This Is Just the Beginning

An illustration of a chart with a downward facing arrow.
The Atlantic

We are only at the beginning of the crisis. The number of people infected with the coronavirus is still growing exponentially. Most of those who are sick were infected so recently that we don’t yet know how many of them will live or die.

And yet, public figures, especially on the right, are already calling on us to beat a hasty retreat in this desperate fight. “The costs of this national shutdown are growing by the hour,” the editorial board of The Wall Street Journal wrote a few days ago. It is about time to wind down the “vast social-distancing project of the last 10 days.”

Similarly, in light of the economic damage that the current response is causing, the New York Times columnist Thomas Friedman argued that we need “less herd mentality and more herd immunity.” His proposal basically boils down to accepting that the majority of Americans will be infected: “Let many of us get the coronavirus, recover and get back to work—while doing our utmost to protect those most vulnerable to being killed by it.”

President Donald Trump seems to be considering the same course of action. On Sunday night, he tweeted, “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF. AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!” A few hours later, he retweeted a follower who explicitly endorsed a version of Friedman’s plan: “15 days. Then we isolate the high risk groups and the rest of us get back to work!!”

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I can understand the wavering. The economic damage inflicted by our mass social distancing is enormous. And when the economy tanks, the human consequences are also enormous. But the decisive objection to Friedman’s approach, which is now apparently being pondered by the president of the United States, is simple: It would kill millions of Americans.

Estimating how many people will get the coronavirus, and what percentage of infected patients could die, remains difficult. In Germany, the government assumes that six or seven out of every 10 citizens could get it. The World Health Organization has estimated the case fatality rate to be 3.4 percent, meaning that about one in every 33 patients will die.

But let’s be unduly optimistic for a moment and imagine that we can somehow achieve “herd immunity” without infecting more than one out of every three Americans. Let us further assume that the true fatality rate turns out to be much lower than the current figures suggest—say, about one in 100—and that our hospitals somehow figure out a way to manage the flood of patients that would stream through their doors in need of lifesaving treatment.

In that implausibly sanguine scenario, more than 1 million Americans would succumb to COVID-19 in the next few months. That is about as many people as the country lost in the Civil War, World War I, and World War II—combined.

There is an alternative to either shutting down the economy until we have a vaccine or letting more than 1 million Americans die. If we commit to strict social distancing now, we can radically curtail the number of new cases and buy time—time to put in place the measures we need to contain the pandemic in a less economically destructive way.

What are these measures?

First, we need to ramp up testing dramatically. Countries such as Singapore and South Korea have shown that it is possible to tame the outbreak by instituting a thorough test-and-trace regime. Each day, these countries test many thousands of people. Then they isolate those who have been infected and trace their contacts, so they too stop spreading the disease.

Second, we need to expand hospital capacity. The biggest danger posed by the coronavirus is that it will overwhelm the health-care system, leading to a dizzying spike in mortality. But over the coming months, we can increase the number of critical-care beds to deal with COVID-19. All over the country, gyms and exhibition centers are about to be turned into makeshift hospitals. Companies are ramping up production of urgently needed supplies, including masks and ventilators. Over time, medical students and other volunteers can be trained to perform basic tasks that free up trained personnel to do their lifesaving work.

Third, we need to research treatment options. Currently no drugs are effective against COVID-19. A miracle drug is unlikely to materialize anytime soon. But the many trials now under way in Asia, Europe, and North America are likely to uncover pharmaceutical options that could save a significant number of critically ill patients.

Right now, the number of cases is still exploding. We don’t have the infrastructure for test-and-trace on a grand scale. Our hospitals aren’t ready for the onslaught they are about to face. Our treatment options are dismal. To give up on the fight against the coronavirus at this stage is to condemn an unspeakable number of Americans to death.

But if we take energetic measures to contain the outbreak right now, this picture could change relatively quickly. At that point, the power of these interventions will lie in their combination. Test-and-trace will mean that fewer people get infected with the disease. An expanded medical system will be able to heal more patients. And better treatment options will save a greater portion of the critically ill. Each of these measures will amplify the others.

Recessions exact a real human toll. They don’t just destroy people’s livelihoods or defer their dreams. In a recession, people go hungry, fall into depression, or even die by suicide. To ignore the economic damage done by pandemic-containment efforts is not to put human lives above profit; it is to ignore one form of suffering in the service of alleviating another.

So I understand the desire to stop social distancing. But people who now advocate that we “choose the economy” are not being honest about the consequences of that decision. According to all serious projections, a premature capitulation to the coronavirus would result in death on a truly monumental scale—far more than the country can, should, or needs to bear.

That is why the only rational way forward is to continue the national shutdown, for now, while we prepare for the second phase of the fight against the coronavirus. While it does impose serious hardship on everyone, this is by far the least bad option. And the more resolutely we act right now, the faster we will get back to some semblance of normality.