• Unfortunately, no. When people go back to work, the virus goes with them. As long as the Rt (infection rate) remains above 1.0, it will spread faster than our ability to contain it. It is impossible to keep an economy functioning when so many people are infected and spreading the disease.
• When you are dealing with an exponential situation like this virus, the appropriate response is to OVERREACT. Because it doubles every week when we are not social distancing, we must react when we see the earliest signals. For example, when 2.5% of ICU bed capacity is used in any one region that would be time to act. It will seem extreme. It is not.
• Check the timelines. Often they are not specified, or they don’t extend very far into the future.
• McKinsey published a 9-cell 3×3 scenario matrix showing recovery pathways under different assumptions of viral control. There’s no timeline.
• Letting infection proceed unchecked is potentially economically, psychologically, morally and politically devastating.
• While social distance shut-downs have projectable economic and health costs, unchecked pandemics do not.The costs of a decision could be orders of magnitude higher medically, economically, psychologically and socially if unchecked.
• This bet would be all–in: No do-overs, non-reversible.There’s no way back because we have no pharmaceutical weapons and no infrastructure to detect or halt the virus.
• With no weapons to fight it, this could run tragically amok.
• Such a decision would be irresponsible at this early stage. Just as you would never jump off a cliff without knowing how far you would fall, one would never make such a call unless one had a very good idea of the eventual downside risk. We would need to have an understanding of the following variables, all of which are completely unknown, before even considering such a course of action.
• The range of possible outcomes spans orders of magnitude.
Total COVID-19-related mortality rates worldwide are uncertain, but global deaths on the order of 1–2% of total population—75 to 150 million people in 2021-22—would be a plausible first guess.
• Healthcare services would be utterly overwhelmed, which in turn would further undermine our ability to fight it.
• Any large mobile population can trigger a brutal pathway that envelops the world.
• In addition to a staggering death toll, we don’t know yet what long-term health effects there might be, or whether the immunity achieved would even be significant. And we do know
that there would be huge damage done to systems by the speed of such a die-off: healthcare, governance, finance, manufacturing, social services, democracy—everything really.
• COVID-19’s true fatality, reproductive and mutation rates are still unknown.
• So far, researchers have discovered that the virus causes not only respiratory disease, but also attack the entire circulatory system and many organs in addition to the lungs. The heart,
brain, liver, kidneys, and intestines are thought to be targets.
• The degree and duration of herd immunity after infection are unknown.
• There’s evidence that people have recurrent bouts of the disease, either from new infections (meaning poor immunity) or from reemergence of the same infection (meaning the virus is persisting, hidden, in the body)
• There is no scenario in which we will have the herd immunity needed for us to relax strict social distancing before some irrevocable and previously unimaginable personal and economic
and losses will have taken place, or a vaccine has been deployed.
• We can minimize the damage by maximizing the management: testing, contact tracing, precision quarantines, precision social distancing, travel control, and enforcement as necessary.
• Imagine that every employer (private-sector and public-sector) can be scored by how vulnerable their operations are to infection, and also scored by how essential their operations are to the “war effort” to protect our health and economy.
• Operations that are quite essential but not very vulnerable to infection will be encouraged to be as open as possible.
• Operations that are equally essential but unfortunately vulnerable to infection will be given assistance revising their operations to minimize risk.
• Operations that are not particularly essential but also not very vulnerable will be subject to market forces.
• Operations that are vulnerable but not essential face a bleak
future unless they can innovate their way out of vulnerability on their own.
• Our old normal is probably gone for good. We need to establish a new normal that restores, as much as possible, the benefits of the old normal, in new ways.
• Until we achieve herd immunity via a vaccine that has been successfully administered to at least 84% of the population, social distancing will be required, and our social and economic lives won’t feel normal.
• We need to adjust our time horizon substantially farther out.
I have read about lots of things that are happening that will make this situation better. Will those change your assumptions?
• I heard there may be treatments that will ease the problem before we get a vaccine.
• Yes, there may be, and they may help reduce suffering and death. These are necessary and important benefits, but not sufficient to control the virus or reopen economies by
• Won’t we be most of the way there once we get an antiviral cocktail?
• Antiviral cocktails can be powerful allies, as they are, for example, in controlling HIV-AIDS in countries with advanced healthcare systems. However, this is a far more infectious virus that will potentially infect many times more people than HIV, many beyond the reach of antiviral cocktail therapy.
• I heard that the FDA is reducing rules that may have slowed the process in the past. Might we be able to achieve a successful vaccine in 12 -18 months?
• Even streamlined rules and accelerated review processes can only partially reduce the time required to step through the trials necessary to determine safety, efficacy, and scalability. It would be a huge achievement to produce a successful vaccine in 18 months, and that assumes maximum safe FDA collaboration.
• Historical time frames for vaccines: The RNA platform vaccines have never been successful and never scaled up.
• I have done this 6 times successfully (average development time has been 9.2 years(!) and I am better than average) and I failed
• three times with malaria and once with Ebola and once with Zika.
• We still do not have any coronavirus vaccines (there are 7 strains).
• We know nothing yet about how this virus will respond to the selective stress of a vaccine–how readily it might mutate to evolve around the vaccine.
• We also need to include time to vaccinate sufficient people to get herd immunity. How many people is that? In a perfect world we would need to vaccinate 54% of the population. Given two complicating factors for which we must account–anti-vaxxers and infected bridge populations entering into the community–we will likely need 84% vaccination levels to prevent all outbreaks.
That is 275M people. How long will that take? For a vaccine approved by late 2021, best case would be February 2022, but a more likely case would be November 2022.
• We assume that we’ll get about 70% public acceptance, which takes into account the American preference for high individual privacy and freedom.
What assumptions do you make that are different than those being made by folks who believe that as long as we keep super-spreader events to a minimum and make other mobility sacrifices, that we might muddle along without an invasive program of testing, tracing, and surveillance?
• We believe that the only way to control the virus enough to restore significant economic activity is with precisely-timed impositions and relaxations of social distancing, applied carefully to different economic sectors. Without the data that is only available from
testing and surveillance, such precision is impossible. Badly-timed shutdowns and reopenings could quite easily make the situation worse and spin the virus up at frightening speed.
• Significant, but not full, economic recovery for the US is possible by Q4 2020, but with many caveats. We could get close to 80% recovery by year end IF:
• We do not have a big rebound of new cases.
• The virus is does not mutate into a significantly new form.
• Federal stimulus is timely, very substantial, and includes funds
to build a COVID-19 infrastructure.
• If any of these assumptions does not hold then we could be in for extended delays
• Extended delays will undermine consumer confidence, making economic recovery harder even after control of the virus is achieved.
• YOU HAVE TO ASSUME EVERYONE CURRENTLY HAS COVID 19 and protect yourself.