COVID-19, Top Stories

Winning the War on Coronavirus

A report released by Imperial College London researchers on Monday shook the world. The report gave a glimpse into the coronavirus’s battle plan. It was to kill over two million Americans and at least a half-million Brits. 

Thanks to the wartime mobilization by the people of both nations, we can feel confident that we have thwarted its plan. There is very little chance that, after the lockdowns and social distancing occurring around the world, coronavirus is still on track to infect and kill as many people.

But we are only at the very beginning of what will be a long, difficult, and deadly war, and things are changing quickly. To balance saving lives with minimizing social disruption, Imperial College scientists foresee societies engaging in several, weeks-long waves of social distancing between now and the fall of 2021. By then, most experts expect we will have a vaccine. We could get one sooner, but few believe we will have proven a vaccine’s safety and effectiveness sooner than 12 months.

The events of recent days and past epidemics, including the 1918 flu that killed 50 to 100 million people, prove that strong governmental action and transparency are the keys to winning the public’s trust, which is the key to winning the war.

There is a one-to-one relationship between transparency and trust. The more transparent the government is the more people will trust it. And the more people trust the government, the more effective public health measures, particularly social distancing, will be.

The governments of the US, UK, and other nations have made real progress, but they must go much further in being transparent about their vision of how to win the war on coronavirus, and what they are doing to achieve it. 

The war on coronavirus

On Monday, I published a manifesto calling on Congress to take seven concrete actions to address the pandemic crisis. I am happy to report that President Donald Trump and Congress took major actions on all seven recommendations, including the first and most important, which was to treat the virus as a foreign enemy. 

President Trump has embraced the “kill the virus” message and adopted a wartime posture. The president is visibly more comfortable today with his role as commander-in-chief of a nation at war than he appeared last week. This is not a war President Trump chose but he knows that it is a war he must fight and win.

War metaphors are appropriate when society as a whole is faced with a grave threat. I am against using war metaphors on most issues, including for fighting drug addiction, cancer, and climate change. But in this case, “killing” and “war,” are the right metaphors because they dramatically focus our attention, motivate us to urgent action, and help us to transcend our selfish natures in service of humankind’s collective interest. 

The metaphors work at individual and collective levels. We kill the coronavirus directly by washing our hands with soap, disinfecting surfaces, and with our immune systems after it attacks us. We are at war with the virus in that saving our lives and our economies requires collective actions similar to those taken during wars. 

At the same time, there is an important difference between the war on coronavirus and other wars. With today’s war, there is little to no need for secrecy. Indeed, secrecy in China allowed the virus to spread while transparency in South Korea saved lives. And secrecy dangerously undermines public trust in government, which will undermine public compliance with critical public health measures, particularly social distancing.

Winning the war on coronavirus will require strong societal discipline around social distancing. The Imperial College scientists propose letting up on radical social distancing and other measures only when local hospital intensive care unit (ICU) cases decline to 50 total, and re-imposing them when they reach some higher multiple, say 100, 200, 500, or more. 

Given that COVID-19 victims are likely to exceed hospital and ICU beds in Europe and the US for several more weeks, it could be early summer before ICU cases drop back to around 50. 

And we should take these numbers figuratively, not literally. Cities, states, and nations could trigger micro-suppressions, including radical social distancing, at higher or lower ICU bed availability, depending on much and how quickly they can expand hospital capacity.

Many expect, but we do not know for certain, that the spread of the virus will slow in the summer and pick back up next fall and winter. Scientists and historians believe that if we relax our defenses too much, the virus will strike back, and could end up taking many lives that we could have otherwise saved. 

“In 1918 many cities imposed restrictions, lifted them too soon, then reimposed them,” wrote 1918 flu historian John M. Barry. “Covid-19’s average incubation period is more than double influenza’s, so compliance may have to be sustained for months, and openings and closings may also have to be repeated.”

There is still much we do not know, including how many people will become infected, and how many will die. Imperial College’s scientists assumed 81 percent of the public would become infected at some point during the duration of the virus. Mortality rates in cities and nations range at least ten-fold, from 0.7 percent to over seven percent in Italy.   

The New York Times has published a COVID-19 mortality calculator, which allows readers to adjust infection rates from one to 70 percent, and a mortality rate from 0.1 to three percent, to estimate various forecasts of total US deaths, from 3,300 to seven million. 

The actions we take in terms of coronavirus suppression and COVID-19 treatment will determine how many people die, and how massive of an impact our actions have on society and the economy.

The war has to be understood as a whole. Greater hospital capacity means more lives saved but also might mean less social distancing. 

A radical increase in testing may help societies decide when and how to let up on strict social distancing measures. Widespread testing, the tracking of virus carriers, as done in South Korea, and the declaration of some cities as free of the virus, may allow for greater freedom of movement.

However, it is still not clear whether we are on track to produce sufficient tests at a low enough cost to achieve this and, if we are, by when. The Trump administration must do more in this regard to provide transparency into the current and future status of testing.  

Nations, not states, win wars

Around the US, and the world, governors, hospital executives, doctors, and nurses are pleading for personal protective equipment (PPE), and reporting that they are having to make their own masks, re-use masks, and go without proper PPE, thereby exposing themselves to coronavirus.

President Trump yesterday invoked the Defense Production Act, but at today’s press conference said, “[The] federal government’s not supposed to be buying vast amounts of items and then shipping, you know. We’re not a shipping clerk. The governors are supposed to be, as with testing, the governors are supposed to be doing it.”

But wars are ultimately the responsibility of the federal government, which Trump acknowledged, saying “we’ll help out wherever we can and we can buy in volume.” That’s great news, and the president will go a long way if he can clarify what exactly the federal government is doing and what it is considering doing. 

Vice President Pence told a reporter that 3M is making 35 million masks per month, but experts estimate the US will need 3.5 billion masks. Including the pledge of five million masks from the Department of Defense’s own stockpile, our total national stockpile sits at around 35 million—one percent of our projected need. 

The Trump administration must be similarly transparent about what it is doing and not doing to build ventilators. Knowing how many ventilators there are is one of the factors that will determine hospital capacity, which will help determine when local governments should trigger micro-suppressions. 

American industry leaders want to help. After at first denying the seriousness of the crisis, Elon Musk announced yesterday he would convert his Tesla factory to make ventilators. President Trump must ask Tesla and other automakers to do so, just as President Roosevelt asked Ford and other automakers to make bombers at the beginning of World War II.

If state and federal governments fail to maintain adequate supplies of PPE, they will not only put the health and safety of frontline health care workers at risk, they will threaten the entire health care system with collapse. High exposure to COVID-19 has already infected 2,629 Italian doctors and nurses even though many wore PPE. Without adequate PPE, that number will be even higher. 

The Trump administration must thus do more to produce masks and other PPE and the ventilators hospitals need to deal with the coming flood of COVID-19 victims. China is a major bottleneck in most existing supply chains. 

PPE is not easy to manufacture and so strong federal action is required to replace missing links in the chain. If that requires creating or nationalizing firms, then that’s what we should do. Lives, and the broader society and economy, are at stake.

Finally, President Trump must also be more clear and transparent about what the Federal Emergency Management Agency (FEMA), the national guard, and the US military are doing. It appears that relations between Trump and the governors of New York and California have improved. That is great news. But now we need much more information about what the wartime mobilization plans are.

Why we must stay focused

Humankind has proven it is capable of rapid and radical social distancing and thus should be able to carry out Imperial College’s plan for future micro-suppressions, or something similar. While young people have made headlines partying in Florida, and attending rock concerts in the UK, I believe we will soon see major behavior changes by people under the age of 30 in response to widespread condemnation of such behaviors.

At the same time, as we enter economic recession or, worse, economic depression, individual and collective opposition to social distancing will rise. Workers will need and want to work. Employers will want to make money. Economically desperate people will do desperate things. 

Rising opposition to social distancing could manifest at the individual level as well as politically. People may make the case for loosening or ending social distancing. Already we have seen people openly ask why they are being required to sacrifice to prevent a few more deaths of the sick and elderly. 

Growing opposition to existing and future social distancing will worsen the spread of coronavirus and may even threaten the functioning of society. Popular resistance to social distancing can be met either through social norming (i.e., moralizing) or through coercion. In order to protect our freedoms as much as possible during this war, the focus of societies and governments must be on the use of as much voluntary, rather than coercive, action as possible. 

As people lose jobs, business, and even lives to the economic recession and perhaps depression, some people may argue that we should reduce social distancing, even at the cost of more deaths, to increase economic growth. Societies are unlikely to decide that they want to just “get the deaths over with” and accept COVID-19’s plan to wipe out millions of their citizens in return for higher economic growth. But people will set limits on what they are willing to do and spend, to reduce deaths, either explicitly, through laws, or implicitly, through behaviors.

That means that the focus of societies and governments should be on “no regrets” policies, such as PPE and ventilator production, testing, and sharing information. They will build the trust required for repeated periods of social distancing. 

The deadly coronavirus raises important questions about America’s relationship with China, but for now, national leaders including President Trump should make clear that our enemy is the coronavirus, not China. We will need to work with China for the next one to two years to defeat the coronavirus. 

The message from President Trump and other national leaders should be that all of humankind has, for now, a single enemy. We need to defeat coronavirus now and figure out the post-war world order later.  

The alternative to trust, truth, and transparency is unthinkable. Noted 1918 flu historian Barry, “society is based on trust. Not knowing whom or what to believe, people also lost trust in one another. They became alienated, isolated. Intimacy was destroyed.”

The Trump administration and other governments are making progress in winning the public’s trust. They should keep it up by stating more clearly what they are doing to manufacture the PPE, ventilators, and other equipment the doctors, nurses, and other health care workers on the frontline of our war on COVID-19 need to succeed and stay safe.

Correction: An earlier version of this article noted that experts in California estimated that over half of its citizens will be infected by coronavirus over the next eight weeks. However this estimation was calculated prior to lockdown measures which have been in place since Monday.

 

Michael Shellenberger is a Time Magazine “Hero of the Environment,” and president of Environmental Progress, an independent research and policy organization. Follow him on Twitter @ShellenbergerMD


Feature image: President Donald J. Trump, joined by Vice President Mike Pence, takes questions from reporters during a Coronavirus Task Force update Saturday, February 29th, 2020, in the James S. Brady Press Briefing Room of the White House. (Official White House Photo D. Myles Cullen.)

Comments

  1. A great article. As usual, Michael Shellenberger is a voice of reason, in an often irrational world. A couple of points though. First, I think there is an extent to which social distancing is by no means being applied evenly or across the board- many pubs and gyms are adopting minimal social distancing policies at best. Second, the recent spate of panic buying at supermarkets, exacerbated by the low levels of resilience of just-in-time delivery systems, has exposed our public to greater levels of systemic risk of infection, just at the point that the positive effects of social distancing would have begun to be felt, in flattening the curve.

    If the experiences of Italy are anything to go by, we are in for a rocky ride. One hopes that the natural reticence of those in Anglosphere towards public displays of affection and physical social contact, such as hugging and kissing, might afford us an extra layer of cultural protection from the spread of the disease, but it’s probably best not to rely too heavily on the whimsy of cultural idiosyncrasy to help stave off imminent threat.

    Back in the eighties there was a phrase originally drawn from traditions of the Royal Navy which was used to describe those who act only in their own best interests even if assistance to others would necessitate minimal effort on their behalf. The phrase was “I’m alright, Jack” and it was utilised, in some cases unfairly, to describe the headlong pursuit of financial gain during the Thatcher era. But in the context of social distancing, it’s use is perhaps more appropriate, given that minor changes in social behaviour have significantly less impact on the individual, even the same is not true for the businesses and venues they would otherwise patronise, if conditions were normal.

    I hope things go better, I really do. Because it would be horrible if a whole new “Me” generation were forced to look back on a cultural landscape of desolation, and wonder whether a few minor changes in personal behaviour might have helped mitigate very real human suffering and grief. In the meantime, let’s hope that the Soviet-style queues forming at supermarkets become a temporary blip, as people’s stockpiles of food and modern essentials reach saturation point. Otherwise the social influence of a climate of scarcity, might combine with other factors to make the situation worse than events warrant.

  2. ‘Societies are unlikely to decide that they want to just “get the deaths over with” and accept Covid-19’s plan to wipe out millions of their citizens in return for higher economic growth.’

    Yet that is precisely what many want and the leaders of Germany, France and the UK have seriously entertained, with their insane “Herd Immunity” plans. Why is it that Western countries already have higher death rates than Asian countries at the height of their outbreaks? It’s not authoritarian or drastic restrictions. Democratic South Korea so far leads the world with less severe restrictions than in the West.

  3. The average age among Italians who have died from the novel coronavirus is 79.5. It is not a matter of weighing lives against money and convenience. Economic catastrophe has a human cost. It takes years off of lives. Twelve to eighteen months of forced ghettoization is too much to ask. We are being asked to potentially enter another great depression because old people are unwilling to die of natural causes in their 70s and 80s. This is an outrage. People should be resisting. People should be pledging not to wash their hands until governments agree to end these lockdowns.

  4. This kind of abstraction is not necessary, and it’s not helpful. The Covid-19 crisis should be thought of as what it is – a global pandemic. That’s sufficiently horrifying. We don’t need laboriously overextended metaphors to grasp the meaning of ‘pandemic’. We aren’t “in a war.” It’s much worse than war. Neither do we need to think of Donald Trump as a wartime president. He doesn’t deserve that kind of latitude. He’s not the Commander in Chief of disease prevention. We don’t need his “genious” here. He should shut up and listen to the epidemiologists and infectious disease specialists; and quit lying, for Christ’s sake.

  5. Not a fan, I gather. I should think that after the last four or five years you would have realized that everyone - not just you - has a pretty good handle on his personality.

    Not panicking about COVID-19 starts with not panicking about Trump.

  6. I think we here in rural US can probably stand another week of the “social distancing” thing, but no more. Not only small businesses, restaurants, etc. are shutting down, even big manufacturers are thinking of closing production. Right now, just looking at the numbers, our family has a much greater chance of going without affordable health insurance due to loss of my husband employment, and whatever it may entail to our future and well-being, than of anybody getting sick with this damn virus. We live in rural area, go to store once a week, back and forth to work in our own cars, cleaning our hand obsessively and sanitizing relentlessly. But right now I’m quite stressed about our economical future, and it’s not good.

  7. A “hero of the environment” huh? Fascinating. The perspective is wildly anti-human throughout this whole article. The insane damage it would do to keep people restricted and isolated for a year is not even worth comprehending.

    There is, in this analysis, a strain of thought I’ve seen a few too many times. It’s grasping a situation that can be used to curtail and control people. It’s a way of bringing the population to heel and keep them controlled.

    These hilarious predictions about massive death rates, months of calamity, long term changes in drastic unpleasant ways is the same moral panic you see again and again and again. The virus is a danger to people, yes. The virus is spreading quickly because we have no apparent herd immunity, yes. But most people show limited to very mild symptoms. Of the percent who go to hospital many recover. Promising treatments are already being tested with potential cures only weeks/months away. A vaccine will be developed faster than any in history.

    The knee-jerk response to shut down the western world and the, frankly scary, praise of the authoritarian actions of China show you the real threat here, opportunist dictators-in-waiting hoping to gain control over people however they possibly can because they ultimately fear the population as a whole, they fear the people who would vote for Trump, or agree with Brexit. It’s easier for them to lump them all into one box, lock them in, and throw away the key - literally.

  8. Gotta disagree with you here on a few points. One is that people do recover, yes. However, without herd immunity, the risk of that people are worried about is that it will spread too quickly. There are a small percentage of people who have it who need respirators. Otherwise they will die. Normally, if there is immunity in a population, such as the people who’ve taken their flu vaccine, the spread is slow enough that if you need someone to be repspirated, they can find a respirator. The problem here is that we are running out of them in some countries, end in the US we could very well do so unless we could slow this down.

    If a person only needed to be on a respirator for a couple of days, that would be one thing. However, this tends to take a few weeks. That means that eventually, unless we have enough respirators, people would go without, as we’re getting to in Italy. Then those people would die.

    Also, while it’s the elderly who are most at risk of death, younger people are getting it too, and there is a percentage of them who are ending up on respirators and needing that. So it’s not just the elderly who are at risk here.

    Second, as someone who has made antibodies and done work with Immunology, not so fast on vaccine. The problem is, we need to pick an epitope that is less variable, so the virus can’t mutate out from under the vaccine, and is something that our immune system will easily recognize, because it’s not tucked away in a pocket somewhere under another protein. This takes more work than you might realize, but even if we get the vaccine up and running, to get it into mass production takes months. Especially if we’re doing it the normal way that you would want to do it, egg cultures Etc. There are other ways, but they are not nearly as easy, and I would not trust a vaccine made from some of them. If the person did not know exactly what they were doing, you’d end up with something that was infectious or just a nice injection with saline. It’s not quite as simple as you might think.

  9. I don’t know much about him personally, but there is an opportunity here with the COVID-19 that has not gone unnoticed by progressive socialists.

    An opportunity to habituate the people of the West to accept, and perhaps even welcome, a greater amount of control over the West’s economy being put into the hands of the professional regulatory class. No one who is directly answerable to the voters, but permanent civil servants who are almost impossible to fire, and so are largely unaccountable.

  10. Any model that depends upon the Chinese Communist Party for candor is bound to be suspect.

  11. Regarding the mask shortage, please remember that masks can be re-used. I’m a manager at a hospital with double-digit COVID-19 positive/presumptive patients, I’m at work every day, and I’ve used the same mask for two weeks. Just take care of it and don’t touch it with your hands, except for the straps. Wash first, and afterwards. Only take it off to eat and drink.

    Regarding building mass quantities of ventilators, each patient on a vent requires significant trained & experienced human support, as well as dedicated infrastructure and a constant stream of disposable supplies. We’re talking primarily respiratory therapists and blood gas machines, but also RNs/aids, lab facilities and techs, but a whole lot of other stuff too. Without that the ventilators just sit.

  12. I think it’s instructive to look at the one pretty much closed environment where the virus got loose, the Diamond Princess cruise liner. With approximately 3,500 people aboard, a bit more than 700 (20%) have been infected to date. Only seven deaths (1% of infected), which likely reflects great care provided by Japan. To date more than 500 infected patients have recovered, leaving less than 200 active cases.

  13. I know the author means well and is not an authoritarian. But I find this to be alarmist and now I feel like I need to be alarmist about all the alarmism I see in the media over the Wuhan Virus. It seems everyone in the media, left and right, is trying to outdo each other and see who can propose the most authoritarian solutions the fastest. I think it is madness. Count me out. I wonder what authority governors think they have to order people to not leave their homes. I reject it. It is not in the Constitution. The states could pass emergency laws at the very least. I don’t see how they would ever be constitutional but at least it would throw a veneer of democracy over it.

  14. This comment reflects common misconceptions that, unless corrected, will lead to widespread illness and death. The controls on personal freedoms are not an outrage to be resisted — they are legitimate uses of police power that transcend personal liberty. Your liberty ends when it threatens the lives of others, as it does in a pandemic. There are few situations in which even libertarians recognize a collective imperative, and infectious disease is one.

    My closest friend is a professor of emergency medicine at a major NYC hospital. So this information crosses the line from “anecdote” to “data.” His hospital has seen hundreds of infected—or probable infected, because they cannot get reliable, prompt test results. Private testing providers have been returning results in over six days, which makes testing useless.
    The reported deaths thus far are mostly among the elderly. This is because they have such poor prognoses that they are put on “comfort” measures rather than ventilators, and they soon succumb.

    This will change. Most of the infected are in the primes of their lives, in their 20s through 40s. Once placed on a ventilator, their chances of recovery are poor, but they can hang on for quite some time. My friend has not seen a single patient over age 65, but he has personally intubated several under that age.

    And as another commenter pointed out, a ventilator is not merely a machine. It is a machine, a bed with adequate space and quarantine controls, a hook-up to in-wall O2 supplies, other machines to monitor vitals, and trained personnel to administer all of the above on an ongoing basis. But these personnel, of which there are far too few, will get the disease in large numbers, because guidance about the efficacy of PPE has been false and their exposure is constant. My nurse friend’s colleague, a woman in her 30s, is currently intubated and is losing her fight for life, in middle Tennessee.

    As for the ER professor, he estimated the number of NYC infected at over 50,000. Two days ago, his hospital had zero free ICU beds and 3 remaining ventilators. His chilling assessment was that NYC is a “lost cause.” This is a man inclined to understatement.

    Herd immunity is an illusion, minus a vaccine. Our innate (heritable, Complement system mediated) immune system has not seen this pathogen, so innate immunity will be nonexistent or negligible.

    In sum, educate yourself, isolate yourself, and disabuse yourself of myopic views on what liberty means. Many among the rest of us will die if you and others like you don’t. And you may well find yourself in that portion of the “herd” that is needlessly thinned.

  15. I read the article. The language in the Imperial College study that suggested we could have to endure severe social distancing for up to a year or more is what turned me against social distancing. The article you posted says that it will ease up after a few weeks which will buy us time to figure out how to stop the spread in a more targeted way. I am less optimistic. But if that is the thought behind all this, then there needs to be a deadline. Like, “we public health people are giving ourselves exactly six weeks to acquire the necessary knowledge and equipment and come up with a less draconian plan. If we fail to meet that deadline we let it rip.” I would be on board with that but that is not what is happening.

    Also, the author talks about promising drugs that might help prevent the spread. The same public health people who want all of my friends to go on the dole are throwing water on that hope, and saying we need to conduct studies on the safety and efficacy of these medications first, even though they are apparently benign enough to be sold over the counter in Mexico and the U.K. It is either serious or it isn’t. With the first scintilla of evidence that malaria pills or whatever help keep healthy people from getting infected, Congress should pass emergency legislation granting the manufacturers immunity from tort liability, expropriate some pill factories, and sell the stuff OTC in every grocery store. Yes, some people will have seizures etc. If this coronavirus is not serious enough to justify that risk, it is not serious enough to confine 300 million people to their homes for months.

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