The ability of individual States to decide policy for themselves is a hallmark of the United States approach to government. But despite the spectrum of political orientations across states, COVID-19 produced a surprisingly uniform response: By mid March all the US states had declared a COVID-19 state of emergency, and by late March almost every state had some form of stay at home order. All but one State closed bars and restaurants and non-essential retail stores. Additionally, all states canceled the remainder of their school terms and most States closed day care facilities.

This swift, if somewhat tardy response to COVID-19 reflected the horror of events in Italy and Spain where the outbreak was claiming an unprecedented number of lives. It wasn’t clear what was going to happen in the US, but no state wanted to become the next Italy or Spain.

Two months on, we now know much more about the biology of the coronavirus, and we know that while the initial experience of the US with the coronavirus was bad (over 100,000 deaths) it hasn’t been on the scale of the 1918 epidemic (675,000 deaths in a population one third the size). Further, rates of COVID-19 infection and death vary greatly across states and regions within states. As expected, coronavirus travels much more easily in regions with high population densities (e.g. NY City) where people routinely come into close contact (subways, elevators, etc) than it does in areas with low population density (e.g. Lewis County, NY, no deaths in a population of 27,000).

We’ve also learned that not only are US citizens willing to follow shelter in place orders, but further that these orders are effective in reducing the spread of COVID-19, sometimes described as “flattening the curve”.

Unfortunately, the loss of jobs resulting from this unprecedented shutdown has also been unprecedented: 20.6 million jobs since mid-March, resulting in an unemployment rate of 14.7%, a level not seen since the Great Depression of the 1930s. Worse, it’s likely that many of these job losses will be permanent. The pressure to resume economic activity is thus intense as rent and food bills pile up for those out of work and without a paycheck.

Despite the scale of the pandemic, the US is still far from herd immunity. Although it’s likely that large numbers of asymptomatic cases of COVID-19 that have gone undetected, overall levels of people with antibodies to the corona virus are still generally low. Yes, places like NY City have surprisingly high rates (20%), but this is nowhere near the 60% necessary for herd immunity; and most of the country has far lower lower rates than NY City.

Bottom line: we’re still vulnerable, and COVID-19 is still out there, biding its time.

As we restart economic activity we have the advantage of understanding that COVID-19 is primarily transmitted person to person via the respiratory route; thus the importance of masks and social distancing, as well as lifestyle changes (e.g. working from home, limited social contacts, home haircuts!). Also, we now understand that transmission based on touching surfaces is far less important than first supposed.

Because circumstances vary across the US, it’s expected that our economic reboot will vary across the country. Ideally these variations would be “data driven”, based on the local rate of COVID-19 infections, but unfortunately such an approach requires a level of testing that won’t be available for sometime. In the interim decisions will likely be driven more by politics than science; one can’t make data driven decisions in the absence of data. Yes, deaths will be reported, but unfortunately an uptick in COVID-19 deaths is a lagging indicator: an uptick in deaths asserts that a surge in infections began a month earlier, and a month is a long time when we’re on COVID time.  

The internet continues to spawn and amplify wacky conspiracy theories, of course, but the US has always had a strong affinity for conspiracy theories (see, for example. Anna Merlan’s great book: Republic of Lies). Yet we’ve somehow survived this particular eccentricity.

While the absence of data leaves us to fall back on heuristic answers, this is actually always the case. A governor, or a president, or a commission can issue guidelines or mandates, but ultimately individual people decide the level of risk they are willing to assume for themselves and their families, balancing the competing risks of disease and economic disaster. It does seem that given good information people make good decisions, however. And I’m encouraged that the level of information has improved as time has gone on, with fewer pundits dismissing COVID-19 as “just the flu”, and more people adding “R naught” to their vocabularies. Indeed, virologists would now be sought after at cocktail parties, if only there were still cocktail parties; virologists seem to have no luck. One’s political tribe remains an important determinant of one’s views, of course, but a COVID-19 death of an acquaintance or loved one may override one’s party allegiance.

There will be many different approaches to our economic reboot, and we will learn from each one. With luck, we’ll learn enough to minimize further illnesses and deaths as we await a vaccine that will rescue us from this pandemic, at least until the next pandemic.

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