We’re now six weeks in to our great national crisis. Waco has been officially under a stay-in-place order for over a month: it was implemented on March 23rd, and is slated to be lifted this Thursday. There is little reason, from what I can tell, to keep it in place longer than that: there will be social distancing guidelines still in place, bars will be closed, and so on—and they probably won’t put the basketball hoops back up yet, which is just as well since I’ll need to be kept from the temptation of playing. But we will at least be able to go about some of our business.
For the most part, Waco has avoided any serious confrontation with Covid-19. The highest active number of cases we had peaked, if memory serves, around 23 or 24. We have been steadily decreasing since then: we have had less than one new case per day for the past week. Our medical resources, by all accounts, are well-prepared for a surge that simply never came. And Waco is not alone: Texas has not seen the kind of explosive growth that UT Austin professors predicted we would some three weeks ago. We were told to #flattenthecurve: and we did.
So much has happened that I thought I would update a few of my beliefs about this virus and our response to it. I hasten to note I am not an epidemiologist, much less an expert on economics or anything else. But then, as I noted in one of my essays, neither are our politicians, despite the fact that they are tasked with weighing all the data they can in order to make decisions about how we can live together. So consider this nothing more than an exercise in practical reasoning: my confidence level in the following beliefs varies, and on none of them is so high that I would not be open to revising them.
- Neither epidemiologists nor economists are qualified to make the determination about when to ‘reopen’ society. We have heard much about “listening to the experts.” No doubt we must: but the experts are experts because they have spent their entire lives burrowing into one very narrow field—economics or epidemiology. As such, their testimony must be heard—and then qualified by the vast range of considerations which they may or may not take into effect. Pandemics are political problems: they destabilize society in peculiar ways, and as such, they require political leadership, rather than epidemiological leadership alone. What constitutes the ‘right time’ to reopen rests on a whole host of factors—risk of renewed spread is only one of them.
- Covid-19 clusters seem to happen from: (a) intimate contact (like among families) and (b) mass transit. The chances of spread outdoors seems minimal. While that’s only one study, such a hypothesis would partially explain why New York has seen such a terrible outbreak of coronavirus, but many West Coast cities have not. That isn’t to say rural areas are immune: Georgia and Arizona have both, at points, had more cases in rural areas than metropolitan areas. But I don’t see enough evidence right now to change my prior that places with high-contact systems of transit are more vulnerable to spread than places like Waco.
- The absence of a robust and pervasive testing regime is a scandal of the highest order. Nothing (still) makes me angrier than this. Consider this story about spread in prisons, which indicated that 96% of people who have Covid-19 are asymptomatic. Half-way down we read this little gem: “The figures also reinforce questions over whether testing of just people suspected of being infected is actually capturing the spread of the virus.” Really!? Do tell! We’ve known all along some people are asymptomatic: what we haven’t known is if they will stay that way, or if they will eventually develop symptoms. But given that fact, it is as obvious as anything we know that to stamp out coronavirus from the US we need to be testing not just those who have symptoms but every person that they had contact with.
- Stamping out the virus should have been our goal from the start. Certain countries effectively did stamp it out, like Taiwan. They were prepared, sure, but we’re America. We embraced #flattenthecurve, shut down our economy…and are probably still headed for the ‘epidemic yo-yo’ that Tyler Cowen has mentioned.
- Will it be possible to reopen society without risking the lives of those who are most physically vulnerable to Covid-19? Will it be possible to not reopen society without risking the livelihoods of those who are most socially vulnerable?
Masks matter, and should be mandatory for every person who steps out of their homes—even in places, like Waco, with few known cases. Social distancing matters more than stay-in-place orders. People won’t change their behavior if they don’t feel safe—and without a serious testing regime, no one will is going to feel sufficiently safe as to give up social distancing altogether. Quarantining not only the sick, but those who are exposed to them matters. Temperature checks everywhere, every day matters: they catch cases early.
- Really, again, masks matter a lot. There’s some evidence that even a cloth mask can block 95% of the viral load from breathing. That means that even if people are asymptomatic, we would remove one of the main ways in which it is transmitted in areas with lots of people.
- If we had 100% compliance on masks, and engaged in careful social distancing, would it sufficiently lower the risk threshold for those who are physically vulnerable to Covid-19? It would almost certainly not do so in such a way that we would allow visitors into, say, nursing homes or prisons. But it would presumably allow mean spread would happen much more slowly, which would allow time to test not only symptomatic people but those without who had contact: and that matters. (I’ve actually been tempted to wear a mask inside my own home, for this reason.)
- Colleges and universities should contract with hotels for the fall to put anyone who catches Covid-19 in them, and anyone who was exposed to them. It may be the only way to prudently have on-campus classes.
We’re going to spend the rest of our lives diagnosing all that has happened in these past six weeks—along with all that will happen over the next few years, as we work through the fallout from them.