America spent the spring building a bridge to August, spending trillions and shutting down major parts of society. The expanse was to be a bent coronavirus curve, and the other side some semblance of normal, where kids would go to school and their parents to work.
The bottom line: We blew it, building a pier instead.
There will be books written about America’s lost five months of 2020, but here’s what we know:
We blew testing…
We blew schools…
We blew economics…
We blew public health…
We blew goodwill….
The objective of sheltering in place for the spring was two fold. First, give the hospitals a chance to not get slammed in the first wave. That mostly worked everywhere except Metro-New York City. We also bought time for learning and development to happen. We know a whole lot more about how to clinically approach severe COVID with better tools now than in March.
The second objective was to buy time to moblize other resources that could successfully suppress and minimize viral spread with tools that are more precise and less costly than what we had to do in the spring. We failed at that.
Harris County + #Houston together can contact trace 600 COVID patients a day.
But the daily average is 1,500+.
This means tracers often miss a critical window to warn potentially pre-symptomatic COVID carriers to isolate away from family and coworkers. ➡️https://t.co/CDjTSrHSwc
— Zach Despart🖊️ (@zachdespart) July 19, 2020
If there are 900+ people a day who are not being contact traced, that invites either massive community spread or necessitates wide spread shut-downs again until the number of new cases per day are back within the capacity to aggressively, quickly and comprehensively contact trace and isolate anyone who was likely to have been exposed to an individual. Contact tracing is a combination of public resources which, if they are state or locally funded, extremely scarce and social behavior. It is far easier to contact trace someone who walked to a mail box, drove to the store for a once a week 30 minute in and out and then stayed home then someone who ha a full and active social life. Precise tools get overwhelmed with high prevalence and increasing social mobility so the only tools left are either riding things out with massive death and suffering OR blunt tools.
My wife and I spent most of the weekend talking about the schools. Our school system had planned initially on a hybrid model and then switched to a full remote model for at least the first quarter. Duke University is still planning on having students on campus in under a month. The NFL is meandering towards an attempt to start training camps. All of this is happening in the context of significant community spread and a haphazard policy response.
The question being asked right now is “When can we do X?”
The question that we should be asking and solving for is: “What are the conditions needed to do X, and what do we need to do now to make those conditions happen?”
If we want kids in school, if we want students on campus, if we want live sports, then we need to clamp down on community spread. That means massive increases in testing. That means massive expansion of PPE distribution. That means aggressive and prompt contact tracing. That means making isolation a non-ruinous proposition for working families. That means a ton of hard work. But the choice is either doing the hard work to get what we want, or not doing the hard work, seeing massive suffering and not getting what we want.