SUMMARY BY WEST COAST SLIPPERS (ghostwritten by East Coast Slippers): So our Covid-19 sequence continues. In this episode, we expand upon our ideas for moving out of the “hard” clampdown and back into a functioning economy. The seemingly (to us, anyway) innovative aspect of the plan that we have developed is that extended stays in hotels by young, healthy workers who normally live with vulnerable individuals should be able to live in government-subsidized hotel rooms and receive meal stipends to 1. protect the vulnerable; and, 2. help out the hospitality and restaurant industries.

Make some time to absorb this one and then you can spend the rest of your valuable time on other mission-critical activities like pacing, fretting, worrying, hand wringing, and softly rocking back-and-forth, arms wrapped around knees, and trembling ever so slightly with a catatonic expression while emitting a high-pitched, almost ultrasonic keening sound.

Here is a link on the Deepwater Horizon oil rig that EC spoke about.

And here, for what it is worth, is a draft of the proposal that we have been discussing:

A NEW APPROACH IS NEEDED TO COPE WITH THE COVID-19 OUTBREAK

That the greatest public health threat of the modern era is also our most profound economic crisis has created massive trauma for the United States and the rest of the world. Although the future may appear benighted, we suggest that a viable solution is within our current reach once we understand that Covid-19 is not one event but two. To the elderly and the infirm, it is virulent, but to the young and healthy, it is not nearly as dangerous. Our response in the United States so far has missed the mark because we have been trying to force a single solution on a binary problem. Permit us to expand on the idea that Covid-19 is not a “one size fits all” pandemic.[1]

On March 18th, Bloomberg News Online published an article by Tommaso Ebhardt and Chiara Remondini titled “99% of Those Who Died From Virus Had Other Illness, Italy Says” that reports on a study of deaths from Covid-19 in Italy.[2] The substantive takeaway is that 99.2 percent of deaths in the sample population were patients who had serious pre-existing illnesses (such as diabetes, hypertension, or heart disease). Importantly, almost nobody was healthy when they contract the virus died. That finding is hardly and an outlier. The Los Angeles Times, [3] using figures published by the Chinese Center for Disease Control,[4] reports that the Case Fatality Rates based on just under 45,000 patients was 0.2 percent for ages twenty to twenty-nine; 0.2 percent for ages thirty to thirty-nine; and, 0.4 percent for ages forty to forty-nine. Any death is awful, but clearly, Covid-19 is not taking a vast toll on the under fifty set.[5]

If those reports are substantially accurate, we have the opportunity to use those finding both to save lives and to rescue our imperiled economy. The following steps are necessary:

>>> Those who can work from home continue doing so for the time being;

>>> After a “hard” lockdown of two or more weeks, healthy people under thirty who work outside of the home and do not live with individuals in high-risk categories return to work in planned phases over a few weeks. Older workers get phased back into the workplace as testing for the virus ramps up (obviously everyone would be called upon to continue to limit their unnecessary travel and social mixing until the crisis has passed).[6]

>>> Healthy people who work outside of the home and live with vulnerable individuals present a particular problem because China found that seventy-five to eighty percent of Covid-19 transmissions there took place within family clusters.[7 at 3:50] Happily, the obvious solution (and one of the main ideas here) is to utilize the excess capacity in our hospitality industry, providing temporary government-sponsored housing for able workers while simultaneously putting stimulus dollars in the pockets of hotel owners and employees. As further stimulus we give those individuals a daily meal stipend;

>>> K-12 schools, colleges, and universities return to their regular schedules. Minors who live with vulnerable individuals would either be excused from school if younger or given online education during the duration of the crisis;

>>> A government program is created that delivers necessary supplies and services at no cost to the vulnerable individuals so they can remain in temporary quarantine. That workforce would require testing regularly to prevent them from spreading Covid-19 to the population that they are serving (National Guard troops could be used for that work as a bridge while the raining of a dedicated workforce is complete);

>>> Per the best practices used to stem the spread of Covid-19 in other countries, local dedicated “Fever Clinics” that can quickly provide those exhibiting symptoms with white blood cell counts, flu tests, and actual Covid-19 tests is be set up and staffed (using skeleton crews of medical professionals until the training of a dedicated workforce is complete).[8 at 0:40] The same entity trains other workers to administer temperature checks in places where people congregate in numbers such as supermarkets, larger workplaces, and malls (something that robots are apparently built for in Hong Kong). Potentially infected individuals would be isolated from others and given access to necessary medical care if their conditions began to deteriorate;

>>> A rapid expansion of our healthcare capacity is required. The government leases available buildings and converts them into ready bed space; individuals in training who are not yet officially nurses and medical technicians are accelerated to assist medical professionals in rendering care to Covid-19 patients; and—most importantly—the manufacture of ventilators, protective gear, and other necessary equipment and medicines are spun-off in an effort comparable to that undertaken during World War II with the Manhattan Project (an effort that is to some extent already getting started).

>>> For a time, the avoidance of large gatherings and non-essential travel is necessary. As testing expands and we arrest the virus, recreational travel and some public gatherings could come back. When a vaccine in place life would return (more-or-less) to the next normal; and,

>>> Over a longer timeframe, we migrate critical supply chains back to the United States, thereby reducing our dependency on distant places for vital goods.

That coordinated approach produces several tremendous advantages after the hard clampdown is eased:

>>> A return to full employment can begin as many go back to their regular jobs at the same time as the workforce expands to meet the needs of the vulnerable;

>>> Those who are most vulnerable are well protected while having their basic human needs met;

>>> This plan preserves vital ICU capacity because the sickest among us who are most likely to crash if they get Covid-19 are quarantined, and only a scant few should not need Covid-19 care in the near term;

>>> Medical professionals are less taxed and in less danger of infection;

>>> Medical space, equipment, and consumables get used at a slower rate;

>>> Significantly more medical resources are available to use on those who do fall ill because the most vulnerable individuals have been kept safe; Government bailouts, although doubtless still necessary, are significantly reduced; and,

>>> Confidence can return to the markets, and the economy starts to bounce back.

The greatest obvious concern is if the number of otherwise healthy people who contracted Covid-19 might overwhelm the healthcare system. Again, based on what we have learned from Italy, that seems to be a remote risk as their system only lost 0.8 percent of previously healthy individuals even while that system coped with the burden of treating the vulnerable elderly and those with pre-existing conditions.

This plan is not perfect, and many important details will require expansion. But because the current situation is urgent, we cannot allow the perfect to be the enemy of the possible. To put the United States back on course, Congress must enact legislation that puts this plan (or one similar to it into) action before more lives are lost, and before our economy suffers further damaged. Even if federal action is not forthcoming, state-level adoption of the salient elements of this plan will make a difference at the local scale.

On March 20th, the website FiveThirtyEight.com published a meta-analysis of studies that model the lethality of Covid-19.[9] The highest estimated death toll in the selected models is six million. Using a 0.6 percent estimated fatality rate for those individuals (who are all previously healthy, mainly under thirty, and treated in hospitals not overrun with elderly patients who were already in peccary) would mean that even if every person who went back to work under this plan became infected with the virus, 36,000 would die. At the same time, the number of lives that we would be saved by the proper quarantining of the vulnerable population would be considerably more. At some point, a sizable number of individuals will have to take some level of risk. The alternative is that we all quit work and stay inside forever because of the persistent risks that bee stings, shark attacks, and lightning strikes present.

All of the shifts outlined here, although significant, would be of limited duration and would end once a viable vaccine becomes available. While the type of hard lockdown that China used galls most Americans,  we can learn to adapt. For this plan to work will require unprecedented levels of cooperation, unselfishness, and above all else, that we have faith in each other. We believe that the citizens of the United States are ready to rise to the occasion.

[1]. This is as good a point of any to acknowledge the potential perils of “Armchair Epidemiology” https://tinyurl.com/vtmdeyg
[2]. https://tinyurl.com/wbplmwf
[3]. https://tinyurl.com/qq3t6kg
[4]. https://tinyurl.com/qwb7xyh
[5]. The data pointing toward the low risks for young, healthy people is substantial. For example, the CDC reports that between February 12th and March 16th, fifty-one percent of hospitalizations for Covid-19 were people fifty-four and under. During the same period, people under age forty-five were roughly three percent of all ICU admissions (the CDC acknowledges that they only had partial data to work with for that study so it would be unwise to put too much weight into those numbers) https://tinyurl.com/wb6hwl7
[6]. The U.S. population is 71.03 percent fifty-four and under  https://tinyurl.com/ybjtbjqg     
[7]. https://tinyurl.com/s7y286a at 3:50.
[8]. Ibid at 0:40.
[9]. https://tinyurl.com/samrcrw

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