Thinking the unthinkable

“Castle Bravo” blast in 1954. Public domain image from US Department of Energy.

Will a million Americans die due to the COVID-19 pandemic? I doubt that the casualties will get this high, but it is not unthinkable.

When I was young, the “unthinkable” was the possibility of human-caused nuclear war. Today, we face the reality of human-caused pandemic diseases. The destruction from this pandemic probably won’t be quite as grim as an all-out nuclear war. But it is getting into, perhaps, the terror of a limited nuclear exchange.

Coming up with a good answer to the question of the pandemic’s ultimate outcome is not just a strictly scientific problem about viruses and epidemiology; it is also a political one. It is political both because politics could alter the course of the pandemic, but also because whom we regard as an expert is itself a political decision. Is it Anthony Fauci, Michael Greger, or the very stable genius leading our nation? Moreover, this is not a question that we can let the scientific community sort out at their leisure. It matters to us, now. We want to be objective, but in a hurry.

Let’s go with what seems to me to be the more-or-less mainstream scientific consensus and see where that takes us. Informed conventional wisdom is that mortality of COVID-19 is in the range of 0.5% to 0.8%, about 1 death for every 125 to 200 cases of the disease. Dr. Anthony Fauci, of Presidential briefing fame, has said that it will be 12 to 18 months before we have a vaccine, but others have said that even this may be optimistic. Informed conventional wisdom is also that recovering from the virus confers at least some immunity, though we don’t know for how long. We don’t know how fast it spreads (the “R0” value), although all reports are that it is highly contagious in “natural” conditions, e. g. “business as usual” with no face masks or other precautions.

The default option seems to be what is happening in many countries, including many of the states in the United States: do nothing, or do little, and let the disease take its course. We will acquire “herd immunity” when enough people recover from virus, and thereby get immunity. This option requires the least political effort and we can always blame the Chinese to avoid any untoward political results.

Something like this happened during the 1918 pandemic. Wartime censorship suppressed news of the pandemic. It was called “the Spanish flu” when neutral Spain didn’t censor the awful news. People died, but the economy didn’t shut down as much as it could have.

We might “declare victory” and send people back to work even though medically the virus would still be active and still be sickening and killing people. Alternately, we could allow the pandemic to continue but on a “slow burn”: just enough restrictions (face masks or whatever) to prevent the hospitals from being overloaded with COVID-19 patients, which would cause otherwise preventable deaths for those unable to find hospital beds.

So when will “herd immunity” kick in? COVID-19 appears to be highly contagious; you can be sick and contagious for days without showing any symptoms. One recent and troubling estimate for R0 is 5.7 — each person is infecting, on average, 5.7 other people, based on the early transmission of COVID-19 in China. Of course, we can “artificially” reduce the R0 value through social isolation, wearing masks, and so forth, but it seems that the “natural” value of R0 is quite high.

Herd immunity will kick in when the percentage immunized (either by surviving the disease or by being vaccinated) would be 1 – 1/R0. That would be, let’s see, 1 – 1/5.7 = 82% of the population. That’s almost everyone! If immunity is acquired by surviving the disease, then that means the minimum number of people dying in the United States will be: 330 million people * 82% * 0.5% mortality = over 1.3 million.  Yikes! That’s more than the 1918 pandemic, which “only” killed 675,000 Americans.

I am not “predicting” that 1.3 million Americans will die. I’m just trying to establish some sort of reasonable ballpark type estimate to give us an idea what we are talking about. The vaccine, or an effective treatment (remdesivir?), might be here by this July — or only after four years, or never. The “natural” R0 could be considerably less than 5.7. Mortality might turn out to be considerably less than 0.5%. And some people (me, for example) are going to stay inside regardless of what the President says.

Or — I know this is a stretch, but stay with me here! — we might actually come up with an effective strategy. Some countries (and some states in the United States) are coping well with COVID-19. Successful strategies are similar to the aggressive methods taken in South Korea and elsewhere. They lay emphasis on methods such as strict lockdown, travel restrictions, massive testing, contact tracing, and masks.

So how likely is it that we will be able to adopt some version of this more aggressive option? The problem is the current state of politics. Unlike in Plato’s Republic, philosopher-scientists are not ruling in our cities right now. Adopting a different strategy requires some accurate science and a tremendous amount of political cooperation and goodwill in an increasingly complex and polarized world.

All of this seems remote right now. But it’s not impossible. In emergency situations, people understand the need for personal sacrifices and altering our accustomed habits. Dealing with the pandemic will be good practice for all of the upcoming challenges that limits to economic growth now pose — the next pandemic, climate change, peak oil, resource depletion, soil erosion, and the staggering social inequality that blocks us from addressing these problems in a fair way. These problems will be just as serious as, or more serious than, the current pandemic.

6 Replies to “Thinking the unthinkable”

  1. Exactly! This is a disaster response test run for planet earth! You know my bias is that socialist reforms would help us. I’m not advocating communism or total central planning – but if safety mechanisms had already been in place and our healthcare system ranked a bit better, we would be quite a bit more prepared for the shock. And it’s time to talk about animal agriculture: factory farming and CAFO in particular, they need to go!

      1. Peter Turchin has been very helpful to me in understanding the social dynamics of the pandemic on our already-fragmented political system. Here is what he said about a month ago:

        “The shock of Coronavirus has the potential both to create social solidarity within a country, and to break the country apart. . . . For the United States my forecast is rather gloomy. Our governing elites are selfish, fragmented, and mired in the internecine conflicts. So my expectation is that large swaths of American population would be allowed to lose ground. Government debt will still explode, with most of the money going to keep large companies and banks afloat. Inequality will rise, trust in government decline even more, social unrest and intra-elite conflict will increase. Basically, all negative structural-demographic trends will be accelerated.”

  2. If only we lived in Plato’s Republic:
    The work-people will live , I suppose, on barley and wheat, baking cakes of the meal and kneading loaves of the flour. And spreading these excellent cakes and loaves upon mats of straw or upon clean leaves, and themselves reclining upon rude beds of yew or myrtle boughs, they will make merry, themselves and their children, drinking their wine, weaving garlands, and singing the praises of the gods, enjoying one another’s society and not begetting children beyond their means through a prudent fear of poverty or war … We shall also set before them a dessert, I imagine, of figs. peas and beans; they may roast myrtle berries and beech nuts at the fire, taking wine with their fruit in great moderation. And thus passing their days in tranquility and sound health, they will, in all probability, live to a very advanced age and, dying. bequeath to their children a life in which their own will be reproduced.”
    From Book 2 of The Republic

  3. Our sincere prayers to God for the comfort of all past, present and future afflicted, and our deepest thanks for the continued courage of all frontline and essential workers.

    Concerning Republic 372, I wonder if the WHO should not already administer two other public health emergencies of international concern: maternal compromise and animal-based nutrition. Good maternal health implies delivery within carrying capacity. An excess of animal-based nutrition compromises carrying capacity, in addition to other harms. We may not be in agreement that the Earth is presently overpopulated by people, but we are likely in agreement there are too many head of livestock, and that far too many people will die from diet-exacerbated heart diseases and cancers in 2020.

    Prime Minister Netanyahu described the coronavirus as “a plague” in his public remarks with Secretary of State Pompeo earlier this week, thereby punctuating the biblical scale of this crisis, Keith, as does your provocative opening to another educational post.

    I agree with Drew that the US was not as well prepared as it could have been for this trojan horse of a pandemic. Another unthinkable increasingly thinkable by propagandists on both sides of the Pacific: that this was to some degree a planned act of Chinese or US biological warfare. The Chinese mainstream seriously pushes the story of a US military origin, while some US conservatives suspect China not only withheld timely and complete information from the World Health Organization (WHO), but intentionally spread the virus out from China’s borders.

    However unthinkable such paranoia may prove in retrospect, a further breakdown in relations between China and the US would make matters worse. My initial sense is that dissident US vegans should endeavor not to take sides. Unfortunately, some will find it politically convenient to maximize US death toll projections while taking aim at a “negligent” Trump Administration, perhaps even going so far as to fall into lockstep with John Ross at RT (see “Deadly US policy on Covid-19 will split the world in two and force countries to rethink old alliances.”) But your projections are far from maximalist and I do not mean to suggest you have fallen into this bias, Keith.

    Vegans who do not want to take a side against western capitalism and liberalism, tending to view them as a forces for good in the world, will find themselves navigating a very different narrative than John Ross through the rest of 2020, especially if they have serious concerns about the human rights record of authoritarian socialism and the Chinese Communist Party. They will tend to demand greater transparency and human rights reforms from China (on Coronavirus origins, gender equality, recognition of Taiwan, autonomy of Tibet and Uighur rights), and will be less inclined to blame Covid-19 deaths on Trump in the US, Johnson in the UK and Lofven in Sweden – even if they voted for Hillary in 2016. These vegans may accurately say the US has responded with historically unprecedented vigilance, sacrifice and science to “slow the spread.” But they may wish the country had greater capacity for testing, contact tracing, isolation and quarantine (the four corners of ex-CDC Director Frieden’s “box it in” strategy), and they may legitimately wonder how and when to best reopen individual states, districts and economic sectors.

    Supporters may pressure President Trump to portray himself as the most expert and accountable executive US decision-maker in this crisis, but I get the impression he will fairly share that burden with the Governor in Colorado and the governors in most other states, in tension of course with expert federal guidelines, Congressional relief funding resolutions and corporate liability immunity decisions.

    In their search for answers, vegans with interest in Nordic mixed-market economies may find themselves reflecting on Turchin’s 5 May 2020 “A Tale of Two Countries,” which contrasts alternative coronavirus management strategies taken by Denmark and Sweden. The results of this study are strikingly informative. Perhaps our best course of action moving forward is a continental laboratory of resilience and recovery. Or perhaps a blanket strategy would indeed be better. Either way, thanks for your post and for earlier directing me Turchin’s way.

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