Friday, March 27, 2020

What's After Lockdown? Imagining a New Post-Covid19 Lockdown Normal

Roboseyo! Are you blogging again?

Here's the thing I wrote about how South Korea flattened the curve.

USA just had 3.2 million people file for unemployment in a week. USA also just blew past China to take the world lead in Covid 19/ ChinaVirus TrumpVirus infections.

Meanwhile, US politicians are starting to float the idea that maybe a few hundred thousand deaths is just the price you have to pay to keep the economy chugging. (Seriously, fuck those guys.) That idea -- the "herd immunity" idea Boris Johnson floated in the UK is inhumane, and anybody who promotes it should have to pick which 20% of their parents (or beloved elderly relatives, friends or mentors over 70) "gets" to die to save the economy, and then sit at their bedsides.


But... something's gotta give, right? You can't just lock down for eighteen months.

I've been thinking about this. Basically... everyone's so busy responding to the immediate in-your-face crisis, but this can't be the new normal. It just can't. This cat is out of the bag right now. This morning USA rocketed past China and Italy as the country with the most CoVid19 infections. And US has not done nearly enough yet to flatten the curve, to the point now that it is too late for any measures short of extreme. It is going to get worse in the USA before it gets better. The only question now is how much worse.

However, until there is a vaccine, this thing will keep coming back. Thanks to slow responses in USA and Europe, this thing might already be endemic (that is, in the population and impossible to totally stamp out).

So... what is the new normal? I haven't seen many places where people have thought about what the new normal might be, so... let's start the conversation. I said earlier that I think the key to South Korea's success was overtesting, so that they got the number of unknowingly infected people as low as possible. That works, but not if the rate of spread is out of control.

That means step one is: countries with out of control spread rates need to get things back under control. This is going to be painful. The things South Korea or Taiwan did to get infection rates down (tracking and massive overtesting) work when you have a smaller number of new infections to track, but not when you have a huge number. South Korea's system almost broke with 1000 new infections a day in late February, but it's turning out to be viable with less than 200 a day. If we can do enough tracking and testing to keep new cases below 200 a day, and continue to minimize the number of people out and about who don't know they're carriers, this could work. South Korean shops and restaurants and parks remain open. But first you have to get the number of new cases in a day low enough that it doesn't overwhelm the people tracking and communicating with the public about new cases.

Three or four weeks of Wuhan or Italy-style total lockdown is probably what it will take in a lot of places now. I don't entirely trust China's data over the last week or two -- it seems a little too good -- but weeks of sustained, aggressive intervention is moving the needle in Hong Kong, in Vietnam, in Taiwan. If complete shutdown is what it takes, to get to where tracking and testing is again viable, so be it. Total lockdown will work best if every country in a region is doing it simultaneously, so that new cases aren't coming in from places not on lockdown. Local governments need to make sure people don't run out of food (civil service and delivery companies will have to work together on this) make sure the homeless are off the streets (civil service and empty hotels will have to work together on this) and then keep everybody indoors for four weeks.

For leadership, though, those two to four weeks must not be times of total shutdown. Those two to four weeks of shutdown buy them some time, and a better outlook when it's over (hopefully). Here's what has to happen during that time, and until these things are in place, ending lockdown is a bad idea, because they'll just ping-pong back up to pre-lockdown infection rates:

1. Ramp up domestic production capacity for infection protection. Surgical masks, sanitizer, gloves, facemasks, until everybody who needs them has enough not to worry, and everybody who wants some can get some. Make people wear masks in public, because if you're an asymptomatic carrier, your mask protects others. Control the supply if necessary, so that people don't panic-buy or hoard, but get them to people. I'm reading stories about businesses shifting their production facilities to making masks and other protective gear or disinfectant substances. Let's get those people in front of cameras and on TV, to add momentum to this kind of effort.

2. Find and mass (like, mass mass mass) produce a safe Covid 19 test that gets a reliable result in less than ten minutes, and get those suckers into every choke point where there's a lot of people coming and going -- travel hubs, airports, etc.. If it can be produced quickly enough, get it into schools so they can hold classes. Make sure that supply is inexhaustible before reopening airports and bus terminals. The new wave of infections in Hong Kong and Taiwan and South Korea are from foreign students who got scared and came home, bringing the virus with them. That means they're still getting through the airport. Let's catch them at the airport. Requisition one of the hotels near the airport and make it a quarantine station for as long as it needs to be.

3. Use PSAs and every kind of messaging available to educate and train the locked-in population about the new safety protocols to be used when lockdown ends. Develop these protocols with the advice of the best epidemiologists and family doctors around.

4. Set up medium to long term screening and quarantine facilities in all airports. Maybe also bus and train terminals for geographically large countries.

5. Set up tracking and communication infrastructure so that local administrations can track, trace the movements, and blanket test possible cases based on the movements of people who turn out to be infected. Make sure everyone in the area is getting the messages, and checking in or self-quarantining if they were in a place that might have contained pathogens.

6. Get domestic supply chains working so that essentials are available, and will be, for everyone. Don't end lockdown until there are enough nonperishable foods, toilet paper, sanitizer, bleach wipes, facemasks and surgical gloves on all the store shelves (or it's being distributed in a fair and logical way) that nobody is worried anymore.

7. Middle to longer term: work with business owners in the service, travel and tourism industries to rethink or redesign their facilities with safety in mind. This might mean reducing seating in restaurants, increasing booths, or eliminating seating and making restaurants take-out only. This might mean getting every restaurant connected with food delivery infrastructure that has well-thought-out safety protocols. Make sure delivery services are not eating so much of restaurants' profits that selling food by takeout becomes unviable. Figure out what kind of layout and safety procedures from staff and patrons would make people feel safe (and also be safe) going to a movie, or a play, or a concert again. Make cheap loans available to businesses willing to make these changes. Going to a live show, or a movie, or a restaurant, will be really important for morale when lockdown ends, for people to feel like things are getting back to normal...and for people whose livelihoods depend on those services.

Social distancing and extra sanitation steps with full participation from society, paired with aggressive tracing and overtesting, seems to be working in South Korea. This means they could probably work in other places, once the exponential spread is a little more under control. Unless we want a return to exponential infection curves, this is going to be a way of life until there is a vaccine, and things like playground equipment might be a no-go even after lockdown ends. But there's got to be something after lockdown, other than more lockdown, and while everyone's at home stewing in boredom, it's time for our leaders to start imagining what that might be.

While I'm speculating anyway, here's my pie in the sky suggestion:

Shut down Wall Street for the duration of total lockdown. Shut down New York, London, Hong Kong -- shut down the stock exchanges for four weeks of a planetwide lockdown. And it works better if every country does it at once. We've got bigger things to worry about than stock indexes. The FiveThirtyEight podcast I was listening to basically said that this economic collapse is not because of a fundamental problem in the market that needed to be corrected: viable and solid businesses are shutting down for a reason that has nothing to do with their business plan or its long-term viability. It's just that we need to take a pause. The phrase they used was "freeze our economy in amber" until the public health crisis is over. That's what we really need.

Total fantasy:
78-year-old (high-risk population) Mitch McConnell realizes that Trump is putting his life in danger, and Article 25s the fool. Mike Pence steps in and finds a few doctors who are willing to say the Earth is 6000 years old in order to get him to listen to the latest expertise in epidemiology, and we go from there. Hoping for better leadership all the way in November is too late.

PS: Since we started out talking about Trolley Problems, let's end with Jay-Z's take on them.

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