By Jonathan R. Wetherbee
When COVID-19 first came on the scene, our initial questions were around the infection rate and the fatality rate. And that, to me, makes sense.
You probably saw a chart that showed the fatality rate. You were probably less likely to see the infection rate, or the R0 (pronounced, "är-naught"). And if you were familiar with infection rates you could have compared COVID-19’s to that of the seasonal flu and you could have seen how this whole thing would get out of hand.
So, highly infectious and death rates that are no joke.
And if you’re making decisions based on those numbers, alone, (and a lot of people and governments were/are) you might think that the solution is a simple one: This disease is particularly harmful for older folks. So, let’s quarantine those who are most at risk, and let relatively younger people who are not at risk go out, participate and prop up what would otherwise be a weakening economy, while a fraction of us remain indoors.
Coronavirus responses are made while balancing the economic impact of preventative measures against the health and well-being benefits of those efforts, and governments vary based on how aggressively to combat Coronavirus. Some take more drastic measures to fight the disease, while others are relatively slower or less-drastic.
Take the United Kingdom. The UK initially lagged behind it’s cross-channel peers, France and Germany and, as of March 16, they were pretty far behind the rest of Europe when it came to locking down non-essential businesses, schools, and large events.
The British government was relying on the counsel of a group of behavioral psychologists, known as the “nudge unit” and so they were very averse to doing anything drastic to fight the COVID-19 outbreak too quickly. That nudge unit, advised on the idea that only older folks were at risk, and so the kids should actually go out and get the disease to acquire a herd immunity so that at-risk folks could re-enter society.
But less than a week after the March 12 press conference where UK officials explained their thinking, the UK dropped this act pretty abruptly. By March 24 the UK was in full lockdown mode with police being empowered to enforce social distancing and the closure of non-essential commercial businesses and public events, among others.
So, we’re left asking ourselves what changed in that short amount of time for the UK government to go from one end of that policy spectrum to the other.
The Framework Changes
In a pre-COVID-19 world, the essential questions were infection and fatality. In my lifetime, we’ve never had to look beyond those questions. Ebola was incredibly fatal, but it’s infection rate allowed us to contain the epidemic. SARS was in the same boat, but less fatal. COVID has proven to be very contagious because of the ability to carry and infect others without showing symptoms, and that had introduced an issue that many in the public health world predicted.
At around this time, the #FlattenTheCurve movement started picking up. We’re probably all familiar with this movement by now, but it’s simply the idea that if we take more aggressive measures to combat COVID-19, we will lessen the burden to our healthcare delivery systems and, if done right, can even prevent us from surging past our medical capacity with a more stark curve of infection.
It takes the two-part gut check from before and adds a 3rd part, medical capacity.
Not only was that movement gaining traction right at about this time, but (getting back to the UK) it was also starting to be backed up by the available data. For example, Spanish data, which broke down hospitalization rates by age bracket, showed that even if you were in your 20s, you could still have a 1 in 10 chance of being hospitalized (assuming uniform infection rates across age groups).
Those hospitalization rates and #FlattenTheCurve concept got spelled out in incredibly stark terms via an Imperial College of London study, which said that even the UK imposes fairly stringent mitigation measures, they would surpass their critical care capacity by early May. “And they also said that the second we quit our preventative measures, that the spike would just happen at a later time.”
When we Boris Johnson made his next appearance, he had a brand new crew and, to make it abundantly clear why he changed course, the banner at the front of his podium read “Protect the National Health Service."
With the #FlattenTheCurve view of the world, the UK saw that there were two things they could do. As I mentioned earlier, the first was the stay in place order and the cancellation of large events, among other tactics to flatten the curve.
The 2nd was trying to raise the medical capacity line itself. They called for retired medical professionals to come back to the profession and they accelerated the graduation of final year med and nursing students. They turned a London-area conference and convention center into a 4,000 patient hospital, with another convention center in Glasgow that could fit a thousand more.
But that still doesn't answer every single COVID-19-related capacity issue. You can raise the medical capacity line, and still not have raised the line at all.
If we raise medical capacity lines for beds? Congratulations; more people can be in a monitored environment.
If we raise the medical capacity line for health care professionals? Congrats those patients can now get looked after.
Another area that the UK was watching when they changed their COVID response strategy, was the Lombardy region of Italy, which got so overwhelmed with Coronavirus cases, that they were reporting Italian medical shortages as early as March 11. And the shortages weren’t just in critical care beds, it was in medical equipment as well.
In the UK, after all their efforts, that will no doubt make things better. The UK will still be faced with a shortage of medical equipment, like Personal Protective Equipment or PPE, which is vital for helping our healthcare professionals not get Coronavirus. And we will still be faced with a shortage of ventilators. And you can’t just make enough of those overnight. And then we’ll likely see a shortage of medications, like hydroxychloroquine, which is vital for people with Lupus.
Medical capacity is its own challenge that governments and the private sector will have to hustle to enhance. Ed Yong of The Atlantic has a phenomenal explainer of the various medical capacity restraints.
So, what does all of this mean for Georgia?
Well, these are some of the inputs as to why Brian Kemp just announced a shelter-in-place order along with the closing of schools and empowering county sheriffs to enforce social distancing and business closures. Kemp just announced $72 million plan to ramp up to 296 additional hospital beds.
The model that the White House uses for its medical capacity projections shows that Georgia will exceed its capacity for ICU beds through early May. Which is terrifying. And what this graph also shows is that we are a week or two out from Georgia being hit hardest by the disease, so what we do today ensures we stay at the low end of this range of uncertainty.
We know that the Atlanta area is taking off with confirmed cases. And they are still very much climbing that curve. Mayor Keisha Lance Bottoms instituted a Stay at Home order the day after the United Kingdom did, citing above average rates of chronic illness and ICU bed shortage.
Southwest Georgia, due to a couple of funerals from where the disease predominantly spread, has had the steepest climb and the hardest hit counties are in either of those metro areas.
Southwest Georgia is particularly concerning because on a per capita basis, it’s seeing as many cases as Lombardy, Italy. So, it’s no surprise that we’ve resorted to building temporary, emergency beds where COVID has hit the hardest.
And we have to talk about the economy, and let’s first all agree that the guys who are saying that they’d kill themselves for the economy are much less Katniss Everdean and much more Jack Dawson from Titanic. You do not have to do the thing that you say you have to do.
Unemployment claims suggest that we are above 10% unemployment for the working population. That would represent a jump in unemployment numbers like we’ve never seen before... Like ever.
Ever since the first ever act of employment when one neanderthal paid another 10 deer tenderloins in exchange for remodeling his fire pit, we’ve never seen an unemployment spike like this.
It’s sometimes hard to conceptualize what it means for an economy to screech to a halt unless you currently work in the travel or hospitality industry. Of all the graphs we’ve seen, this one, to me is the scariest.
We may have to look at mortgage holidays and extended stimulus payments and see whether we can afford those things given the amount of debt we’re currently in. We may have to re-open society with social distancing norms and procedures.
There’s no way that we can cover the entire economic side in the amount of time we have left, but definitely use the movements and resources at your disposal to the extent that you feel comfortable.
Companies that are doing well through this, shouldn’t be cutting back on expenses to their employees, consulting firms, ad agencies, or any other people expenses.
So, without the ability to quickly move the medical capacity line, our best short-term option for everyday, non-healthcare industry folks like me and you is to go the self-isolation rout and help flatten the curve. Although it’s too early to see the impacts of the UK lock down, even the most pessimistic models show that Italy and Spain are successfully starting to flatten the curve and give their medical capacity time to catch up. And markets have rallied in light of data that showed that these tactics were working.
At some point, Georgians will have to ask whether we should re-open the economy or whether we as a country borrow and spend our way through this. Luckily for us, the decision today is a pretty clear-cut one. We should all just chill, make sure we have a good handle on our medical capacity lines and then ask the questions around when and how to re-open the economy.