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To Open or Not to Open…

To Open or Not to Open, that is the question:

 

One month ago, Gavin Newsom the governor of California became the first Governor to issue a statewide shelter in place order.  At the time of the order California had 900 positive cases and 19 fatalities.  Some thought the Governor jumped the gun in shutting down the state’s economy.  Others applauded him as educated and forward thinking.  Over the next days and weeks other state governors follow suit.  One month after the shutdown California has had 27,000 cases and 890 fatalities.  While that number seems like a great deal it’s actually a picture of success.  California has the highest population of any State in the country.  In spite of that they are 7th in the number of reported fatalities.  If California had the same per capita fatality rate as New York they would have over 28,000 fatalities.  So, you could make an argument that California’s early actions saved over 20,000 lives.

 

The side effect of all of these shelter in place orders are an incredible increase in unemployment and the resulting damage that does to the US economy.  In the last 4 weeks we have lost over 22 million jobs.  That is the total job growth we have experienced over the last 12 years.  It begs the question how much longer we can shut down the economy and be able to survive the lasting economic damage it will cause.

 

The dilemma this creates is a question of what is worse or what will kill us first, the virus or a destroyed economy.  Recently I have listened to people take extreme positions on both sides of this issue.

 

On one side are the people who think the economy should be opened right away.  They believe that this shelter in place order is an act of tyranny and it impedes their god given constitutional rights.  On the other side are some public health experts who say the only course of action is a complete shutdown of the economy until August or September.  I watched one such individual suggest that the government should just print about $10 Trillion dollars and pay everyone to stay home for several months.

 

This raises the question; which side is right?  The simple answer is they are both wrong.  What’s worse is the more extreme people on either side get the more their position become idiotic and not helpful.  At this point I am sure some of you reading or listening to this just got angry because you think I just called you an idiot.  I did not.  I said our position is idiotic.  I don’t know you well enough to decide if you are an idiot.

 

Let me explain.

 

The crowd that thinks this shelter in place orders should be lifted right away and these orders are a violation of their constitutional rights often make statements that this is not different from the flu so why are we shut down.   Some of them even believe the virus was man made or its some kind of political conspiracy.  Ok, lets deal with these arguments.  First of all, the constitutional argument is ridiculous.  Nowhere in the constitution does it give a person the right to put others in danger which is exactly what violating the shelter in place order does.  Your rights do not extend to the point of putting someone else at risk or in danger.  So, let’s stop being silly with this nonsense.  The other argument that this is no worse than the seasonal flu is also nonsense.  Covid-19 is significantly more contagious and deadly than the seasonal flu.  There is simply no comparison.  What is abundantly clear is the direct correlation between testing and mitigation efforts like social distancing and shelter in place and a significant reduction in cases and fatality.  Because of this correlation we know that ending these mitigation efforts too early and without a vaccine will result in a significant outbreak and a large number of fatalities.  I don’t see anywhere in the constitution where it points out that my rights supersede someone else’s right to live.  As for the theories that this is man-made and somehow politically motivated, I’m not going to even justify that with a response.

 

Now, for the other extreme.  The public health academics who take the position that we have to close the economy for several months because every single life is precious are equally wrong.  Their idea that our government can just print trillions upon trillions of dollars and pay everyone to stay home for an extended period of time is about as realistic as me thinking that the Red Wings are going to call me and offer me an NHL contract to be their goalie.  If we shut down our economy to the extent that these people are suggesting the lasting damage it would cause would be worse than the Virus.  In response to their suggestion that we just print money to solve this economic problem I would ask them to research post WWI Germany.  After WWI, Germany was forced to make reparations for the war.  This caused them so much debt that their economy went into a period of hyperinflation and their currency was seriously devalued.  In 1919 it took 48 German Marks to buy one US Dollar.  By 1923 that exchange rate was 4.2 trillion marks to one US Dollar.  That’s not a typo folks the exchange rate was 4.2 Trillion to one.  In 1922 it cost 120 Marks to buy a loaf of bread in Germany.  One year later that same loaf of bread cost 200 Billion Marks.  My point here is if we shut down the economy for 6 months or more and just print money to pay for it, we could experience similar kinds of hyperinflation.  Getting a government check doesn’t help you very much if it won’t buy a loaf of bread.

 

So, what should we do?  Well, like all things the truth is in the middle.  The key will be to thread the needle and balance the risk of further outbreak with that of lasting economic damage.  This is not going to be easy because it’s a balance between two bad choices.  From my perspective we need to intelligently open up the economy in stages and with this balance in mind.  We need to also ramp up testing to help make these decisions.  For example, I don’t see any value in sending kids back to schools until next fall at the earliest.  This is not the economy and a school are a perfect breeding ground for transmission.  I also don’t see any need for sporting events and concerts with live audiences.  Those things should be done for TV only right now.  On the other hand, we could start looking at allowing some small businesses to open with sensible restrictions and in certain geographic areas.  A restaurant in a rural area with very little outbreak could open with 50% capacity.  This would allow for an open table between each occupied table.  Wait staff could wear masks and gloves.  It may not be great ambiance but its relatively safe.  A small shop in that same area could open and limit the number of customers at one time so they could social distance.  Now it may be some time before those types of businesses could open in New York City but in other parts of the country it may be ok.  Options like that should be pursued and evaluated as a way to balance both the need to be clinically safe and the need for people to be able to work and earn money.  As I said it won’t be easy.

 

The key to all of this is for smart, reasonable people to make the best decisions they can in a fact-based balanced approach.  They should know that it won’t be perfect and accept that we are balancing between two lousy situations.  What doesn’t help are the idiotic statements being made by both extremes.  Those people need to permanently social distance themselves and we need to find a way to turn off their internet.

 

Take a listen to our podcast that coincides with this blog post!

https://podcasts.apple.com/us/podcast/fulcrum-strategies-analyzing-changes-in-health-care/id1281557675?i=1000472182631