The Morning Jolt


What Is the Limit of American Patience?

Empty street in Manhattan following the outbreak of the coronavirus in New York City, March 15, 2020. (Jeenah Moon/Reuters)

We have confirmed the widespread rumor that it is Friday.

Today’s Jolt begins with some good news, moves on to math, and points out hard truths about how long the public will continue to consent to government lockdowns.

Hurrah! Signs of Some Effective Treatments for COVID-19!

Everyone prefers the good news, so let’s start with that.

It’s early, but remdesivir might be a really effective treatment for COVID-19.

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

There’s another extraordinarily simple treatment that is generating great results, at least in some patients: simply having them lie on their stomachs.

Doctors are finding that placing the sickest coronavirus patients on their stomachs — called prone positioning — helps increase the amount of oxygen that’s getting to their lungs.

“We’re saving lives with this, one hundred percent,” said Dr. Mangala

Narasimhan, the regional director for critical care at Northwell Health, which owns 23 hospitals in New York. “It’s such a simple thing to do, and we’ve seen remarkable improvement. We can see it for every single patient.”

“Once you see it work, you want to do it more, and you see it work almost immediately,” added Dr. Kathryn Hibbert, director of the medical ICU at Massachusetts General Hospital.

As for chloroquine and hydroxychloroquine, the drugs that somehow turned into a partisan football because President Trump touted them, the evidence continues to be mixed. For perspective in how we discuss health and medicine in this country, compare the number of articles that mention the recent study indicating that chloroquine can cause heart arrhythmias to the number of articles that mention Rita Wilson’s description of the side effects. Apparently nothing seems real in American life until it happens to a celebrity.

Better treatments should mean a better survival rate, which should make the consequences of a gradual reopening the economy less dire. The debate about this huge decision in the last several days has been extraordinarily frustrating. The “reopen the economy” side is accused of being callous and selfish, and the “keep people home” side is accused of being blithe about economic catastrophe.

We’re Going to Have to Choose Between Two Bad Options

I have a sneaking feeling that a certain number of people who are touting “herd immunity” have only the vaguest sense of how difficult achieving that goal will be. Yesterday in the Corner I tried to lay out the range of outcomes. Even if you make extremely optimistic assumptions — that herd immunity could be achieved with 40 percent of the population getting the virus, and that the death rate for those infected will be one half of one percent — you get about 660,000 dead Americans by the time you achieve herd immunity. If you make an extremely pessimistic assumption, that it will require 95 percent infection to reach herd immunity, you get 1.56 million dead Americans.

The actual infection rate required is probably closer to the worst-case scenario than the best-case one. A recent study out of Los Alamos National Laboratory calculates that for SARS-CoV-2, herd immunity would kick in at about 82 percent of the population having the virus — roughly 270 million people. If that calculation is correct, and the virus has a one-half of one percent death rate, we would see 1.35 million people die before herd immunity was achieved.

In all of these cases, I’ve assumed a death rate of one half of one percent. I keep hearing people insisting, “We don’t know how many people have the virus, so the death rate numbers are meaningless.” But imprecise and meaningless are not synonyms. A few weeks ago, virologists generally believed the death rate was one percent. Right now if you divide the numbers of deaths by the number of confirmed cases, you get a much higher percentage in most countries; in Italy, it’s 13 percent! But the current death rate is higher because we’re not measuring asymptomatic cases — so not only is Italy’s death rate unrepresentative, it is possible that when all is said and done, and we know exactly how many people caught it and died, we will find the death rate is below one percent. But it is probably not going to be way below one percent. One half of one percent is roughly half the early consensus; I think that’s more likely to be a too-optimistic percentage than a too-pessimistic percentage.

Also please read Robert VerBruggen’s assessment of the “everyone’s got it” theory, the notion that right now American society has a large percentage of people walking around asymptomatically. He notes a study cited in The Economist speculates that the U.S. could be detecting only one out of every thousand cases. If the country currently has about 678,000 cases, and we’re only detecting one in a thousand, it means we have 678 million cases in a country with about 330 million people. So, uh, no, we’re not missing 999 out of every thousand cases.

Robert also notes that one percent of the population of the state of New York has been diagnosed positive, so unless everyone in the state of New York has it, we are not failing to detect 99 out of 100 cases. He looks at a variety of studies and thinks our limited ability to test the public means we are probably detecting one out of ten or one out of 20 cases.

As of this morning, the United States has 678,210 confirmed cases. If our testing is only detecting one out of every ten Americans who have it, then 6.7 million Americans either have the virus or had it and fought it off. If you take our current total of 34,641 deaths and divide that into our suspected total of 6.7 million cases — remember, some who are currently testing positive will die — it comes out to a death rate of one half of one percent.

If we’re detecting one out of every 20 cases, that means about 13 million Americans have the virus or had it and fought it off. Applying the current death total to that sum suggests a death rate between two-tenths of one percent and three-tenths of one percent.

There’s one other reason I don’t think a large percentage of Americans are walking around infected and asymptomatically. New York City looks like the clearest example of what happens when this virus spreads in an unprepared population.

When you lay out these numbers, a lot of people jump to the conclusion that this is an argument for keeping everyone in America locked up indefinitely. It is not. I just want everyone to know what we are in for as we take steps to reopen the economy.

I think a lot of Americans on both sides of the aisle — and particularly a chunk of the apolitical — believe that there has to be some “good” solution to this problem, and that someone who is sufficiently smart or wise would find one. I think they are psychologically unprepared for a situation where there are no good solutions, only varying degrees of bad — a no-win situation. It says something about American society that one of the most popular tales of Star Trek was the “Kobayashi Maru,” an academy test where the simulation ended in failure no matter what the student did, because the purpose of the test was to see how students coped with failure. James Kirk beat the test, because he snuck in and reprogrammed the test to allow him to succeed, insisting that the original testing parameters were flawed — “I don’t believe in the no-win scenario.”

That’s a terrific example of American optimism, determination, and a faith that with enough ingenuity, some “winning” solution can be discovered. And who knows, maybe later today some scientist will have a “eureka!” moment and discover a vaccine. But until that happens, we have to deal with the situation as it is. We can choose the path of continued lockdowns that absolutely crush our economy and will eventually lead to bad health problems of their own — depression, alcoholism, drug abuse, suicides. Or we can choose the path of reopening the economy and inevitably an increase in exposure, more infections, and more deaths.

This Is Not a Time for Governor Eric Cartman

Because an end to the lockdowns must arrive, and it must arrive probably in a matter of weeks. New York governor Cuomo wants his state to remain shut down until May 15. Virginia governor Ralph Northam still thinks residents of his state will obey the stay-at-home order until June 10.

If governors want people to limit how much they leave their homes, they must suppress their inner Eric Cartman, bellowing, “Respect my authority!” If lawmakers turn this into a test of wills with their constituents, those governors will lose, and public order will be the ultimate victim. Most police forces do not want to get involved with arresting people for minute violations of quarantine restrictions. For starters, arresting people involves getting physically close to them! They’re having a bad enough time dealing with people checking their mail while not wearing any pants.

Michigan governor Gretchen Whitmer’s executive order, declaring stores of more than 50,000 feet must close areas of the store that sell carpet or flooring, furniture, garden centers or plant nurseries, or paint, is bonkers. It is not what you sell that represents the danger of spreading the virus, it is the interaction with other customers and sales staff. There is no medical difference between shopping at a grocery store, convenience store, or pharmacy and shopping at any other store. There is no medical difference between daytime and nighttime. If a locality wants people to stop hanging out in groups in the parking lot of a convenience store or take-out restaurant, fine.

Also note that new research indicates that lower levels of Vitamin D may increase vulnerability to the coronavirus. One of the ways people get Vitamin D is by being outside in sunlight. Maybe this isn’t the best time to keep everyone in America stuck inside indoors!

We may not be quite at the limit of American patience for the lockdowns, but we are not that far away from it.

The city of Los Angeles shut down for seven weeks during the Influenza Pandemic of 1918, through most of October and November. On December 2, movie theaters reopened, as did stores, churches and schools. But that proved too early; by mid-December, the schools had to close again, as cases had started rising again.

Most of the country is in its fifth week of the coronavirus-driven shutdown and self-quarantining. Colleges and universities started moving to online classes March 10. The following day, Washington and Ohio put limits on large gatherings, the NBA suspended the season that night, Tom Hanks and Rita Wilson announced they tested positive, and President Trump gave his Oval Office address. Public schools started closing in twelve states on March 12, and for kids in Virginia, that was the last day of attending school for the school year. By Monday, March 16, the federal government issued new guidelines urging people to avoid social gatherings of more than ten people and to restrict discretionary travel.

In a world where every American had near-unlimited financial resources and the psychological stamina to remain in their homes indefinitely, we could keep the quarantines going for two months or three or as long as it was needed to beat this virus. But we don’t live in that world. Americans need to get out of their houses, they need to get back to work, they need to be able to shop for something besides groceries and medication, and they need to be able to interact with each other — even if it’s while wearing masks and standing six feet apart. They need to be able to go to the parks and beaches and lakes, and to soak up that sunlight. They need to be able to get into restaurants and sit in small groups while spread apart.

We’re doing this to save lives. But we also need to make sure that those lives we’re saving still have an actual life to live.

ADDENDUM: Every now and then, this crisis spurs the creation of something that seems like an improvement upon pre-coronavirus life. Take-out mixed drinks. Virtual happy hours with far-off friends. Car insurance rates are dropping, because people are driving so much less these days. Regulations are getting suspended left and right. And now airlines might not keep their middle seats.. Sure, this will make flying more expensive, but lots of people won’t want to fly for a while . . . and did anybody ever like getting stuck in the middle seat?


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