We are in a public health crisis, an economic crisis, a crisis of self-confidence. If this isn’t an existential crisis, I don’t know what is. The overwhelming majority of us will come out of this, as will the country. But to assert so is neither reassuring nor compassionate for those who won’t, and for those mourning those who haven’t: more than 1,000 in the United States, 22,000 around the world, an untold number ahead. They are the focus now. As New York Governor Andrew Cuomo put it this week, “It is about the vulnerable. It is not about 95 percent of us.”
But it isn’t a zero-sum game. It isn’t about either protecting the vulnerable or protecting the economy. It’s not even about what failed weeks ago when this could’ve been handled better. Every country failed at one point or another. It’s about immediate and continuous action, about correcting what was done poorly or not done, and about reducing failures from here on, managing public health and the economy.
We’re heading into Great Depression territory that can cause immense and lasting harm. Steps can–and are being–taken to amortize the economic calamity. Congress is beginning to do its job in that regard, emphasis on beginning. The $2 trillion emergency bill isn’t perfect, but it’s not about the details right now.
And no, we are not in uncharted territory. This isn’t the world’s first pandemic, nor are responses to pandemics a mystery. Even with coronavirus , we have the experiences of half the world and the pathologies of 20,000 deaths to go on. Scientific studies about it are being written at a rate of 300 a week in an unprecedented world-unifying effort by scientists. There’s a glut of charting. How to control, corral and delay the virus’s lethality, even if it can’t be defeated yet, is no longer an unknown. The question is how much are we willing to do to get there, with how much clarity and seriousness.
The answer at the moment, especially on a day when the United States surpassed every other country, including China, with known cases of Covid-19, is not encouraging. The current response in Florida and across much of the nation is often haphazard and contradictory, too often reliant on voluntary measures, with decisions at times ideologically poisoned and immune to more professional advice. The patchwork of responses, especially in Florida, is resulting in more damaging and stretched-out half-measures when harsh but more temporary measures may be more effective. I say may be: Nothing is certain, but some things are more certain than others, and in the end, this is not about speculative opinions, politics or unemployment figures. It’s about actuarial probabilities: the if and when of who will die of Covid-19.
A lockdown may have never been necessary had the outbreak been tackled with the required tools at the outset, as it was in South Korea and other Southeast Asian countries after some bungling. But several factors now make a lockdown more necessary, not less, even after two weeks of unenforceable recommendations to stay in place.
First, enough people are shrugging off stay-in-place recommendations, amplifying transmission risks to everyone else. Second, the massive amount of testing capabilities that’s been promised is still nowhere near what it should be. In Flagler, testing is barely in the dozens a day, if that. Consequently, the extent of continuing infections is nowhere near known. Third, lack of real data on infections means it’s all guesswork in Florida and elsewhere: what the peak of the epidemic will look like, how many people will be infected, how many people will be hospitalized, how many will die. What we do know is that every day of inaction or half-measures populates the grimmer actuarial tables.
With Italy’s, Washington’s and New York’s experiences in front of their eyes, it’s easy to imagine the people running AdventHealth Palm Coast and other regional hospitals being terrified at the half measures the communities around them are taking, when every community should be asking itself one question: what must we do to keep our hospital from being overrun. The hospital is not the bunker. Every community should act like a bunker around its hospital, protecting the hospital from the kind of invasion New York hospitals are experiencing. We’re not doing that. We’re nowhere near doing that. It’s nice to donate supplies. It’d be more responsible to behave with the hospital’s viability in mind.
The only absolutely certain way to get a handle on the disease before it spikes to runaway hospitalizations is near-universal testing on the South Korea model, which also has the benefit of making lockdowns unnecessary. So imagine this. If Flagler County today received 100,000 testing kits and had the capabilities to test almost everyone, it would do so. It could then map out precisely where the disease is, who must be isolated, and who doesn’t have to be. Once the county does that, and depending on the extent of the contagion, it could theoretically reopen schools, businesses, governments and community organizations because it would know precisely where the virus clusters are. It would then maintain vigilant monitoring and residents would stay cautious, but the county would not shut down. That was the South Korean approach, where even social distancing was less drastic, where schools and businesses never closed, and where the economy was not crippled. (It’s the South Korean model in its simplest form anyway: there was a lot more to it, the “contact tracing” alone being pushed to a marvel of investigative wiles, but also with some intrusions in private lives: in a pandemic, there is no choice).
This is not pie in the sky. It’s essential, basic necessity. Ultimately and absent a vaccine, preventive screen-testing, as opposed to the extremely limited diagnostic testing we have now, is the only way the virus can be mastered. Even then, it’s not a cure: flare-ups are inevitable (as those same Southeast Asian countries and China are detecting now in a second wave of the virus). But by then we’ve bought the necessary time to counterattack and make the battle more manageable, to allow our hospitals to care for Covid-19 patients and others equally without rationing care or risking collateral deaths (as when an ambulance can’t get to a heart attack patient in time because it’s too busy caring for a Covid-19 patient, or disinfecting the rig after picking one up). By then we’re not talking pandemic anymore, but outbreaks. They’ll be disruptive, but not in the realm of lock-downs and recessions.
That’s unfortunately not where we are for now. We missed that chance, and more people will die because of that. So the only other option without universal testing is a hammer-like lockdown until widespread testing is here. We have to buy time. We have to drastically reduce infection rates. We have to protect our hospitals. We know what we have to do.
That should not be months. It should be weeks (in France, the timeline now is six weeks), if the state and the nation get serious about rolling out testing kits like food in a hunger emergency or bullets in a war. Otherwise, we’re gambling with catastrophe, and Cuomo is not exaggerating when he says conditions in New York are potentially in every community’s future. We are in this together. It’s not a slogan, but a responsibility: We’re all draftees in this war. Let’s all fight accordingly.