Coronavirus: Herd immunity may be our best bet to protect the vulnerable
Here is what the next few months will look like in the United States.
I’ve done research for my entire career, first at a big bank then at a healthcare tech company. Research is when you listen to people a hell of a lot smarter than you and then try to piece together a bigger picture. It’s like putting together a puzzle when you have no idea what the end result should look like. It’s challenging, but if you do it right, you get a brief glimpse of things to come…
I’ve been researching COVID-19 and its socioeconomic impact for the better part of the last two months. And the puzzle that is coming together is scaring me witless. And even yet, I have friends and family who are trying to brush this off. I frequently hear phrases like “It’s no worse than the flu” (it is), “This will all blow over soon” (it won’t), “I bought toilet paper and I am all set” (you are most certainly not).
I want to walk you through what will happen in next few months in the U.S. This is fairly simple and does not even require much imagination on our parts, because we have fantastic leading indicators on this disease and its impact. Namely, China, Iran, Italy and South Korea.
Schools will close down. This has already started happening. And once they close, they may well not open until next September (if then).
Social gatherings of all sorts (from concerts to sporting events to birthday parties) will get cancelled.
People will stop going out to dinner, to the movies, to get a haircut. Small businesses will suffer greatly, some will close down permanently. And take note: Small businesses account for 44 percent of U.S. economic activity.
Flights will be cancelled en masse. Our borders may also close indefinitely. Even if our borders do not, many other countries will close their borders, de facto creating the same isolation.
As a last measure, entire cities (NY, LA, SF, Seattle leading the way) may go on lockdown. No one in. No one out. We hopefully have a ways to go before this happens, but make no mistake, the CDC has the right to quarantine any city at any time.
We will of course experience vast shortages in unexpected items as supply chains get interrupted. We live in a global economy and much of what we have come to depend upon is partly manufactured elsewhere. From iPhones, to medication, to diet coke , to wedding dresses — things are going to become harder to locate and purchase.
Meanwhile prices of those same items will skyrocket.
(I won’t even mention the stock market, other than to say that soon Trump will no longer have it as a rallying cry for his re-election. We are most certainly heading below 2016 levels.)
This list may sound like fear-mongering, but I swear to you it is not. This is all just an unavoidable consequence of the ride we are all unwillingly on.
And I haven’t even come to the crux of why I am so scared yet.
Which is this:
First, the fact is that the US is very much NOT like China, Italy, or South Korea. All of those countries, for better or worse, have some aspects of socialized medicine. Meanwhile, the US has 30 million uninsured Americans and another 11 million that are underinsured. That means as of now, for these people, every test, every hospitalization will be out of pocket.
Additionally, America has an at-will employment policy and more recently it has been moving towards a gig economy. That means for the majority of people, their employers can fire them at will, or they themselves can quit at will. That they only make money as long as they work. And worse, they only have insurance for as long as they are employed. Do you see where I am going with this?
Think of your job. Think of your own situation. What will your family do if your children have no school, no camp for the next six months? Will you or someone in your family have to scale back work to be home with the kids? Do you even have that option? How long will the restaurant keep employing you as a server if they have no customers? How do you earn money as an uber driver if everyone is stuck at home? Will you go get that tickle on the back of your throat tested if you have no insurance? Can you afford to be under quarantine and not working for 2+ weeks?
Now extrapolate. Apply your own answers to the millions of people around this country. Apply it to all the single parents, uber drivers, restaurant servers and the 30 million people without insurance and the 16 million people who are self-employed. The scope of the damage that is coming is unparalleled and is about to expose the festering underbelly of not having adequate social safety nets in place. It’s gonna get ugly.
Second, let’s touch on the virus itself. Let’s assume that the leading epidemiologists in this country are right. That this thing will sweep the nation and that 20% to 60% of us will be exposed at some point. Let’s also make a wild assumption that this thing is not nearly as deadly as 3.4% that the current numbers suggest it is. Let’s put the actual numbers (once testing becomes widely available) at .1 to 1%. What is undeniable is that many of the people who are sick are going to head to their local hospital, whether they should be there or not. And some of those people (about 10%) will absolutely need intensive care in order to get better.
The American Hospital Association says the total number of intensive care unit beds is about 65,000. (But that number can be doubled in an emergency.) The demand for those beds is going to range somewhere between 200,000 to 2.9 million depending on how quickly the virus spreads. Even by the most conservative estimates, by the end of May, the US is going to run out of hospital beds for critically ill patients. It is also, coincidentally, going to run out of respirators and face masks for its front line health care workers. (As a nurse or a doctor, will you continue going to work if your hospital does not provide you with protective gear? And how long can our healthcare system function if the frontline nurses and doctors are getting sick?)
Third, and finally, take a look at how all of this ultimately winds down, where fears go away and parents feel safe enough to send their kids back to school and book vacations and eat out at restaurants. The first is a vaccine. Experts suggest that this solution is 1 to 1.5 years out, not even accounting for worldwide distribution. The second is effective treatment. This is a dubious goal at best seeing how the yearly flu has been around forever and we have yet to crack the code on treating it. The third is herd immunity. Herd immunity occurs when large proportions of the population are immune to a disease through vaccination or in this case, recovery from infection. If many of us got sick and then recovered, we can then be the herd to protect those of us who cannot afford to get sick.
So here is my proposal: In so far as work is expected to continue as normal, and schools are not closed across the United States and the government refuses to shut it all down, then maybe those of us who are young(er) and healthy need to expose ourselves to this virus sooner rather than later by not limiting our social interaction, by not cancelling birthday parties and trips, by living our lives as we normally would. With any luck, most of us will be fine. Even with today’s current inflated death rates, those under 40 have only a .2-.4% risk. We then will be able establish herd immunity for those of us who cannot afford to get sick with this disease…anyone over 60 and with underlying illnesses. We need to save our hospital beds, our ventilators, all our medical resources for those who will truly need them down the line. I mean, you should still wash your hands, cause the alternative is icky. But maybe don’t worry so much about getting the virus itself. Think of it as a social good. You getting it and recovering can create a barrier around your 90 year old grandma. (Just be sure to strictly self-isolate while in recovery.)
So what next? Here is what I told my family:
- If you are over 60, or have underlying complications, and the means to self-isolate, please do so. Batten down hatches and ride this out. If you can travel (by car) to somewhere warmer/more isolated for an extended period of time, do so. Please take this seriously. Stop hugging and kissing your grandkids. Stock up on food that you can prepare for yourself and just hide from the world.
- If you are under 50, and healthy, I believe the best thing you can do is go about your daily life while practicing social distancing as much as you can. (Btw, social distancing is a myth for as long as schools are open and people are expected to go to work).Yes, you may catch the coronavirus sooner rather than later. At current infection rates, it’s almost inevitable. Just remember though if you are one of the unlucky few that needs medical treatment, it’s far better to be hospitalized now than in April/May. Trust me on this.
- Expect major disruptions in your daily life no matter who you are. Figure out who will take care of the kids. Hint: it should NOT be your 60+ year old parents. Put some money in your rainy day fund. Talk to your employer about their sick-leave policy. Look at refinancing your home (mortgage rates are crazy low).
- Corona-proof your small business. Institute no-touch policies. Have your workers proudly display their temperatures if touching can’t be helped. Offer no-cost deliveries. Protect your employees. Apply for federal grants and small-loans. Take advantage of whatever help is available to keep your business afloat and your workers paid.
- Help your neighbors and help your friends. Help those in self-isolation by getting them whatever they need so they do not have to venture out. And for the love of all that is good, please don’t hoard more than what you can reasonably use in a month or two.
I have enormous faith in my friends, family and humanity. We will get through this and come out the other side better for it…
