. “I felt like I was a biohazard—and I was.” The doctors stuck a long swab into the back of her nose and sent her home to await results.   

Lying in bed that night, she began to shake, overtaken by the most intense chills of her life. “My teeth were chattering so hard that I was really afraid they would break,” she said. Then she started to hallucinate. “I thought I was holding a very big spoon for some reason, and I kept thinking, Where am I going to put my spoon down?” 

An ambulance raced her to the hospital, where she spent three days in the ICU, before being moved to a newly created coronavirus-only ward. Sometimes she barely felt sick at all, and other times she felt on the verge of death. But after two weeks in the hospital, she walked out. 

Three days in the ICU and then two weeks in the hospital in a special ward--that's a lot of medical resources for one person. So far California seems able to handle the level of disease that they're experiencing, but we do well to bear in mind the intensity of care and the level of resources that are demanded to fight this virus. This is a major reason behind social distancing--to prevent an unmanageable flood of cases. This is what modifications of our risk management strategy have to take into account.

COVID-19 is, in many ways, proving to be a disease of uncertainty. According to a new study from Italy, some 43 percent of people with the virus have no symptoms. Among those who do develop symptoms, it is common to feel sick in uncomfortable but familiar ways—congestion, fever, aches, and general malaise. Many people start to feel a little bit better. Then, for many, comes a dramatic tipping point. “Some people really fall off the cliff, and we don’t have good predictors of who it’s going to happen to,” Stephen Thomas, the chair of infectious diseases at Upstate University Hospital, told me. Those people will become short of breath, their heart racing and mind detached from reality. They experience organ failure and spend weeks in the ICU, if they survive at all.

Meanwhile, many others simply keep feeling better and eventually totally recover. ...

For those affected, it's really serious. Low percentages don't tell the real story. Very low percentages can still overwhelm a health care system if the cases occur rapidly enough.

“There’s a big difference in how people handle this virus,” says Robert Murphy, a professor of medicine ... None of this variability really fits with any other diseases we’re used to dealing with.”

... As Murphy puts it, when doctors see this sort of variation in disease severity, “that’s not the virus; that’s the host.” Since the beginning of the pandemic, people around the world have heard the message that older and chronically ill people are most likely to die from COVID-19. But that is far from a complete picture of who is at risk of life-threatening disease. Understanding exactly how and why some people get so sick while others feel almost nothing will be the key to treatment.

At this point the author gets into the meat of the article--how COVID-19 is a disease of the immune system that is still not understood but which attacks multiple organs. He also gets into the tradeoffs that some promising--or simply available--treatments involve. I highly recommend the entire article.

Again, the question is how to manage these risks:

Our Pandemic Summer

The fight against the coronavirus won’t be over when the U.S. reopens. Here’s how the nation must prepare itself.

Note that the author isn't arguing against reopening. He's arguing against complacency and in favor of targeted risk management:

... the dozens of experts whom I have interviewed agree that life as most people knew it cannot fully return. “I think people haven’t understood that this isn’t about the next couple of weeks,” said Michael Osterholm, an infectious-disease epidemiologist at the University of Minnesota. “This is about the next two years.”

The pandemic is not a hurricane or a wildfire. It is not comparable to Pearl Harbor or 9/11. Such disasters are confined in time and space. The SARS-CoV-2 virus will linger through the year and across the world. “Everyone wants to know when this will end,” said Devi Sridhar, a public-health expert at the University of Edinburgh. “That’s not the right question. The right question is: How do we continue?”

Next, Michael Snyder via Zerohedge. Yes, I know that Snyder makes a living off predicting disasters, but bear with me. Here's the link to Snyder's article:

Is The "Second Wave" Of The COVID-19 Pandemic Already Here? (And Is It Worse Than The First?)

There's no possible way for me to intelligently assess whether a "second wave" is starting up. Snyder is extrapolating from limited data. He may be right, he may be wrong. However, just as expert opinion warns of a continuation of the the pandemic over a span of years, others are specifically concerned about next year. Thus, Snyder cites the recent statement by CDC Director Robert Redfield:

A second coronavirus outbreak could emerge this winter in conjunction with the flu season to make for an even more dire health crisis, the director of the Centers for Disease Control and Prevention told The Washington Post in an interview. 

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” CDC Director Robert Redfield said in a story published Tuesday. 

“And when I’ve said this to others, they kind of put their head back, they don’t understand what I mean.”

Redfield actually offers some recommendations for mitigating that possibility, in line with Devi Sridhar's caution: "The right question is: How do we continue?”

"We're going to have the flu epidemic and the coronavirus epidemic at the same time," he added, predicting a dual assault on the health care system. 

...

To have both the flu and the coronavirus circulating at the same time could overwhelm hospitals and doctors' offices that are already stretched thin in a bad flu season. 

... 

... Redfield called for state officials to spend the next few months preparing for the next phase by continuing to tout social distancing and scaling up testing and contact tracing.

Looking ahead, Redfield cited the need for a preventative campaign to emphasize the importance of flu shots to reduce flu hospitalizations. He said that getting a flu vaccine "may allow there to be a hospital bed available for your mother or grandmother that may get coronavirus."

In the past I've suggested that COVID-19 may "piggyback" on the flu. That appears to be the idea behind Redfield's cautions. In the linked blog I cited Steve Sailer on rates of vaccinations by age groups both in the US and in European and Asian countries. It's not a systematic study, but it does suggest a correlation between flu vaccination rates and prevalence of COVID-19 illness--illness, not just the presence of the virus. That correlation may actually explain discrepancies across age groups. The overall point is that infection with the flu lowers one's immune system. That's a welcome mat for a serious case of COVID-19. Given our high flu infection rate, we want to avoid that, so a high profile vaccination campaign is another really practical step we could take--because the US has enormous scope for improvement in that area, especially in the most socially active ranges of its population. And don't throw your masks away.

If this long blog seems too negative--especially for those waxing enthusiastic about recent studies that are claimed to minimize the severity of the pandemic--here's an article that addresses those studies, finds hope in them, but ends on a similarly cautionary note--Evidence That the Virus Is Much Less Deadly Than People Feared Weakens the Case for Maintaining Lockdowns:

Those projections [of high death rates in the general population] also assumed "no intervention," referring not just to lockdowns but also to narrower regulations as well as voluntary precautions such as hand-washing, using face masks, limiting social interactions, avoiding crowds and working from home. It was never realistic to imagine that Americans would simply carry on as usual in the face of the COVID-19 epidemic. 

Policymakers right now are not choosing between lockdowns and nothing; they are choosing between lockdowns and less costly, more carefully targeted measures. That choice should be informed by evidence that undercuts their worst fears.

Finally, a link to an article that offers an example of what public officials ought not do in this pandemic: Andrew Cuomo’s coronavirus nursing home policy proves tragic.