Several weeks ago, I wrote about a plan for us to get back to normal. Now that politicians are finally starting to talk about this issue of re-opening the country, I thought this would be a good time to review my plan.
My plan consisted of two steps: the first was the lockdown of hard-hit cities, until the infection rate got low enough. The second was to create a permanent environment of R0 less than 1 using a variety of measures, with extensive testing to provide feedback on their effectiveness. I believe that this is the best way forward.
Re-opening the economy is tricky. In some sense this is the hardest part of the overall plan. In comparison, lockdowns are easy. They're hard to get wrong. They're simple to implement and they work. But getting things wrong for the re-opening can send us right back to square one.
And yet we must re-open - and sometime soon. Perpetual lockdowns over many months are simply not an option. Human lives are meant to be spent in powering human activity. The "lives or economy" question has always been a false dichotomy. If we get out of this, it will be because we'll have harnessed our economy to save lives. Essentially, we've absorbed the impact of the virus by sacrificing a part of our economy, to buy time for the other parts to find some solutions. Conversely, poorer countries, which could not cushion the virus's blow with their economy, are suffering - and they need our help. For all these reasons, we need to get our economy back.
Under my plan, there are three conditions that must be met before lifting the lockdowns: they are 1) low enough numbers, 2) extensive testing, and 3) measures to reduce R0. These are measures that you've already heard of before - things like washing your hands and keeping 6 feet apart - along with more involved measures like contact tracing. They're also the most important of the three conditions: if we get this right and keep R0 under 1, then we will eventually win, regardless of the other two conditions. If we get it wrong and R0 stays above 1, then we will lose, again regardless of the other conditions.
Recently, governors of various statements have made some statements about how they'll make the decision to re-open their state. And yesterday, the White House released a more detailed plan for how we should re-open the country. Go ahead and take a look at those links: The remainder of this post will be a commentary on this plan, and I'll assume that you know what's in it.
Here are some of the things that I like about the plan:
I like it that it implements much of the same personal hygiene and social distancing measures that I floated in my plan.
I like that it's in multiple phases, with defined conditions for advancing to the next phase. This mimics the core negative feedback loop in my plan, where the testing results determined whether we can add or lift additional measures.
I like that it's local, allowing for one state, county, or city to be in a different phase than another, as I suggested the example for my plan. After all, it makes little sense for California to be still locked down because New York still has a high case number. Dense metros are very different from rural communities and should deal with this pandemic differently.
I like that it's flexible, with the governors of each state having broad latitude in its implementation. This is well in keeping with the multi-phased and local nature of the plan. It also provides for the governors and other local leaders to address some holes in the plan, along with some some other things that I didn't like so much.
Here are some of these things that I found lacking about the plan:
I think it should ask more of the individual citizens. For example, face masks (homemade ones are fine) should not be optional: they could have the potential to stop the virus single-handedly. Personal measures like these can have a huge effect on reducing R0, without impinging much on our comfort or freedoms. Similarly, face shields, like the one pictured to the right, are cheap, easy to wear, and effective. They could be made locally at a grassroots level. Any such efforts - cheap, easy measure that anyone may take to effectively reduce R0 - should be encouraged.
Remember, keeping R0 below 1 is the most important thing. This point should have been very strongly emphasized.
I think the possibility of going backwards in phase should be made more explicit, including the possibility of going back into lockdown. Of course, if any city needs to go back into lockdown for a month, someone will have really dropped the ball. But the tight link between the people's behavior and the progress through the phases - whether forward or backwards - should be made explicit to everyone, along with the expectation that people will be asked to be more or less vigilant depending on how the numbers are changing.
The specific numerical conditions seem poorly defined. How much testing do we need? How low does the infection level need to be to re-open a city? In my previous posts, I said that we'll need to detect infection levels at a 0.01% resolution, because that is about the level when we need to consider locking down the city. This was under the assumption that nothing is being done, so there is some leeway here when we're taking all these additional measures.
To detect the virus at a 0.01% resolution requires testing about 10,000 people. In a city of one million people, that would mean testing 1% of the population. So "enough testing" here can be roughly understood as testing 1% of the US population fairly regularly - every week or so. Currently, the US testing capacity seems to be about 1 million tests per week, in a population of 330 million people, which is about 1/3 of what's required. But this is only an estimate, we can perhaps do better than random testing, and our testing capacity continues to ramp up - so I think I'm not too worried about the testing. There's of course more work to be done, but I believe that testing will not be a significant factor in holding us back from re-opening the country.
What about the infection level? What's "low enough"? Well, as more and different kinds of tests come online, it becomes harder to fix a certain number for the required infection rate. So let's look at deaths instead: the probability of dying in a car accident in a given day is about 3 in 10 million. Once your risk from the virus is at or below this level, you can re-open the area in question. For my state of California, with its population of 40 million, this translates to 12 coronavirus deaths per day in the whole state. In fact we can open a bit earlier, since deaths are a lagging indicator of infections. So for California, opening up the state - with possible local adjustments - near the beginning of May is quite reasonable. Other parts of the country will of course be opened at different times. I would say that, as a rule of thumb, if there's less than 1 death per 1 million people in your city or state, that's when you should consider re-opening.
So that's my overall opinion on the re-opening plan. It's not bad. It has many key features from my plan, and while it does have some deficiencies, the fact that it's quite flexible means that state and local leaders can fill in those gaps as necessary. In fact, that responsibility goes all the way down to the individual - to you. As we start re-opening parts of the country in a few weeks, please do your part: take all the standard measures, and do anything else you can that will reduce R0 below 1.
You may next want to read:
Coronavirus endgame: how we get back to normal
The coronavirus pandemic: status report on the United States
Another post, from the table of contents