It’s not easy to grasp. Ever since “flatten the curve” became our mantra last month, the key metric seems to be hospitalizations. With widespread infection inevitable, the goal of the lockdown is to slow the spread enough to ensure that all critically ill patients have hospital beds. At the same time, we don’t want to impose any more economic pain than is necessary to keep the case load manageable. Logically, the ideal quarantine policy would be loose enough to keep hospitals near capacity but tight enough to avoid exceeding it.
Now peak resource use is supposedly upon us, but most hospitals are far from overflowing. Thanks to expansion of ICU wings, postponement of non-life-saving care, and overestimation of the number of people who would need to be admitted, some hospitals actually have too little to do rather than too much. Isn’t this strong evidence that the quarantines can be loosened? Even just a partial economic restart could make a significant difference in the lives of people who have lost their jobs or have seen their incomes drop.
Another curious part of the lockdown is its universality. Some large fraction of the population will be infected as we develop herd immunity, but how do we ensure that the oldest and most immunocompromised people are not among them? Universal lockdowns seem to discourage targeted protections for the most vulnerable.
Part of the confusion here is due to health officials gesturing at two different goals. Is social distancing intended to slow the spread and develop herd immunity, as a month of “flatten the curve” messaging claimed, or is it actually intended to minimize total infections? The former implies that we are probably ready to loosen restrictions; the latter implies a far longer and more painful quarantine.
Adding to the confusion is our inability to answer a fundamental question — namely, how useful has the lockdown been in the first place? Staying at home obviously can slow the spread of a virus, but there are other factors at play as well. As several NR contributors have already pointed out, the IHME model built the lockdown into its projections but still overestimated the caseload. Furthermore, the correlation between the severity of outbreaks across states and the timing of their lockdowns seems tenuous. Late-closing Florida is still far better off than New York, for example.
There is a temptation out there to assume that the lockdown must be responsible for the lower-than-projected caseload. “The IHME [death] estimate has only gone down by about 2x. That’s what you’d expect if we took countermeasures that were just a little more stringent than their model assumed,” Kevin Drum concluded. Maybe, but that reasoning is backward. If we’re going to measure the stringency of our lockdown by how much the projections overestimated deaths, then a stringent lockdown will always look like the right policy. In reality, no one knows how effective government policy has been so far, and this may add to the indecisiveness we’ve seen from officials regarding how and when to change it.
Perhaps the nascent White House Economic Task Force will provide some clarity. We need straightforward descriptions of what evidence we still need to collect, what containment strategy the government will be pursuing, how containment will coexist with a revival of economic activity, and how we can measure progress. Such a statement would, at the very least, help gauge public support for the ongoing efforts.