We Are Definitely Screwed Maybe is a newsletter about the things that scare me. You should subscribe, so you’ll always know what to be afraid of.
This is the ideal COVID-19 curve. You may not like it but this is what peak performance looks like:
That active case graph (which I got from Worldometer) belongs, of course, to the United States. The active case graph for South Korea looks like this (also from Worldometer):
That little bump on the far right is South Korea’s recent surge of infections. Their health officials are so concerned about the surge, they’re considering reintroducing the kinds of restrictive policies that helped contain their outbreak in the first place. “At the least, we might have to invest as much effort as we did until now, or even more,” said Kwon Jun-wook, director of Korea’s National Institute of Health at a Thursday briefing.
Face masks are, of course, still compulsory in South Korea on public transportation and in taxis—which pretty much means you can’t leave home without one. Meanwhile in Orange County, California, where my parents live, they made face masks compulsory, and then the county’s Chief Health Officer received death threats, so she quit, and then they made them no longer compulsory (Almost the exact same thing happened in Ohio by the way). And what, you might be asking, does the COVID situation look like in Orange County? It looks like this:
Disneyland is also in Orange County, and Disney just announced that the park will reopen in a little over a month.
Disney World meanwhile (the Florida one), is scheduled to reopen almost a month ahead of Disneyland, on June 22. At press time, Florida had just recorded 1,698 new cases in one day, which is 20 percent more than its previous record of 1,419.
Incidentally there’s this dream sequence from Terminator 2: Judgment Day that I feel like I live inside of a lot of the time, and now is one of those times. You know the one:
How can the reopenings be regarded as anything other than, well, insane?
That’s the exact phrasing I used when I asked Sander Greenland emeritus professor of epidemiology and statistics at UCLA if I was right to be freaking out a week ago. He told me, basically, expert opinions differ. “Everyone is waiting to see outcomes elsewhere,” he told me, adding, “everyone will have different stakes and preferences depending on their age, health, wealth, business, etc.”
A good public health outcome is, in short, in the eye of the beholder. Let’s look at Arizona for instance, which, right when I was about to publish this, announced a record 1,654 new cases in one day.
The state lifted nearly all of its restrictions May 11, with Governor Doug Ducey reasoning at the time, “We are clearly on the other side of this pandemic.” He said on May 28 that he’d even consider placing the Republican National Convention in Arizona after our president had a tantrum about South Carolina’s social distancing requirements, and said the convention would have to move. Ducey said to a radio host, “If the president wants to relocate it—if he wants to bring it here—we’ve pulled off a lot more in Arizona. I’m confident we could do whatever came our way.” (Florida has since won that prize). Arizona’s case count then doubled in two weeks, so Ducey revised his assessment to “This is not yet behind us, we’re navigating through this,” but without indicating any changes in statewide policy.
Arizonans I love and care about have brushed off their state’s spike in cases as the result of a spike in testing, and that’s simply false. But testing remains a primary feature in Ducey’s rationale for continuing to reopen. Arizona “got an increase in testing, an increase in cases and an increase in positive test results. So we’re going to continue to stay laser-focused on Covid-19,” he said Thursday. Ducey claimed that Arizona hospitals “are not seeing an increase in patient volume,” and that “we are prepared if that increase should come.” He points to a sanguine statement from several Arizona hospitals as proof that Arizona is fine hospital-wise.
Oddly, that statement is wildly contradicted by a statement given by one of its signatories six days earlier. Dr. Marjorie Bessel, chief clinical officer at Banner, Arizona’s largest hospital network said last Friday in no uncertain terms that Arizona is rushing headlong toward a crisis of hospital capacity if people don’t start social distancing. Looking at the trend line of deaths in Arizona, she said, “if you continue to follow a curve like that, at some point we will exceed our capacity.” I can’t explain this discrepancy in messaging. Banner’s narrative has changed, but the trend in Arizona hasn’t.
On Thursday night, my wife and I took a walk in Tarzana, part of LA’s San Fernando Valley. Less than half the people we passed were wearing masks. About five teens were hanging out in a park, smoking weed and listening to music. We’re not Corona-cops, and we don’t like people who enjoy policing the social distancing of others. Still, all that apathy made us feel powerless.
(Graph by the Los Angeles County Department of Health Services)
At press time, Gyms are reopening in my county. And at the same time that is happening, Dr. Christina Ghaly of the Los Angeles County Department of Health Services is warning us that community transmission is increasing, and that we’re potentially 2-4 weeks from overrunning our hospitals with new critical cases.
If this makes you feel schizophrenic, one thing to keep in mind is that warnings like this are not crystal ball predictions; they’re warnings—scenarios that we should keep an eye out for or else. The expectation is that we’ll change our behavior to prevent a catastrophe—or to avoid deepening an existing one.
This type of decisive alarmism, after all, was how California governor Gavin Newsom earned attaboys from experts for his (relatively) swift response to the virus. Way back on March 20, Newsom wrote a letter to the president saying 56 percent of the people in our state might get the virus over the course of eight weeks. Two days after that, he issued the first statewide shelter-in-place order in the country.
But today Newsom sounds much more like Doug Ducey, touting California’s hospital capacity, and our increased number of ventilators (he also sounded a little like Ducey when he started praising Trump in April), and saying, basically, we’re committed to reopening, full steam ahead, even though reopening the economy means the case numbers will increase, which we always knew.
What message were those people in the streets of LA without masks getting? Was it the one from Health Services saying we need to be careful or we’re going to overrun the hospitals? Or were they picking up on more of a vibe in the air that the coast is clear? A general feeling that taking the pandemic seriously is just kinda over? The sort of lazy, autopilot, lack of vigilance that allows publications like The Hill to tweet that Trump is having a “post-coronavirus rally”?
We’re arguably not even reopening as a country, because we never really locked down as a country. No lockdown in the US—not even New York City—was anything like Wuhan’s, but according to the human movement data of the big mobile phone companies, we also didn’t stay in our homes nearly as much as most Europeans. “Should we have tried what Sweden tried?” some people have asked me, referring to their disastrous policy of not formally locking down, and instead asking people nicely to social distance, and pursuing herd immunity. And the thing is, that is pretty much what the US policy was. Now we’re not even doing that.
So what’s about to happen?
Alan Hubbard, professor of biostatistics at UC Berkeley, was nice enough to make some vague predictions, which is generous for a data scientist. Currently, his team is “treating it as a more long term research problem, and being careful about putting [predictions] out before they are thoroughly tested and vetted by others.”
Here’s what he was willing to guess:
It looks to me like it will smolder through the summer and then, depending on what's done in terms of the most important social distancing (avoiding large and close gatherings indoors) either smolder more in the fall or possibly have another significant wave. I think the increase of cases that are related to the protests will be very revealing. If it's modest, it does tend to narrow down the important venues for transmission (indoors, crowded, no mask) and if it's not, then it's going to be a long summer if people get back to normal and start vacationing, etc. In any case, this thing is complicated and hard to predict, so only consider this speculation.
It’s inevitable that Fox News pundits are going to blame outdoor protesters rather than the wave of reopenings when there’s a spike in infections. Now going to The Yard House because you just gotta have those truffle fries does seem a little different from a spontaneous of outpouring of rage at a horrendous injustice (do your own moral calculus there). But apart from the morality of a social movement that arose organically from circumstances foisted upon people against their will, people who blame the protesters will almost certainly be totally disingenuous and wrong, according to infectious disease researcher Trevor Bedford.
Bedford posts long tweet threads about virus math, showing his work along the way. He guesses that each day there are 600,000 people out protesting—the population of Nashville basically. So if we call the protests Nashville 2, and compare it to Nashville Prime, the actual city in Tennessee where people have been drinking at such bars as Margaritaville, Honky Tonk Central, Rippy's Bar & Grill and Tin Roof since May 11, Nashville 2 is sort of a drop in the bucket of pandemic profligacy if you ask me.
According to Bedford, we can expect that there were probably 3,000 infections per day among protesters, followed by about 3,000 downstream infections, or as high as 6,000, and that these will result in 30-60 deaths per day. “My take home here is that the additional infections driven by protests are likely currently small relative to the size of the US epidemic, about a 3% to 6% increase above the estimated ~100k daily infections in the US,” Bedford wrote.
Bedford guessed back in April that the US would experience something called a “long plateau.” There would be no stamping down the curve. The curve would flatten, and just stay flat with infections (and deaths) hovering around their peak indefinitely—no second wave, because the first wave would never end. Other countries like New Zealand will open up again when there’s a vaccine, but the US will just stay around Peak Death until the vaccine comes to save us.
For my part, early on in this pandemic I felt like I was seeing Americans do something I never thought I would see in my lifetime: take actions that cost them personally, for the benefit of strangers who are weaker than them. My guess now is that what people were really doing was obeying their governors, or hiding inside because they were scared the virus would kill them, or performing good behavior for their social media followers, or some mix of all three.
I don’t know what’s in the hearts of America’s governors, but I have some ideas: They’ve been getting phone calls from campaign donors and local rich people, who need to “get the economy going again.” And I think both Democrat and Republican governors are freaks of nature who, when they see a sidewalk, or a crowd, they see “the economy” instead of a bunch of people getting food and talking to each other. I think if Gavin Newsom looks at a page of Richard Scarry’s Busytown, he sees a bunch of “economic activity” instead of a town.
I think a lot about this woman named Ann O’Connor in Paradise Valley, Arizona, who survived cancer and has asthma. Back in March, when Doug Ducey was dragging his feet on giving a statewide lockdown order, she told The Guardian it was “like a huge, sick experiment.” And at that point, I was thankful to be in the much saner state of California. I never saw real evidence that Gavin Newsom valued human life more than the green, upward-facing Dow Jones arrow, but I at least took comfort in the fact that he had enough panicked people around him that he was acting like he did.
But now we have more PPE, more masks, more ventilators, and we’re slightly better at treating patients with the virus. For a while, it looked like we were really going to prevent hundreds of thousands of people from getting the virus and dying. But we weren’t. The problem was that back then, they would have died in horrific, chaotic triage tents, and emergency hospital ships just off the coast of our major cities. There might have been ugly photos, and harrowing news stories.
But the lockdowns did their job. The idea was to dampen the numbers a bit, sure, but mainly it was to make all those deaths happen in an orderly fashion, in the right place. Now we think we can do that, and keep Buffalo Wild Wings open in the process.
Note for people who read all the way to the bottom: Hi. If you’re enjoying this newsletter, please subscribe and spread the word. I’m hoping to post these four days a week instead of two, with a paid tier, and more in-depth reporting, etc. Earning more subscribers is the only way to make that possible. —Mike