Georgia re-opened many types of businesses yesterday, including a lot of personal-care services, gyms, spas, and restaurants. They’re opening another range of businesses on Monday. Another handful of states is in the process of easing restrictions at the same time.
The picture at the top of this post is NOT some wish that these re-openings fail. To the contrary, we should all pray for their success.
It’s a statement of fact. If you want to have a robust plan for responding to this pandemic — one that won’t crumble at the first adverse event — then you ignore this at your peril.
And it’s something that I wish every official involved in this would take to heart. Because, as near as I can tell, not only are the Federal “guidelines” more-or-less a political document (as opposed to a technical document), there’s no Plan B here. There’s zero guidance on how to judge whether or not re-opening a state has succeeded or failed. And, as far as I can tell, literally no thought has been given as to what a state should do, in the event of an obvious failure.
Literally, there’s no plan for how to respond to a failure in this case. That’s not a part of the Federal “guidelines”. At most, they vaguely indicate the circumstances that warrant delay of further economic opening. It’s as if they didn’t understand the phrase at the top of this posting. Or, more likely, it’s as if they’ve deliberately turned a blind eye to that possibility.
To me, that’s striking. Given the vast uncertainties here. Given that social distancing is just about the sole tool at our disposal. Given that it shows a proper dose-response relationship (extreme lockdown led to a near-immediate reduction in new cases in Wuhan, left; half-baked lockdown led merely to a slowdown in growth in new cases in Virginia, right). (So, if you weaken it further, logically, it’s not question of whether there will be negative consequences, the only question is, how large or small will those be.)
But just stop for a moment and think about it. Put aside all the technical details that may drive success or failure here. Put aside politics, and economic costs, and your own subjective beliefs that this will succeed or fail.
Can a state governor afford to admit that a state re-opening has failed? Think about what that means. It would mean admitting that a decision made purely on the basis of limiting economic damage led to so many excess deaths that it had to be rescinded. It would mean the governor of a state admitting that his or her mis-judgment led to a substantial increase in deaths.
Practically speaking, I don’t think that’s possible. Human nature being what it is, and humans having this illogical blindness when it comes to failure to taking action versus taking action. For sure, a lot of governors already got a lot of people killed by delaying lockdown. But killing people by failure to act doesn’t really register with people. Here, if one of these “re-openings” goes south, the relevant governor would have to admit that he or she positively made a decision that resulted in those deaths. Even if that decision was made in good faith, even if that decision was in fact the right thing to do at the time, given what was know, my guess is, that ain’t gonna happen. More likely, if you need to have one of these decisions reversed, you’re going to have to impeach the relevant governor first.
So let’s just look at this as coldly as possible. Absent some huge catastrophe, these re-openings are a one-way street. The “guidance” on how to go about it, from the Federal government, is … pretty much a joke, from a technical standpoint. (I’ll detail that later in this post, or in a separate post.) To me, the Federal guidance document appears to be little more than political cover for governors who want to try this. And there is no metric for assessing success or failure, and certainly no guidance on how to rescind these decisions in the event of failure.
And, because a rise in deaths is such a taboo subject, these Governors can’t even set guidelines ahead of time, so that re-opening orders are cancelled automatically if the increase in mortality hits some agreed-upon threshold. Literally, because social norms bar discussion of this subject, there can be no forward planning for how best to deal with it.
In short, these folks are pretending that failure is not an option. If I learned nothing else from my years of Mythbusters fandom, it’s that that’s an inherently bad strategy. Given the huge uncertainties here, that decision is clearly driven by politics and not by any detailed understanding of epidemiology or public health.
My guess is that the only things standing between this policy and a public-health disaster are the fear and common sense of the population. People will judge their risks for themselves, and I suspect that high-risk individuals will simply not show up at the newly re-opened businesses. We’ll get a “soft” re-opening populated by the low-risk, the unworried, and the economically desperate.
And that’s fine. Because, apart from this, our whole “social distancing” and stay-at-home approach is not very-well-thought through. It’s as blunt a blunt instrument as has ever been used. And it’s high time that we started re-thinking it. My impression is that the proposals for re-opening these economies aren’t very smart. The are driven by economics and special interests, not by epidemiology and biology. But, however it turns out, I will at least give them credit for trying. As long as somebody has the good sense to undo these decisions in the event of an obvious failure.
Outline of next series of posts.
And so, that raises a few questions, that I would like to answer in my next series of posts. I’ll provide detail later, but here’s what I’ve concluded so far.
1: What, exactly, do the “Federal guidelines” for re-opening states say? Surprisingly, the answer is, not much. And what they do say is so ambiguous, and so clearly just-kind-of-made-up, that it’s hard to take them seriously. The “guidelines” are some common sense rules, with some ill-defined terms like “downward trajectory” and “rebound” that are absolutely undefined. E.g., there are no quantitative rules whatsoever.
2: Did Georgia meet the basic criterion for re-opening businesses under those guidelines? No, not even close. The guidelines call for a 14-day “downward trajectory” in … something. New cases, I think. Take a look for yourself. Does the top graph below look like a 14 day “downward trajectory” in new cases?
Last 28 days of count of new coronavirus cases, Georgia (top) versus Virginia (bottom). Note the scales at the left are different. Based on population, Georgia has more new cases daily, per capita (10.6M population) than Virginia does (8.5M population).
3: How will Georgia tell if this is working out or not, and what criteria will be used to “pull the plug” on this re-opening, if necessary? Near as I can tell, nobody knows, there are no criteria, and there are no plans for what to do if this goes wrong. It looks very much like Georgia has no plans to rescind this. No matter what. Or, at least, there is no public-facing information or discussion of that.
4: But, at the very least, once Georgia does this, we’ll at least be able to tell whether or not it works, right? Nope. No, that’s not true, for a wide range of reasons. Unless this goes very wrong, very fast, it’s going to be hard to say exactly what the impact of re-opening these businesses was.
I’d go so far as to say, I fervently hope we’ll never really know. Because the only way we’ll get a clear and unambiguous estimate of the impact of this change is if the bodies start piling up at a rapid clip.
What comes next is a completely serious analysis of this issue, from a guy who spent a good part of his career trying to answer questions exactly like this. E.g., when the Medicare program did thus-and-so, what was the impact on use of services?
Dealing with this intelligently has two parts. First, “can we tell what happened”. That’s the area in which I have expertise, having done studies like that all my life. And the short answer is, it’s not as easy as you think. Second, if this goes wrong, can we “put the genie back in the bottle”. That’s where my prior discussion of the hog-slaughter cycle comes into play. It’s difficult to control any system where there’s a long lag between actions and consequences. Add a virus with a potentially explosive growth rate, and at first blush, this is probably a situation where putting the genie back into the bottle, if necessary, will be a long, hard, and expensive process.