Unherd — a British website featuring independent thinkers on the left and right – has a good interview with Anders Tegnell, the epidemiologist who has led the pandemic response in Sweden. Sweden is one of the few western democracies that did not impose a strict de jure lockdown to deal with COVID-19, though as Tegnell notes, the government did encourage, and get, a lot of voluntary social distancing from the Swedish people.
I supported a temporary lockdown during the late March–early April timeframe here in the United States, but otherwise I think Tegnell’s basic approach to the disease is the correct one, and I’m concerned that governors across the country may be abandoning it in light of the recent surge in infections in some regions.
The great difficulty with pandemics is getting a firm grip on the characteristics of the disease. Unfortunately, medical experts cannot simply study a virus and draw good conclusions about its severity, its preferred vectors of transmission, or the demographics that may be either particularly susceptible or relatively immune to its effects. That information can only be gained by observing how the virus actually works in a population, and the fog of pandemic war makes drawing firm conclusions very difficult.
Even after living with COVID-19 for half a year, there are only four things I believe we can say with high confidence about the disease: It’s highly contagious, it’s much less severe than we originally feared, only the very elderly are at serious risk, and those who have been infected and have recovered acquire an immunity that removes them from the pool of targets for the disease.
In dealing with a pandemic, the right goal is to reduce the total human harm over the life of the pandemic. That includes serious illness and death inflicted by the disease itself, but also harm from other illnesses that would have been treated but for restrictions imposed by the pandemic, as well as the secondary but very real human deprivations that occur when the normal patterns of life are disrupted.
The ripple effects of an epidemic are alienation, abuse, poverty, and mental illness. Those effects tend to cascade over time, and they have the potential to be greater than the immediate health consequences of the disease.
That is the reason there is such value in getting through the epidemic as quickly as possible. It’s the only way to minimize both the immediate and secondary damage. In the absence of a safe and effective vaccine, the disease has to spread enough, and create enough natural immunity across all the regions of the country, that infection becomes uncommon, deaths are reduced, and people feel free to work, learn, travel, and socialize on normal terms.
Epidemics obey Farr’s curve. Once a contagious virus has seeded sufficiently in an area — and that had happened in parts of the United States by at least January and probably before — then in the absence of artificial controls infections will spike rapidly and then just as rapidly subside as those who are most likely to get and spread the disease are removed from the target population.
Fortunately, there is evidence that the necessary level of immunity is reached at levels far lower than a majority of the population. Sweden seems to have reached that point.
We can not repeal Farr’s curve, and it is not desirable to flatten it beyond what is necessary to protect the vulnerable demographics and preserve hospital capacity.
That means we should quarantine the sick, take every possible step to keep the virus away from where senior citizens live or congregate, and manage our ICU capacity to prepare for surges in need. We should continue the search for and use of therapeutics to reduce further the severity of the disease. We should strongly encourage protocols, such as hand washing, and yes, wearing masks, which hold some promise for moderating the epidemic without actually prohibiting social interaction.
Other than that, we should keep society as open as possible, relying mostly on the good sense of the people to flatten sufficiently the upside of the epidemic curve.
As an economics professor of mine was fond of saying, “The crew of the Titanic stopped doing dishes when the ship hit the iceberg.” Populations change their behavior when an emergency like a pandemic hits. They learn to balance the danger presented by the disease in light of their individual and family circumstances. Not everyone makes the best judgments of course, but over time people and organizations learn how to reduce risk and slow the spread of the disease while continuing to go about some semblance of normal life.
As that adjustment occurs, government lockdowns become less necessary to flatten the curve. Since lockdowns cause cascading damage the longer they are in place, and especially if they are re-imposed after having been lifted, the balance of harm therefore weighs more and more against them over time.
Four months ago, I predicted the “rolling series of epidemics” we are now witnessing around the country. It is concerning to see infections going up in different regions, but as long as fatalities remain low, and hospitals have sufficient capacity to care for the sick, the fact that the disease is progressing through the less vulnerable parts of the population is a sign of progress, not failure. It means that more areas are moving closer to the end of the pandemic.
The only other possible policy is what Tegnell calls “eradication,” which means isolating the country, and locking down people within it, to the extent necessary to snuff out incidence of the disease. As Tegler notes, that has been the approach in New Zealand. So far it’s worked there, and more power to the Kiwis. But they are going to have to remain very isolated until a vaccine is developed, and the economic devastation from that is already great and will continue to grow.
More to the point, New Zealand has a small, homogeneous, and compliant population. It’s also an island country that can easily regulate or prevent entry. The United States is none of those things, and it’s simply not feasible to believe that the American people as a whole will be willing to submit to the kind of restrictions for the length of time that would be necessary to eradicate the disease here, even if we were willing to accept the secondary harm that would cause.
We have tools at our disposal to deal with COVID-19 that we did not have five months ago: better therapies, more stockpiled capacity, a population that is more aware of how to balance risk, and the knowledge that most people are not at serious risk should they become infected. All of that has increased our margin of safety. We should push that margin to the limit if necessary. The faster we can afford to allow the curve to go up, the quicker it will go down, and the less harm of all kinds it will cause over the life of the pandemic.