The Strategy that Beats COVID

In this post I strongly recommended that people read two articles by Tomas Pueyo that lay out a context and strategy to beat COVID without totally trashing our economy or allowing millions to die. Now, I would add a link to a podcast at Harvard Business Review that says the same thing.

If you absorbed those explanations, you will see and understand that there is a clear strategy to beat COVID-19, without totally tanking our economy. I outline the broad strokes of the strategy below:

Hammer and Dance

First, we must hit COVID with a lock down for at least 3 or 4 weeks. The tougher and longer the lock down the better. There are two goals for the lock down:

Suppress all transmissions – The lock down has to last longer than the normal course of the disease in a victim. During the lock down period someone should be able to contract the virus, become infectious and either recover or go under medical treatment without having a chance to meet and infect someone else. If that can be achieved, an entire generation of infections will pass without retransmission and the number of new cases should fall close to zero by the end of the lock down. That gives everyone a fresh start and a chance to keep the virus from resuming its explosive growth.
Reveal or neutralize the hidden carriers – Unlike other viruses, COVID appears to spread from people who are infected but don’t yet show symptoms, or whose symptoms are very mild. That means there are probably far more carriers in society than official test results show. A several week lock down gives time for those silent carriers to either a) recover and become post-infectious without passing it on, or b) display overt symptoms that reveal them to the medical system where they can be isolated and treated. Either way, the silent carriers go away.

Tomas Pueyo calls the lock down phase “the hammer“. Experts don’t put a calendar time limit on it because lock down compliance may vary. However, it must always be longer than the typical course of the disease for a non-hospitalized patient (2 to 3 weeks). That is the only way to create a time window where close to no new infections occur. We have to keep hammering until we stop seeing new cases. We can’t let up too soon.

A huge secondary gain from the hammer is the hope that, by stopping the emergence of new cases, we can hold our medical system’s workload to a level they can handle. The evidence from other countries is stark. If people can get modern medical care (including ventilators), the death rate is 1 to 2%. If the medical system is overwhelmed, the death rate is 4 to 5%. For the US, the difference could literally be millions of fatalities.

We must simultaneously use the lock down time to invest and ramp up our testing and tracking capability. Those are critical because, when the lock down is over, new cases will occasionally appear. The trick is to apply localized lock downs and quarantines to keep them from restarting explosive growth. We will need the testing and tracking resources to catch and kill them as they emerge. Pueyo refers to this whack-a-mole process as “the dance“.

We can allow most economic activity to resume as soon as we start the dance, but we may need to keep a lid on high contact, large group activities like concerts, parties, church services, nightclubs, conventions, etc. These are events where people congregate and try to interact. It’s too fertile for a spreader to randomly emerge and blow us up again. Small group activities should be OK. Even larger congregations like commuters on subway platforms are less threatening because people mostly keep to themselves.

We will be in the dance until the cavalry arrives in the form of prophylactics, therapeutics and eventually a vaccine. .

The hammer and dance was used by China, South Korea, Taiwan and Singapore to bring COVID-19 under control. Control means that those countries are still dancing aggressively to keep the virus from resuming its explosive growth. There are occasional flareups that are hit hard again with a localized hammer, but most of the country is back to business as usual.

What are the risks?

China and South Korea proved the hammer and dance will work. Some countries like Italy, France and Spain started tentatively, but eventually they were forced to do it. Countries like Canada and the UK are all-in with strict lock downs and aggressive plans. The only major developed country that seems genuinely confused is the United States. In that confusion, I see three risks:

Uncertainty in the lock down – The lock down will work if there’s strict compliance. If compliance is haphazard, it might still work, but it will take longer and cost far more. So it’s critical to get maximum compliance the first time. Every authoritative voice in America should tell the same story … stay home! stay 6 ft away! wash your hands! Unfortunately, there are too many people arguing against the lock down, downplaying its significance, or even blocking its implementation. This single lock down is costing the American taxpayers $2 Trillion and the economy vastly more. We must get our money’s worth. We can’t afford to have to do it again.
End the lock down too soon – We need to hold the lock down until new cases drop near zero. Other countries have shown it can be done, but it will take longer if there is weak compliance. In general, the stricter the compliance, the sooner it can end, but it can never be less than 3 to 4 weeks because that is the time required for a typical case to run its course.
Underprepare for the Dance – When the lock down ends, we must be primed and ready to hunt down and suppress the small flareups that will inevitably occur. We must be able to test and track and that means America needs the capability to do millions of tests. Currently, we’re a long way from there.

If we can manage to avoid these risks and execute a decent lockdown, we must maintain the dance until permanent solutions arrive. Somewhere between 6 and 18 months sounds about right. Then COVID-19 will join the ranks of the routine infections that we take in our stride.