Some Early Thoughts on the Reopening

I'm trying to work through the implications of easing of the shutdown, which easing appears to be coming, whether through government edict or growing civil disobedience. I need the more epidemiologically inclined among us to help me out here, but I keep coming back to this train of thought:

(1)  The Contagion is still active among us.  Still out there infecting people as it always has.  (I learned of my first "positive" acquaintance yesterday; he's fine and over it after self-quarantining.  He reported it was like "a bad flu.")

(2)  The shutdown and enforced social distancing have been effective in keeping the mortality rate lower than it would have been without those rules.

(3)  With restrictions loosened, the death rate will increase, if not "spike."

(4)  In fact, depending on how much reopening takes place, we will be returning to a civil order in which the death rate will approach what it would have been had there been no loosening to begin with. That is, since we are assuming The Contagion is still active, people will be exposed to the same degree as they would have been had there been no shutdown.

(5)  Which means that leaders and citizens are willing to tolerate the increased number of deaths and the risk to themselves in order to get their lives, and society's general health, back to something approaching what they were before the shutdown.

(6)  Which in turn suggests that the shutdown accomplished little or nothing and was almost solely destructive.  Put another way:  If The Contagion returns with anything like its initial ferocity, then the only difference between not shutting down early and reopening now is that in the meantime we severely damaged the economy and suffered the many other ills identified with social isolation.

What would make this analysis wrong is if the prophylactics of the past couple of months make it far less likely that deaths will increase to the level they would have reached without them. I haven't seen a suggestion of this anywhere, but one can envision a way that this could be the case. Perhaps, for example, it has forestalled deaths while progress has been made toward a vaccine/cure and that "flattening the curve" for this period of time (if that has in fact been its benefit) will result in fewer deaths in the long run. Again, I have not seen this as a justification for the shutdown, but it's possible; if the shutdown will have materially decreased total deaths by the time this has passed, then the foregoing chain of reasoning is weakened.

This train of thought also may wrongly assume that the loosening will return us all the way to pre-loosening freedom. If loosening is not total, deaths may not return to the "worst-case" non-loosening levels, but will increase to some material degree. So even if the analysis  overstates the danger for this second reason, it still suggests that the shutdown was too severe because it did not sensibly balance the economy/social order and the mortality rate; we're willing to tolerate some trade-off.

I concede there is some unfairness in this line of thinking.  We were uncertain of the lethality of The Contagion, so it is difficult to blame policymakers for acting decisively to be on the safe side. But at least based on what we know about decisionmaking in this case (which, of course, may be quite incomplete), this kind of balancing wasn't even considered by policymakers. Radical prevention entirely supplanted intensive fact gathering that might have permitted the kind balancing we are apparently now willing to undertake.

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A final toss-off thought:  If the majority of the population accepts the new freedom/death rate trade-offs that loosening represents, whom does it help in November? There seems to be a right/left divide emerging on the issue of economy rescue versus every-life-worth-every-sacrifice. Depending on how it's handled by both federal and state officials, and assuming the spike in deaths is not too horrifying, I think it helps Trump and Republicans.

Perhaps not much, and perhaps not enough to preserve Trump's incumbency.  But that's a topic for an upcoming column.


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I welcome correction on any of the medical or epidemiological errors in the foregoing.  I would love to publicize anything that points to a less gloomy conclusion on (1) what will happen to the death rate on reopening and (2) whether the shutdown will have accomplished anything if reopening results in a material increase in deaths.

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