Optimal Strategy for Confronting the Coronavirus Pandemic in the United States

When faced with a viral pandemic there are only two logical strategies that can be pursued.

1. You can try to prevent anyone from becoming infected. You can attempt to prevent herd immunity by getting the virus to die out.

The only way to prevent infection is to prevent people from coming into contact with each other. This would require shutting down the world and national economies indefinitely and everyone staying at home. If it were the case that the virus could then run its course in those currently infected and fade away, this would seem like a good course of action. But that would mean a GLOBAL order for everyone to stay at home until the infection died out. This seems unlikely to happen.

Alternatively I have seen arguments for testing every single person, using a miniaturized test similar in form factor to home pregnancy tests, and quarantining the sick rather than quarantining everyone. While nice in theory, would everyone really do their home test and quarantine? Because if you miss some people then the virus will spread. And then again you would have to implement this around the entire world.

Now that the virus has made its first foray into the entire world at large, there will be infections somewhere that will then restart the chain of infection unless global borders are durably closed. Therefore the economy would have to be stopped everywhere repeatedly. Any time you attempted to restart economies, the virus would start to spread anew. This would be of course catastrophic and lead to loss of wealth and well-being on a massive scale, until the only people who can afford to live are the very very wealthy, and even they would run out of things to buy as too few people would be working. The economy would self-destruct. Meanwhile the virus would spread over time to everyone in any event. Herd immunity would eventually be achieved but at incalculable economic cost in wealth, and lives.

2. You try for herd immunity so that the virus fades and can no longer gain a foothold.

There are several ways to go about achieving herd immunity. Different outcomes depend on how achieving herd immunity is managed.

A. No management. You simply let the virus run its course, doing nothing to prevent its spread. Everyone continues life as before. Herd immunity is achieved as rapidly as possible.

The problem with this approach is that unless health systems are able to handle all patients, with caregivers having all means of protecting themselves as well as providing care to all comers, you will wind up with these systems overwhelmed in many areas, potentially even a plurality or majority of population and health care centers. With a shortage of items for both patients or caregivers you will wind up having many deaths that would otherwise be preventable if the health systems were wholly able to supply the required care. Perhaps 5-10 million people would die in the US, perhaps half or more of them otherwise preventable. One can argue about the final death toll, but the denominator of the lethality rate would quickly become apparent and hence the lethality rate itself. Economic disruption would still occur to a degree as large numbers of people succumb to the virus and others self-shelter to avoid infection.

B. Maximum management. You shut down the economy until you can administer a vaccine to most people. Herd immunity is achieved with significant delay.

The problem with this approach is that it would likely take more than a year. And there are now some scientists saying a vaccine may not be possible on any time frame. Even waiting a year means that the economic devastation associated with the approach of trying to prevent anyone from becoming infected would still occur. Perhaps 250,000 to 1 million people in the USA would die from the virus, but tens if not hundreds of millions of people would have their lives devastated economically. In other words you would minimize the number of deaths from infection, but that would be offset dramatically by severe economic disruption and the loss of lives, liberty and economic security that result. If a vaccine were to arrive earlier so much the better, as long as it is a straight vaccine that does not incorporate any of the monstrous vision espoused by groups such as id2020.org. It would then shorten the normal herd immunity process.

C. Optimal management. You can shut down the economy for a brief period, flattening the curve as they say, while immediately and swiftly marshalling the resources for the health care system to be able to handle all infected patients as they come. Herd immunity is achieved as rapidly as possible while minimizing preventable loss of life and also minimizing the loss of life, liberty and economic well-being associated with severe economic disruption. Once sure that the supply chains for production of all necessary equipment for caregivers and treatments and equipment for patients are on track to be able to provide all of the necessary items to care for the large surge of infected, you open the economy fully and things proceed as in 2A above, but without suffering deaths that would be otherwise preventable but for want of items for caregivers and patients.

Crucially in order to minimize the time necessary to shut the economy and to minimize loss of lives to the virus, the Federal Government uses emergency wartime powers to marshall the resources of the economy to produce all of the items necessary for the health care system everywhere to provide the best care to all comers. It might take 8 weeks (?) to start the system in motion to providing all such items. Once things are underway, you end the lockdown and let the economy restart in full. The virus then runs its course, but preventable deaths are minimized. Perhaps 1-2 million people die of the virus (this is arguable), but the economic devastation associated with approaches 1 and 2B are minimized. The economy is reopened the moment it appears that filling the pipeline of supplies required to prevent deaths due to restriction in the supply of goods for patients and health care providers will occur.

Clearly this last approach (2C) is the one that best balances the inevitable loss of life from the virus spreading until we reach herd immunity with the loss of life, freedom and financial security associated with economic disruption and dislocation.


Discussion

Though the Trump Administration has convened the Coronavirus Supply Chain Stabilization Task Force (“CSCSTF”) under the auspices of FEMA, a reading of their approach at https://www.fema.gov/fema-supply-chain-stabilization-task-force indicates that the CSCSTF will act mostly as a facilitator between the various State Governments and private firms. While The POTUS has activated the Defense Production Act and is pressuring firms to produce some of the Necessary Items in some cases and having the CSCSTF do it in others, it does NOT appear to be acting as the sole point of purchase (for example they are still insisting states take the lead in acquiring tests…wow), which will mean that the purchasing and production processes necessary to marshall resources as quickly as possible at the lowest cost will be suboptimal. It will take more time and cost more than if the Federal Government acted as the sole purchaser and maintainer of the List of Necessary Items. Time is the crucial element. Every day lost to inefficiency means a day longer that the economy is shut down and staggering economic losses accrue. The Trump Administration has strangely taken the stance that the Federal Government is there as a backstop to the States and that it is the States that are to manage the pandemic. In almost all cases this is the correct approach, and as for the local administration of care still is. But once you have decided that the pandemic is a true emergency on the scale of War then arguments about Federalism that should normally prevail lose their might and persuasiveness. Both state governments and the Federal Government have in fact declared this to be such an emergency, on par with the notion of a Wartime emergency, and clearly the notion of issuing stay at home orders and shutting the “non-essential” economy indicates that has been the decision.

If that is the decision, then in order to minimize the duration of the economic shutdown that needs to occur while marshalling the nations health resources to be able to treat all infected patients optimally, the Federal Government MUST take the lead in doing so. President Trump must marshall the economy to quickly manufacture the items on a List of some 30-50 things the health care system needs to avoid preventable deaths. That List includes Masks, Gloves, Disposable Gowns, Eye Protection, Ventilators and Respirators, Inhalers, Hydroxychloroquine and Zpacks + Zinc, Vitamin C, Other Antivirals (Remdesivir, Lopinavir and Ritonavir, Other treatments (plasma from those who have recovered, antibody therapy as touted by Jacob Glanville, of Distributed Bio etc), testing capability to identify possible plasma donors for plasma treatments, additional temporary treatment facilities and everything else that should be on the List both for patient treatment and caregiver protection. The President can marshall his stable of technocrats to flesh out the List of Necessary Items (you could call it the “LNI” if you are a lover of acronyms as the CSCSTF seems to be). The Federal Government can persuade or in some cases coerce private firms to produce the Necessary Items on the LNI. The Federal Government can then distribute items to the various States and localities as needed to ensure as few people die of the disease as possible, and none for the want of anything that is needed by caregivers or patients.

Failure of the Federal Government to aggressively take the lead in directing the economy to produce the LNI to allow the nations health care system to be able to handle the entire influx of patients while minimizing otherwise preventable deaths will mean that the period of economic disruption will increase in duration and will thus lead to failure to minimize the spiraling and recursive cost in life, liberty and economic wellbeing being wrought by the pandemic. It is therefore imperative that the President takes immediate and complete charge of the marshalling process in order to get the economy back into full motion in the shortest period of time. It is also necessary that the President formulates and communicates this strategy during the Press Briefings and provides updates on progress in marshalling the LNI. Right now there is a great deal of uncertainty and most of the prattle on news networks is superfluous and misdirected. If President Trump were to enunciate the chosen strategy clearly, many of the questions and uncertainties plaguing people now about what happens going forward would fade away and people would have a renewed sense of purpose which would be a healthy step in recovery of the economy. The issue of testing, while still important in the intermediate to long term, would fade in immediate importance, except to the extent it helps identify those who have recovered and may offer plasma for use in treatment. Identification and contact tracing are nice if prevention is your goal, but if optimally managing herd immunity is the goal, it is secondary. Pronouncements by advisors like Dr. Fauci would also fade in importance as the virus will not dictate timing, rather the progress of the marshalling process would do so. Fear of repeated shutdowns would also be mitigated, as once the marshalling process has achieved critical mass, normal life would return. It is this marshalling process that would dictate the timing of economic reflowering.

Cuomo posed the question on 4/15/2020 “When will this end?” And he answered “When there is a vaccine”. But he could not be more wrong. Does he really contemplate using governmental authority to decree that millions of people can not work for over a year? That he will use the power of government to destroy the lives and livelihoods of millions of people until they are destitute? He said he might open up his state slowly, but if there were signs of increased infection he would have to back off. Well, once you open the economy of course the infection rate will pick back up. That is how you get to herd immunity. The second wave will be much larger than the first. That must be the PLAN. Once again, the ONLY question is whether we have taken the necessary steps to ensure the health care system can handle the second larger wave of infections once we reopen the economy. The only thing that determines when we open it up is when we have set in motion the processes that will ensure we can serve all of the infected and prevent deaths from a shortage of caregiving items and treatments. We can not keep the economy closed indefinitely to prevent people from getting the disease. We are all (well most of us) going to get it or we will all get the vaccine. Will the government really close the economy until the vaccine is ready? What causes the greater harm in the long run?

If you agree with this analysis of the Strategies for Confronting the Coronavirus Pandemic in the United States, please forward this message to friends and family in the hopes that someone can get the message to President Trump and his advisors.

Thomas Bergerson

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