Now part of the problem is that professional-quality (hospital-ready) personal protection equipment (PPE) is in tight supply. Conventional/homemade face masks or gloves may be too porous or fragile (e.g., easy to rip) and/or difficult to maintain for reuse (one reason you often see an emphasis on disposable items for health personnel); for example, Betsy McCaughey claims homemade face masks (vs industry standard N95 units) are ineffective against 97% of microbes. In the meanwhile, lockdowns are impairing industry efforts domestically and internationally to scale up to meet soaring demand, never mind regulatory hurdles and trade policies for new suppliers; China is also running into notorious quality control problems as the leading exporter. To give one example from recent news, Governor Hogan (R-MD) welcomed a shipment of 500,000 COVID-19 test kits from South Korea today (there are issues with certain Chinese test kits; his wife is Korean-descent).
There are a lot of nuances that really don't fit simple heuristics, like the 6 feet of separation rule. For example, is the wind blowing with the person approaching you? When I tweeted recently against Hogan's order mandating the use of face masks, part of what I had in mind that I have personally been unable to find N95 masks available, at least on sites like Amazon, no doubt in part to the health professionals' complaint of consumers diverting part of the supply in the midst of a industry shortage. I do have masks my RN sister has made for me, but they likely (as McCaughey points out) are unable to filter most, if any microbes I might encounter. So what's the point? Maybe it captures some larger drops of spittle, mucus, etc., if and when I cough or sneeze in the presence of others, which almost never happens. Not to mention you have to maintain masks (i.e., launder them). But over the last several weeks, I've rarely met others except passing people in the grocery store. Is it possible that I could have passed by asymptomatic shoppers or handled grocery items touched by them? Yes, but not probable. And strategies of avoiding touching one's face, especially near breathing passages, and washing one's hands can mitigate those risks.
Probably the most serious issue that the COVID-19 alarmists are seizing on is the fact that asymptomatic and presymptomatic individuals can spread the virus. The latter, individuals who eventually manifest various symptoms (common symptoms: fever, tiredness, dry cough. Others: .
aches and pains, nasal congestion, runny nose, sore throat, loss of appetite, diarrhea; shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, headache; new loss of taste or smell; emergency ones include "trouble breathing, persistent pain or pressure in the chest, confusion or inability to arouse the person, or bluish lips or face.") within 2 to 14 days of infection reportedly shed the most virus within a couple of days of manifesting symptoms. So a person may still look to be healthy but be infected and exhale virus to infect others, without telltale symptoms like coughs and sneezes; one study showed nearly half of infections spread by the infected happened during the presymptomatic stage. By some heuristics (e.g., a cruise ship case study: see Vox link below), up to half of so of the infected individuals showed no immediate symptoms but up to half of those eventually developed symptoms; some one-fifth to one-quarter remained without symptoms.
There is still we don't know much about virus spreading from asymptomatic individuals. Most of the cases I've seen documented have been of presymptomatic individuals during the symptom-free incubation phase and/or people with mild symptoms, such as CDC documented of a mildly-symptomatic (cough? fever?) family friend in Chicago who attended a funeral and subsequent birthday party which propagated a cluster of 16 infected, three of whom passed from COVID-19 complications. There does seem to be some anecdotal evidence that truly asymptomatic individuals (who do not develop signature symptoms) can infect others.
This can lead to a certain paranoia, because there is no clear way of distinguishing healthy or true asymptomatic vs presymptomatic individuals. Currently there are two types of tests (in dubious/short supply): testing for COVID-19 RNA, the genetic matter of the virus directly (this is the one most people implicitly reference); the second is an antibody check for the disease, sort of a check for naturalized immunity via COVID-19 exposure. There are a number of technical issues with the later (regarding reliability and validity). Still, some studies suggest an undercount of reported infections by a factor of 50 or more, e.g., from Santa Clara county. The "good news" is the fatality rate, artificially inflated by mostly rationing RNA tests to people showing symptoms, plummets to a fraction of a percent, still a serious multiple of the seasonal flu. For more discussion on antibody testing, see here.
Part of the problem is that we don't know much about acquired immunity through COVID-19 infection:
But not all antibodies are created equal -- tremendous variance is seen in immune system responses to different viruses. Some antibodies confer early and long-term immunity, while others take longer to develop and are short-lived, providing a limited period of protection. It's now known that antibodies produced in patients who contracted SARS, which emerged less than two decades ago and belongs to the same coronavirus family as COVID-19, confer protective immunity for several years.(There's some evidence of short-term immunity in monkey studies.) What people, of course, are focusing on is herd immunity. I haven't seen any randomized studies (to mitigate factors like selection bias), but I've seen numbers ranging from 2 to 30% infection rate across international studies. The Santa Clara rate was still below 5%. We are multiples of infections and/or vaccinated (unlikely for at least a year) to reach herd immunity.
There are some anecdotal reports of COVID-19 reinfection (i.e., the person showed negative results at the end of infection to positive results again), although the rates are fairly low and no reports of propagating infection. Obviously not knowing the interval of any immunity has an implication for testing strategy, say among employers. The costs of repeated testing (even assuming it is feasible in terms of testing supply) on a uniform basis would likely exceed benefits. You might want to focus instead on randomized testing and expand testing with significant hits.
The emphasis on "bending the curve" has to do with accommodating the capacity of our hospital systems to handle the influx of COVID-19 patients with serious health complications, e.g., admission to the ICU and/or access to ventilators. The point is that to the degree that hospitals lack the room, supplies, and/or manpower to accommodate the demand for services, we are likely to see an escalating fatality rate and who gets access to life-saving resources becomes more of an arbitrary decision. We saw this become an issue with the tragic circumstances in Italy.
One key related metric is doubling time. The longer the doubling time, the slower the rate of increase, the more sustainable the pandemic can be handled by our healthcare systems. Since we don't have tools like vaccines, we have had to resort to extreme measures, including stay-at-home, social distancing, etc., in order to lengthen doubling time, According to this model, we likely peaked on April 16, with a doubling time of about 21 days, increasing about a few hours shy of a day each day.
The large-scale shutdown of the American economy is not sustainable long-term. For a huge percentage of "non-essential" workers, many were living paycheck-to-paycheck before the shutdown with limited, if any rainy-day funds. Modest government stipend checks don't begin to address the shortfall. It's not just that, but healthcare providers have had to shift priorities, including interruptions in service for people with serious conditions, e.g., stroke, diabetes, cancer, etc. (One of my RN nurse nieces has been reassigned in the interim to other duties.) There will likely be an opportunity cost in terms of lapsed care for these individuals. Dr. Atlas, among others, has argued for a more risk-based approach to COVID-19, focused, e.g., at people with age or medical condition vulnerability associated with higher mortality risks.
The COVID-19 alarmists ominously warn of a second wave of COVID-19 if and when current shutdown regulations are relaxed, even as their models (calculated with existing restrictions) have overshot infection and mortality counts. I have gotten my own share of targeting by alarmist trolls on Twitter. My biggest mention in March got nearly 1200 impressions (I don't think I can access it to embed it, so I'll have to copy/paste it below):
@raguillem So only 3,936,000 die. A lot of people might get really mad at a #COVIDIDIOTS such as yourself. pic.twitter.com/HTqXYey5BYLet's be clear: I do see a role in society or its proxy, local government, enforcing a quarantine for public health purposes, particularly for symptomatic infected individuals, and special regulations for certain shared facilities, e.g., hospitals, nursing homes and prisons, especially with at risk populations, like the elderly or chronically ill, or large densely-populated areas or gatherings, like sports stadiums and auditoriums, public transits like subways, etc. I think it's worthwhile for employers to leverage or transition to remote computing arrangements for knowledge workers. For a good discussion of relevant issues, including the constitutionality of quarantines and state-based health regulation, see this discussion via Pacific Legal Foundation.
What bothers me is government micromanaging details to the extent of ignoring voluntary compliance and making arbitrary distinctions, e.g., essential vs. non-essential businesses/employees, which have little, to no impact on disease propagation.
Let me give two examples (arbitrary selections) to make a point over COVID-19 alarmism: (1) Rand Paul's infection and (2) the recent Wisconsin primary:
Rand Paul proactively took a COVID-19 test, tested positive, went into quarantine and has since recovered. But he came under personal attack from political whores like Sen. Sinema (D-AZ) for using a swimming pool at the Capitol while waiting for results. Let's be clear: Paul was asymptomatic. He took a test because: (1) a neighbor attacked him a while back causing him to lose part of his lung. COVID-19 is a respiratory virus, with obvious implications. He had been at meetings with reportedly positive-diagnosed presymptomatic individuals, although he didn't recall being in direct contact. He had had done a lot of travel and could have been exposed. So he took a test, never mind the political attacks of elected officials getting tests over other people. He did not expect a positive result. To date, I have not heard of a single person being infected by Rand Paul, including members of his family (at least my Google search hasn't pulled up an immediate relevant result) or other lawmakers. I'm absolutely sure if there had been, the media would have picked up on it.
The Wisconsin primary was ominously attacked as a death trap, despite over a million absentee ballots. Many Democrats argued that they hadn't gotten absentee ballots and were forced to vote in person; the Democratic governor tried to defer the primary schedule, and the courts rebuffed him. Now, maybe it's an artifact of what I've pulled up, but I couldn't find an aggregate number on how many physically voted in person (I just saw fragmented totals, like this city here and there), but I saw an estimate of 70% or so voted absentee and saw over a million absentee ballots, so quick math on the back of an envelope is maybe 475K voted in person. The point is we have seen recent headlines that some 7 to 19 people who worked or voted at the polls have been diagnosed with COVID-19. Never mind this could just be a coincidence with the people being exposed elsewhere. The main point I'm trying to raise here is even if we accept for the sake of argument the people got infected at polling places, this is a statistically insignificant percentage of those who voted in person--something the sensational media aren't pointing out.
Now let us briefly point out some examples of regulatory excess, some of which are discussed in this Reason post:
- there have been reports, e.g., in New Jersey and Pennsylvania, of asymptomatic individuals being arrested for not wearing face masks
- a woman was fined in Pennsylvania for pleasure driving, despite no social contact with others possible
- people have been arrested in New York for violating social distancing rules, actually being put in COVID-19 vulnerable overcrowded jails, never mind the fact that a large number of cops have themselves been tested positive for COVID-19
- a paddleboarder in California, out in open water, not in presence of others, was arrested.
- in Michigan, the governor put restrictions against buying/selling non-essential goods, say while on a grocery run at Walmart
- cars were ticketed in Kentucky while a few dozen passengers attended Easter services. (Never mind alarmists had spread nails on roads to discourage worshipers.)
- Mississippi worshipers were ticketed for attending drive-in church services.
- An Idaho mother was ticketed for letting her kids play in a closed playground.
I'm sure there are literally dozens, if not hundreds or more of other petty policies being implemented or enforced with little merit, if not counter-productively (e.g., jailing offenders). Just to make a simple point: people need to exercise. Why put restrictions on hiking, jogging, swimming, etc., in parks or other open places? Why are we prioritizing scarce resources like police in enforcing petty, unproductive restrictions?
I remember driving home from a recent grocery run past this poor guy, not wearing a face mask, carrying a bag of groceries or whatever, walking home alone. I was silently praying that he wouldn't get ticketed by some state trooper or cop for being in defiance of Gov. Hogan's face mask policy. I mean, there wasn't any social contact, period.
The crisis has also unmasked some burdensome regulations on business that have gotten in the way of goods and services under current economic constraints. For instance, Gov. Abbott (R-TX) has relaxed certain trucking regulations (weight, registration, etc.), including using alcoholic beverage trucks to transport food and billing restrictions on telemedicine. Boston's mayor has suspended permits for food-to-go services.
Where do we need to go from here in terms of public policy? Avoid undue complexity and restrictions, paternalism. We need more of a risk-based effort; we know particular groups of people, in particular, the elderly and individuals with challenging health issues like compromised immune systems, are most at risk for mortality. There should be an emphasis on restricting symptomatic individuals. We need to focus on voluntary compliance and provide the flexibility to businesses to reopen and operate; they have a vested interest to ensure the health and safety of their personnel and customers.
An extensive strategy is beyond the scope of this post. For interested readers, I recommend reviewing FREOPP and Avik Roy's strategy here. I've also read discussions on testing-based approaches, such as the Harvard proposal, discussed here. (I have been a vocal critic of CDC/FDA's sluggish, incompetent rollout of testing and a failure to engage the private sector from the get-go.)
