Discussions on how to deal with the pandemic — at both the government policy level, as well as individual businesses decisions — have included ongoing debates about the tradeoff between the economic pain of extreme suppression measurements (i.e. shutting down of borders, schools, 
businesses, events, quarantining, etc.) vs. the human suffering and death caused if measures are not aggressive enough and/or not implemented for a long enough period of time. While knowledge about COVID-19 is being rapidly accumulated, there are still many unknowns, making it difficult to predict exactly how different courses of action will play out.Nevertheless, now that the cat is out of the bag (i.e. opportunities for early containment have been squandered)1 it is usually depicted as an either/or — either we take extreme measures that hurt the economy, or we suffer extreme loss of life.
These are incredibly important policy decisions — with the stakes on both sides of the equation incredibly high. Economists at the Federal Reserve warn that if the current rate of job losses continues, unemployment could reach over 30%, higher than the worst joblessness rate at the peak of the great depression (which reached ~25%). At the same time, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, said their models show between 100,000 and 240,000 people in the US are likely to die from COVID-19, if we do all the right things — with up to a million or more deaths if we are too lax.2
So, I was very interested to read a perspective on how we might be able to control this outbreak and minimize deaths, while experiencing short-term economic pain, but then easing off enough to get the economy back up and running (not normal, but much closer to normal) while we implement longer-term fixes. I highly recommend reading the article, Coronavirus: The Hammer and the Dance — What the Next 18 Months Can Look Like, if Leaders Buy Us Time.
The article outlines the current situation, the various options we have, and recommendations for the best strategy. Some of the highlights from this piece: “Countries have two options: either they fight it hard now, or they will suffer a massive epidemic. — If we fight hard now, we will curb the deaths. We will relieve our healthcare system. — All of this will achieve something critical: Buy Us Time. If we choose to fight hard, the fight will be sudden, then gradual. We will be locked in for weeks, not months. Then, we will get more and more freedoms back. It might not be back to normal immediately. But it will be close, and eventually back to normal. And we can do all that while considering the rest of the economy too.”
Figure 1 – Suppression vs. Mitigation vs. Do Nothing — Chart 13 from “The Hammer and the Dance”
The article goes through a lot of data and analysis, which takes some effort to absorb, but is well worth it. It shows how if we do nothing (or not enough) the healthcare system will be overwhelmed. The number of patients needing ICU (Intensive Care Unit) care could be 50X to 100X the number of ICU beds actually available. That means critically ill patients not receiving care and dying in large numbers. It shows how social distancing alone will not be enough and why aggressive suppression is necessary. It explains that a suppression strategy followed by a return to business-as-usual will be an invitation to a second wave of deaths that could be as bad as the first.
It is not all doom and gloom. The article explains that aggressive suppression buys us time to develop capabilities such as mass testing and tracing, manufacturing of many more ventilators, masks, and PPE, and finding effective treatments. It talks about R (the transmission rate) and how, once suppression has controlled the initial wave, we only need to keep R below 1, which should entail only a modest disruption to normal life. My short summary here does not do justice to the topic, so if you are interested, I urge you to read the full piece.
Why We Must Act Now
The piece outlined above is the second article in the series. The first one, published on March 10th — Coronavirus: Why You Must Act Now — Politicians, Community Leaders and Business Leaders: What Should You Do and When? — is a call to action for business, political, and other leaders to take immediate, swift, decisive action. His summary is as follows:
The coronavirus is coming to you.
It’s coming at an exponential speed: gradually, and then suddenly.
It’s a matter of days. Maybe a week or two.
When it does, your healthcare system will be overwhelmed.
Your fellow citizens will be treated in the hallways.
Exhausted healthcare workers will break down. Some will die.
They will have to decide which patient gets the oxygen and which one dies.
The only way to prevent this is social distancing today. Not tomorrow. Today.
That means keeping as many people home as possible, starting now.As a politician, community leader or business leader, you have the power and the responsibility to prevent this.
You might have fears today: What if I overreact? Will people laugh at me? Will they be angry at me? Will I look stupid? Won’t it be better to wait for others to take steps first? Will I hurt the economy too much?
But in 2-4 weeks, when the entire world is in lockdown, when the few precious days of social distancing you will have enabled will have saved lives, people won’t criticize you anymore: They will thank you for making the right decision.
The article also explains the different public policy responses — containment, mitigation, and suppression — for the different phases of the pandemic. Containment is most effective early in an outbreak. It involves identifying, controlling, and immediately isolating all cases. It requires aggressive early testing, isolating each positively tested person. Then tracking down each person that the infected person has been in contact with during the incubation period. And isolating and monitoring those contacts as well. It is too late for that kind of containment in the US — we were not prepared with testing capabilities, nor did we mount the kind of proactive swift response that was needed.
Mitigation and suppression are similar with mitigation being a less drastic approach. Both include aggressive testing, quarantining, and some measure of social distancing. With suppression, the measures go further, to closing of schools, venues, and distancing of the entire population.
If you are a business leader, I urge you to read both of the above articles and take these into consideration when making decisions about the best path forward. In addition, you may want to look at Coronavirus’ Impact on Supply Chains.
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1 With 20/20 hindsight, the US and other nations could have taken the outbreak much more seriously much earlier to avoid a lot of the current economic pain and deaths. If we had taken a number of actions much earlier — much more swiftly doing proactive testing on a mass scale, isolating and treating infected patients, and tracing and quarantining of their contacts — then the virus spread could have been contained with relatively little economic impact. We know this by observing the results in the few countries, such as South Korea, Hong Kong, and Singapore, that did take such actions. However, at this point, that is all ‘coulda, woulda, shoulda’ — we are where we are and have to deal with the new reality. — Return to article text above
2 SeeCoronavirus May Kill 100,000 to 240,000 in U.S. Despite Actions, Officials Sayand Dr. Birx predicts up to 200,000 U.S. coronavirus deaths ‘if we do things almost perfectly’ — Return to article text above
To view other articles from this issue of the brief, click here.