Thursday, May 21, 2020

The Pandemic: What We Know About Covid-19: Ease of Transmission; Mortality Rates; Masks; Summer Expectations; Therapeutics; Vaccines

A reader of a recent blog post recently wrote to me: I thank you for your blog post. As an active Nurse of 40 years, the present statistics for COVID 19 are alarming. The pros and cons to open our economy are plagued with many questions. Though the economy has begun to open, increased cases have been seen in my hospital and my unit. Nurses are crying. As health care professionals, we are wired to give and to care. Though we cannot show this truth, we question our ability to weather this storm. Many nurses have taken leave of absence. A severe hardship to all.  The economy seems to be holding its own for the moment. This is just the beginning. I look forward to further commentary.

The nurse who wrote above likely shares the views of many on the "front line" of this war. Let us try to listen to them better, and heed their warnings.

As we have moved to "re-open the economy," we, as a society, appear to have made the conscious decision to accept tens of thousands of deaths that otherwise would not have occurred. And hundreds of thousands of additional illnesses - some bringing permanent damage to the health of those involved.

Let me stress - I am not against "re-opening the economy." But, I do believe we could be planning and executing the re-opening a lot better. Those who can effectively work at home should, in my view, continue to do so. Those who work in factories should have their workspaces adequately modified to enhance safety, and be provided with appropriate protective gear. Increased measures to facilitate social distancing should be in place. Wearing of masks should be mandated in many situations (and free masks should be supplied to the general population). And so forth.

Here is my most recent update, about the pandemic itself:

COVID-19, the Economy, and the Markets
From Dr. Ron A. Rhoades
EMAIL: (clients)
EMAIL: (students, family, friends)

Sunday, May 17, 2020
Dear Clients, Students, Family and Friends:
Anxiety. Fear. Despair. Grief. Anger.
If you are at all like me, you probably have experienced these emotions, and many others, over the past several months. These are perfectly natural emotions, as our lives have been turned upside down from what was “normal” and we continue to face uncertainty as to what life will be like in the months and years ahead.
I wish this Special Report had better news. I wish I could say that soon life would return to normal. While hope remains for treatments and vaccines (as I will discuss shortly), there is also cause for continued concern. And facts that might encourage some of us to think more about the future, and how we live our lives, in different ways.
First, a look back. In my first “Special Update” this year, on February 28th (when there were only 16 confirmed cases of COVID-19 in the United States) I wrote:
Unfortunately, the characteristics of Coronavirus (easy transmission, few or no symptoms in some of those infected, and lower death rates) make this the “perfect” recipe for broad transmission of the disease …
[I]t is also plausible that, given the limited resources of our  health care system, and the high degree of transmissibility, that a regional outbreak will occur and will then spread through most of the United States. Some health officials have called the spread of Coronavirus in the United States “inevitable,” while others have not yet reached that conclusion.
In mid-March I wrote:
The world is different – at least for a while. For many Americans the next few months will be difficult, as huge changes have and will occur within our society as to how we work and play.
And, most likely, many of those changes will need to be maintained for the next year. Health experts are reaching a consensus that the Coronavirus infections will peak sometime around early May, but infections will continue thereafter. After a reduction of the number of infections during the Summer, new infections of the Coronavirus will accelerate in the Fall. Hopefully a vaccine will be available, but predictions remain that such a vaccine is highly unlikely until about a year from now.
Compared to many of my professional colleagues, and many economists, I have been fairly pessimistic regarding the potential spread of the disease and its longer-term impact on the economy and the capital markets. Interestingly enough, in just the past couple of weeks, more and more economists are beginning to agree with me. I find no solace here; I wish I had been wrong.
What We Know About COVID-19: Cases, Deaths, Mortality Rates in the U.S.
So, where do we stand right now?
Cases in the U.S. Declining, For Now. The number of new cases, and the number of new deaths, in the United States has declined over the past two weeks. Stay-at-home orders by most of the nation’s governors helped. But a major reason for the decline is that many U.S. residents simply chose to be safe – to not go out except when absolutely necessary, to wear masks (especially after finally being told this was the right thing to do), to maintain social distancing, and to clean surfaces and wash their hands.

According to John Hopkins University of Medicine, there have been 1,467,820 reported cases of COVID-19 in the United States as of Saturday, May 16th, at 11:46 p.m. The actual number is probably far higher, as many infections are asymptomatic and testing has not occurred. As a result, it is likely that 1 in 200 U.S. residents have been infected with COVID-19.

The United States peaked at about 33,000 new cases each day around mid-April. Even with more robust testing now occurring, new cases fell to as little as 22,000 by around May 10th. New cases reported on May 21, 2020 were 23,285.

However, even as new cases have declined significantly in New York / New Jersey, new cases are growing in other areas of the country. Over the past five days, the trend has been toward a modest upswing in the number of new cases reported. Again, the actual number of cases is likely higher, as many cases go undetected.

Deaths in the U.S. Declining, for Now. The total number of deaths reported in the United States from COVID-19 are at 89,657 (per NBC News, 11am ET, Sunday, May 17th). The number of deaths likely is less than the actual number of deaths due to local/state differences in reporting deaths when multiple medical conditions exist. (A comparison of deaths over the same time periods, from prior years to this year, suggests COVID-19 deaths may be underreported by 10% to 20%.)
By way of comparison, between 2000 and 2018, deaths from influenza (the flu) and pneumonia combined averaged 57,000 annually. Keep in mind, however, that many U.S. residents possess temporary immunity from the flu, as a result of having the same version of the flu in recent years or from vaccinations (which are partially effective, as to the flu, and not a guarantee that you won’t catch influenza).
Also keep in mind that the death toll in the United States would have likely been far greater, had not stay-at-home orders and social distancing measures been in place over the past 6-8 weeks in many states.
The number of deaths per day, measured by a five-day rolling average, has trended downward in the United States. From a high of nearly 2,100 deaths per day, to about 1,400 deaths per day currently.
Mortality Rates by Age.

It appears that the mortality rate for COVID-19 in the United States – i.e., the likelihood of dying if you catch the virus – is about 0.5% to 1.0%, according to Drs. Jeremy Faust and Carlos del Rio, in a recent peer-reviewed article. This is about 4 to 10 times the mortality rate of those who catch the typical influenza strains (i.e., the “flu”) each year.

However, the older you are, the more likely you are to die from COVID-19. Data from other countries has confirmed that the older you are, the greater the mortality rate. In Italy, where the health care system was particularly overwhelmed at one point (which likely increased mortality rates), recent data shows a particularly high mortality rate for anyone ages 70 or older.
Here is the U.S. data on mortality rates, by age, as of May 10th, according to the Centers for Disease Control: LINK

Again, note that actual mortality rates may be higher or lower. If many more people are inflected with COVID-19 than the reported numbers indicate, then the mortality rates would be lower. If, however, the actual number of deaths is much higher than reported numbers indicate, the mortality rates would be even higher than those stated above.
Mortality rates also vary by whether infected persons possess underlying health care conditions that place them at greater risk. The U.S. Centers for Disease Control estimates that “45.4% of U.S. adults are at increased risk for complications from coronavirus disease because of cardiovascular disease, diabetes, respiratory disease, hypertension, or cancer,” according to a new analysis from the CDC. Those at elevated risk include 19.8% of people age 18 to 29 and 80.7% for people over age 80.”

As the CDC states: "For 7% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19, on average, there were 2.5 additional conditions or causes per death. The number of deaths with each condition or cause is shown for all deaths and by age groups."
It appears, at least in the United States, that about half of all Covid-19 deaths are among people younger than age 80, and more than 20% are among people who’ve yet to reach age 65.
While the rates for young adults seem low, it still appears that for every 1,000 college students (ages 17-24) who contract COVID-19, 1 of these students would likely die. (I can hope the mortality rate is far less.)

The Pressure to Re-Open the Economy.
Many states are permitting their residents to return to work in factories and retail stores. Some are opening up entertainment venues, while most are not.
There is tremendous pressure upon political leaders to “re-open the economy.” Tax revenues have declined significantly, leading to huge budgetary pressures.
Moreover, many U.S. citizens have not only been laid off, but are unable to afford the basic necessities of life (food, clothing, shelter) for themselves and for their families. Imagine being in such a situation and being told, by your own government, “You cannot go to work.”
While unemployment compensation payments and charitable aid (especially food banks) are helping to alleviate some of the personal financial woes that many in today’s workforce face, difficulties abound. Some persons (such as recent college graduates, some of those working for themselves) cannot qualify for unemployment benefits. Others have applied, but backlogs of applications are delaying many payments for weeks, or longer, in many states.

As a result, in the United States, as a result of efforts over the past two months, we have “flattened the curve,” but we have not crushed the curve. There are still 1,300 to 1,400 new deaths each day. There are still some 22,000+ new cases each day. And, as more and more persons venture outside and commingle (many without wearing masks, unfortunately), it is highly likely that the number of new cases in the United States, and deaths, will spike much higher.

UPDATE: Per CNN, "as of Tuesday (May 19th), at least 17 states have recorded a clear upward trend of average new daily cases -- a rise of at least 10% -- over the past seven days, according to an analysis based on data from Johns Hopkins University."

Don’t get me wrong. I’m in favor of people going back to work – when necessary, and where it is safe to do so. Even for “essential” workers, however, the toll has already been hard. For example, in New York City at least 260 municipal workers have already died. Now, many of their families face not only a loss of a loved one, but also a loss of income and a loss of health insurance.
How Easily is COVID-19 Spread?
Some of the fundamental information about how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – the virus that leads to COVID-19 disease – spreads in the population is yet to be discerned, but we know more now than we did several weeks ago.

How easy is the virus, on one person’s hands, transmitted to others at a restaurant’s buffet? Apparently quite easily. Watch this video: (link). In the video, one guest of 10 at a restaurant buffet is shown with the substance on his hands meant as a stand-in for the coronavirus. Over the course of a typical dining period, the rest of the guests behave in predictable fashion, selecting utensils from serving stations, enjoying their food, checking their phones and so on. At the end of the experiment the backlight is turned on and the substance is revealed to be smeared everywhere: plates, foodstuff, utensils and even all over some of the guests’ faces.
According to the U.S. Centers for Disease Control and Prevention and the World Health Organization, the novel coronavirus is primarily spread by droplets from someone who is coughing, sneezing or even talking within a few feet away. That’s right – just talking or breathing by an infected person spreads the virus. Coughing and sneezing result in the expulsion of far more virus particles.
It also appears that virus particles can remain suspended in the air – perhaps many minutes after expulsion by sometime talking. While this recent study was not COVID-19 specific, the researchers in the study used laser light sheets to capture on video the movement of small droplets emitted from a person’s mouth as the speaker repeated the phrase “stay healthy” for 25 seconds. They calculated that the half-life of these particles in the air, considering the time it took them to fall 30 cm, was eight minutes.
In conclusion, it appears that this virus is very, very easily transmitted from person-to-person. Since many of those who are infected – and capable of transmitting the disease – do not have symptoms, this makes it very difficult to detect and isolate the infected from those who are not.
Should You Wear a Mask When in Public? – Yes! 
Although many governments have ordered or urged residents to don masks, it’s not clear how well most of the masks appearing in the general public today prevent the transmission of the coronavirus.
N95 masks filter 95 percent of particles larger than 0.3 µm (according to an early report describing COVID-19 infections, the SARS-CoV-2 viral particles range from 0.6 to 0.14 µm in diameter, and N95 masks can capture particles of this size). N95 masks are uncomfortable to wear for extended periods. Those N95 masks that have front valves may protect the user, but not others around them.
Note: For particles 100-300 nanometres in size: N95 respirators can filter 95% of particles; N99 respirators filter 99% of particles; and N100 respirators filter 99.7% of particles. SARS-COV-2 is estimated to be 125 nm in size. 
For other types of masks, that efficiency varies considerably. Surgical face masks are probably what you think of when you think of a face mask. These are disposable, single-use masks made from pleated synthetic fabric. The fabric is breathable and these masks don't form an airtight seal against the face. How well these types of masks filter pathogens varies according to different studies; given the small size of the virus, these masks likely don’t stop the virus all that well.
But, these masks may limit the spread, by reducing the air flow from those wearing the mask who are talking, coughing, or sneezing (or even just breathing). In medical parlance, this is called “source control.” In itself, that’s a reason to wear this mask when in public.
Many makers of such masks have appeared, and they can be purchased online. Quality and effectiveness vary.
Seek out the more effective masks - and WEAR THEM when out and about. They can assist others from catching COVID-19, and can help you in not catching COVID-19.
You are not "weak" for wearing a mask. Rather, you are STRONG. You know that, through your strength, and your perseverance, you can add to our collective will to combat this pandemic. You are part of this war ... so arm yourself!
Will the Spread of the Virus Be Lessened by Summer Weather?
Probably, but perhaps only to a moderate extent. The virus degrades outside a host cell, and does so more rapidly when exposed to heat or ultraviolet radiation from the sun. In recent weeks, numerous research studies, based on laboratory experiments, computer models and sophisticated statistical analyses, have supported the view that the coronavirus will be inhibited by summer weather.
But just having “warm weather” is not enough – you need “hot weather.” Researchers at Harvard and MIT reported that average temperatures above 77 degrees are associated with some reduction in the virus’s transmission; average temperatures even warmer result in additional decreases in transmission. (Each additional 1.8-degree temperature increase above that level was associated with an additional 3.1 percent reduction.)
However, the transition to summer weather in the continental United States won’t be sufficient to completely contain the virus’s transmission. Partly this is because so many of us work and live in air-conditioned buildings, where temperatures are kept much cooler and humidity is far less. Partly because the virus is still transmitted by an infected person, even in very hot weather – the virus just dies off quicker. Even now, in tropical areas of the world, large outbreaks of COVID-19 are occurring.
What About Therapeutics, to Lessen Symptoms of those Infected?
The search is on for drugs that will lessen the symptoms of those infected, and lower mortality rates. 216 different treatments are now under consideration.
But just one treatment has been approved thus far for widespread use, and its effects are just moderate. Remdesivir by Gilead, a Californian pharmaceutical company, is the first drug that has scientifically been proven to be effective against COVID-19. The treatment is a repurposed drug that was originally developed for other diseases. Results showed a 31% faster time to recovery in patients treated with Gilead’s drug versus a placebo. The median time to recovery was 11 days versus 15 days, respectively. The National Institutes of Health also noted a survival benefit, where the Remdesivir group had an 8% mortality rate compared to 11.6% with placebo, as to those patients who were already very sick when first given the medication.
The application of Remdesivir has large implications for our health care resources, however. Hospital capacity increases by about 30 percent since people are spending 30 percent less time in the hospital; that means the hospital is now treating 30 percent more people.
There are new announcements about “breakthroughs” in therapeutic treatments each week. I’m optimistic that some of these will prove more effective than Remdesivir, and that they may enter into large-scale production by later this year. I’m more optimisitic about therapeutic treatments (that don’t block the disease from occurring, but lessen its severity – and hopefully reduce mortality rates), than I am about vaccine development, for reasons explained below.
When Will a Vaccine Be Ready?
A vaccine is an ultimate solution and everyone is doing their best to get a vaccine out by the end of this year or January 2021. There are currently 133 vaccines under development in laboratories. But few vaccine candidates make the transition from the laboratory to clinical trials.
However, it is possible that 10-12 of the current vaccine candidates will enter into at least the first stage of three stages of human trials necessary to ensure a vaccine’s safety and effectiveness. (In some instances, Phases I and II, or Phases II and III, are being combined to accelerate development. Multiple Phase II trials are often involved, proceeding in parallel, to address the impacts of such variables as dose, age group, etc.)
E ven then, there is no guarantee that any the vaccine candidates will be proven safe and effective enough to devote resources to their manufacture. By some estimates, more than 90% of vaccines fail during one of the three phases of trials.
So many viral diseases have been conquered by vaccination — smallpox, polio, mumps — that the development of vaccines as a cure seems like the solution that will appear. But not all viral diseases are equally amenable to vaccination. In fact, COVID-19 is on the difficult end of the scale, when it comes to developing vaccines against it. Some researchers fear that COVID-19 may be a disease for which it may take a decade, or longer, to find a vaccine; they note that there has never been a vaccine approved for other versions of the coronavirus.
Despite the high rate of failure of vaccines in clinical trials, production of a few vaccines may even begin by September (prior to the date when the vaccine candidates have finished trials and are proven safe and effective). With eight vaccines currently in human trials, the stated objective is to establish the manufacturing capacity to generate a millions and millions of doses quickly.
But the numbers are daunting. Even if a vaccine is deemed safe and effective, with 330 million people in the United States, and nearly 8 billion worldwide, the manufacture of sufficient quantities of the drug is a huge challenge. Also, many countries that are working on vaccines have indicated that, if they are successful, their own residents get the vaccine first. Even over health care workers in other countries, and others at the most significant risk. Does this sound like other countries are not being very noble? Even some U.S. political leaders have stated the same policy, although it is more likely that only a percentage of manufactured doses would be reserved for U.S. citizens if the vaccine becomes manufactured in the United States.
In the U.S., a government agency such as the Centers for Disease Control and Prevention would probably decide where newly authorized vaccines should be delivered and which groups should get immunized first, public-health experts say.
Even if a vaccine candidate survives the trials, is manufactured and distributed, and even if vaccinations are received by many U.S. citizens, the effectiveness of the vaccine may vary. 
No vaccine is 100% effective. Some individuals, even for vaccines deemed very effective (such as the measles vaccine, in children), don’t respond to the vaccine and develop sufficient antibodies to ward off infection if later exposed to the virus. The older a person is, or when a person’s immune system is other suppressed, the more likely it is that a vaccination will not trigger sufficient production of antibodies within the body. One review of influenza vaccine studies showed that they were 83% effective in children ages up to 7 years, but only 59% effective in adults age 18-65, and far less effective (to prevent the disease altogether) in older persons. (However, vaccines in older persons, even when not effective to prevent acquisition of the disease, may still reduce the probability of hospitalization of death by a significant degree).
Even in those persons who receive vaccinations, and develop sufficient antibodies, the effectiveness may not last for long. Some vaccines provide protection for a person’s lifetime (such as polio, and measles in 96% or more of cases). But others only last for years, requiring “booster shots” later. For the flu vaccine, maximum immunity occurs shortly following vaccination, but decreases with each passing month. (For this reason, many doctors suggest holding off on getting the “flu shot” each year until late October or November, rather than rushing to obtain it when it typically becomes available in mid- to late September.)
In Conclusion.
No, I’m not depressed, when writing this. And I didn’t mean to cause you to be depressed.
I’m just sorting through the studies, and observations of many of those in our health care community, and trying to convey to you – the reader – the challenges that lie ahead.
I do remain hopeful.

That more therapeutic treatments will become available that lessen the severity and duration of the disease; if such are particularly effective, this could lead us to treat COVID-10 in the same manner that we treat the flu viruses each year.

That some vaccine will survive the trials, and become manufactured in sufficient quantities, to lessen the number of people infected each year.

That, over the longer term, the tremendous advances in genetics and medical research, in general, will lead to even greater discoveries that render not just COVID-19 a thing of the past, but also the flu virus, the common cold, and more of the viral infections that continue to cause suffering for millions each year.
Continue Safe Practices. I do believe it is prudent for you to continue the safety measures you have adopted over the past several weeks.

And, I suggest to you that you may desire to consider what a “new normal” might look like. Identify new activities that you can undertake, that can be undertaken even if COVID-19 sticks around for quite a long time. Here are just a few ideas:

Learn new ways to stay connected with others.
o   Spatial distancing is unnatural. People who reside in countries where there is a strong emphasis on community and family networks often have the lowest rates of chronic disease, and report greater life satisfaction.

If confined to home, plan out your day as much as possible.
o   Take regular breaks to walk around.
o   If possible, physically separate your professional activities from your private family / personal areas.

 Regularly exercise.

Practice relaxation techniques.

Explore mindfulness.

Eat at regular times.

Be selective and limit the time you watch the news.
Embrace hobbies and activities you’ve always wanted to try, or discern new ones.
o   Make a list of books (or types of books) to read. Explore online (free) libraries in your community.
o   Consider, if you are an avid reader, a “Kindle unlimited” subscription.
o   Explore online educational courses.
o   Take walks in nature (where there are not a lot of people around).
I’ll write in a few weeks about the economy and the capital markets, in this continued era of uncertainty. Until then, stay safe, and explore new ways of engaging with others. All my best.
In the interim, always feel free to contact Cathy and myself. We are here to answer your questions, and to address any concerns you may possess, and to provide guidance.
Thank you,
Ron A. Rhoades, JD, CFP®
Financial Advisor
Scholar Financial

Sunday, May 3, 2020

"Reopening" under the Threat of COVID-19: Uncertainties; Balancing the Interests; Restricting Liberties; Measures to Prevent and Mitigate

I inquire as to whether we in the United States are acting (rationally) to (properly) limit the death toll from the COVID-19 disease. Are we correctly balancing the various interests at stake, as we seek to re-open the economy? Should all of the economy re-open, or only certain parts? What measures should be be taking as this process of re-opening is undertaken?

Please permit me to share some thoughts:


On the date of this writing (May 3, 2020), there are still many, many unknowns about COVID-19. We have so many questions, and so few definitive answers.

  • We have one therapeutic treatment approved, that might provide modest relief, but which may - or may not - affect mortality.
  • We don't know if other hoped-for therapeutics will appear soon (within the next few weeks, or few months) that might lessen the severity of COVID-19, and/or decrease mortality rates and/or damage from the disease that appears to occur in some patients.
  • There are indications that it is not just death that we must fear from COVID-19, but - even for the young - possible damage to the lungs, heart, blood vessels, kidneys, and other vital organs.
  • We don't yet have a very good handle on mortality rates. Due to lack of widespread testing, to see who is (or has been) infected, and how many have truly died (likely higher than official numbers).
  • Will rates of infection decrease in the summer months, due to higher levels of heat and humidity. Some studies suggest this will occur, but other studies dispute these findings. We simply don't know.
  • We believe, but are not certain, that those in the population who have been previously infected, and recovered, may have some form of "protective immunity." Yet, we are not certain. Nor do we know how long such protective immunity might last.
  • We don't know when vaccines will be available. While huge efforts are being made to identify and quickly manufacture vaccines, there is no assurance that any of the 70+ vaccines under development, or the 7+ in actual human trials at present, will turn out to be both safe and effective. (We can hope, however.)
  • Even if vaccines become available, how many persons receiving the vaccine will receive some form of protective immunity? (Typical vaccines in this area might be 50% to 70% effective, perhaps lesser effectiveness for those who are elderly or whose immune systems are suppressed and don't develop enough effective anti-bodies following a vaccination.)
And there is so, so much more we don't know. Answers that scientists are working on, but the scientific process takes time, and multiple studies, to build a consensus toward the "answer" to these and other questions. Thousands of papers have already been released (often in "pre-print" form) and shared; some of these papers rely on sound scientific methods, others less so. All of these papers need close examination, and conformational testing often by many other researchers. Reaching conclusions in this area of science is rarely a "cliff" event; rather it is a longer process of discovery, verification, and consensus-building.


Into this atmosphere of uncertainty, I posit that some principles should apply, as various states and communities move toward "re-opening" - whether now, in the near future, or in the distant future.

1. Local decisions need to be made.

Take, for example, a very small town, located 20 miles from any other small town, and a hundred or more miles from any small city. The town may have very few persons who enter/leave the community each day. (In fact, some such small towns have deterred people from entering/leaving). In such an instance, if no one in the community has COVID-19, there may be no impediment to opening up all businesses.

Yet, in a larger city, with extensive movement of workers via mass transit, and with congestion not only while traveling but also on sidewalks, hallways, elevators, and more, the situation may be altogether different.

2. Local decisions need to be made based on science. Not based on political considerations, or political beliefs.

Let us hope that the state/local leaders who make these decisions are being advised by the best scientists in our various communities.

And let us hope that, in order to counter the biases we all possess (as a result of our own experiences in life, and to some extent our own personal beliefs), that those who are making decisions reach out to hear the voices and concerns of those with different viewpoints.

I applaud those political leaders who, being forced to make such decisions, reach out for guidance from health care specialists, and who "reach across the aisle" to receive input from those who may possess opposing viewpoints.

3. Balancing of the interests must occur.

I have heard the statement made, "One death is too great!" - in relation to COVID-19.

But, stay-at-home orders and other forms of mandated social distancing can also results in deaths. Anxiety and depression can lead to a greater instance of suicides. Spikes in illegal drug usage have occurred (including an increase in opioid abuse, and deaths attributable to same, in recent weeks).

Some risks must be assumed in our society today, for the economy to function. We could reduce car accidents to nearly zero in our society, for example. But only if we limited the speed cars can travel at to 5 m.p.h., and surrounded each car's outside with large cushions or air bags. Some of the conveniences in life, or instruments that are crucial to the modern economy, also result in greater risks being assumed by our citizens.

The tough part is, again, trying to balance these risks.

An early study suggested that, without implementation of social distancing measures, 1 million to 2 million American citizens could die. Currently we are approaching 70,000 deaths in the U.S., and we appear to be headed toward more than 100,000 deaths in the U.S., and possibly much more, just this year.

4. Not every part of the economy should have restrictions lifted.

Take, for example, a town in which a large percentage of the population works in offices. Or attends university. The town also includes retail stores, grocery stores, pharmacies, health care facilities, manufacturing plants, and many other businesses.

We have already made the decision that some "essential services" must be kept going. For health care providers, COVID-19 treatments of course, and other essential (emergency) medical treatments. Grocery stores remain open, albeit with some restrictions in place (at times). As do pharmacies, and transportation / distribution businesses.

Other businesses may be next in line to re-open. Such as factories, necessary to produce goods in our economy - but where the work cannot be done remotely.

But, other businesses might be far lower in importance. For example, offices might remain closed - at least where the work can effectively be accomplished from home. The whole idea is to limit the "chains" that are created. The more people are out and about (even with masks on), the greater the interaction between persons, and the more incidences of infection occurs.

In addition to keeping many office-based businesses closed, consideration might be given to keeping certain other businesses closed where alternatives exist. For example, take colleges and universities. Some colleges and universities have already announced plans to re-open campus instruction in the Fall, despite so many uncertainties existing at present, and without a good indication as to how widespread COVID-19 infection rates will be come August or September. There is no doubt in my mind that a residential college education is valuable - with science and other labs, in-person instruction (and the many opportunities it creates for effective interaction between faculty and students, and among students), and with other activities (that often build lifelong connections, and leadership, and teach teamwork and social responsibility). Yet, much of the instruction on college campuses can be moved online (acknowledging, however, that a substantial percentage of students don't perform, or learn, as well in online classes). Even then, this is just a preliminary observation, as the actual decision needs to be informed as more information about the benefits, costs, risks becomes available.

All in all, if moving classes online for a college or university meant substantially less transmission of the virus causing COVID-19, and could lead to more factories and other businesses employing thousands of workers being open (or staying open for longer), it seems to reason that moving most instruction to online classes might be preferable.

5. Restrictions on our liberties do exist, and some restrictions may be expanded (at least temporarily) for the greater good.

Many might say that restrictions on opening businesses restrict our liberties. The liberty to work, as we see fit, for example. But the states (primarily) have long imposed restrictions for health and safety. So that incidences of death or injury (or disease) are lessened.

Perhaps no single "freedom" or "liberty" we possess is absolute. For example, freedom of speech does not provide a person to yell, without cause, "fire" in a crowded theater. Freedom of religion does not permit a religious sect the ability to engage in human sacrifice. Freedom of the press does not permit the press to knowingly publish falsehoods against public figures that would cause great harm. All of our freedoms and liberties are subject to some rational, and targeted, restrictions.

We must carefully guard our liberties against undue governmental interference. Yet, restrictions imposed by government upon our liberties, through our representative form of government, are often necessary for the greater good. Even then, we must stand ready to challenge whether such restrictions continue to be necessary, as the situation changes.

It is also proper to have public debates on any restrictions imposed, for such debates are essential to our democracy. Yet, in having such debates, it is incumbent that each of us seek to understand the full dimensions of the circumstances in which we find ourselves, and to understand the arguments of the other side. We must be willing to listen to those who oppose our own views. We must be willing to explore potential solutions, rationally. We may end up disagreeing, but we should do so with respect to each other.

6. Efforts should be taken in three major areas, as the economy is re-opened.

    A. Keep the chains small, to limit the areas, and people, exposed.

Through a balancing of the interests, limit in-person contact. Limit the number of "chains" formed to which a person is a member, and limit the length of such chains, by limiting human interactions as much as possible.

Keeping the chains small has been done to date by means of self-isolation, stay-at-home mandates, and other social distancing measures. Yet, these measures are not without their consequences - to the mental health of many (sometimes causing other death or harm to others). Such measures may be required much longer than we might desire, or may be relaxed when appropriate to do so.

Where relaxation of these measures occur, we can still limit the number and length of chains. We can do this, for example, by keeping some businesses closed - where those businesses might operate (effectively, to a large degree) remotely, for example. This may permit us to open other businesses, such as factories and certain small businesses where working from home is not possible. We should take every reasonable step to limit the number, and length, of the chains which people may be joining, as we seek to re-open the economy, by releasing restrictions only where and when appropriate to do so.

I submit that we can take greater efforts as a society, in this regard. For example, many in our society, shopping at various stores, don't wear masks and ignore social distancing recommendations. Our leaders, and our media and press, and each of us individually, can make it known that in this new era such conduct is no longer "acceptable." Social pressure can bring about changes in behaviors; many of us have changed our behaviors when (by necessity) we are out and about, but others have yet to be influenced correctly to change their behaviors.

Many grocery stores have limited opportunities for outside pick-up of groceries (i.e., delivery to the car), or won't deliver milk or eggs to cars. It may cost more (for consumers) to have greater availability of delivery (to cars, or to homes) of essential goods, but many would pay for same.

While restaurants may re-open, many of us can still choose to have meals delivered to the curbside (or car), for consumption in our own homes.

This is not to say that tremendous work has not been done, and great accomplishments made, by many who have been working in dire circumstances for many weeks. We can applaud those "essential" workers in our economy, for assuming risks. Yet, we can perhaps do more to limit these risks, and keep chains from expanding in number or reach, for a relatively low incremental cost.

    B. Clean and disinfect, wash hands, often. Undertake other measures to kill the virus.

We cannot completely stop the virus causing COVID-19 from being present in some physical areas, as we re-open sectors of our economy. In the instances, we must ensure that the virus has less opportunity to infect others.

Of course, hand-washing (properly) is essential. Even at home. As is wiping surfaces with soap and hot water, the use of disinfectants, etc.

Technology solutions such as UV lights might be explored, either within ventilation systems or in various rooms. Or via UV light units that can sterilize a phone, or item of clothing, or backpack.

Cleaning of common areas very, very often - whether in public transit, in stairways, in elevators, or in rooms used by many sets of people - appears to be prudent and necessary. We can do more in this regard.

Other ideas exist that, in essence, may lead to killing the virus when it becomes present, but before it causes infection of another.

    C. Mitigate, when new infections do arise.

Even when transmission of the virus occurs to an area, which is not effectively killed by cleaning or other measures, and which then leads another person to contract the disease, the third type of activity to limit further transmissions must occur.

Mitigation requires: (1) extensive testing to detect; (2) contact tracing; and (3) isolation (of those infected, and of those likely exposed).

The media has recently explored each of these activities in detail, and I won't repeat their observations here. I would state that vast resources are necessary to devote to mitigation efforts, which in most geographic areas don't appear to exist, or be available, as of yet.

In conclusion.

 I don't possess all the answers. I am no scientist. But, I would hope that we, as a nation, can effectively weigh (at a local level) when it is appropriate to "re-open" the economy, and that we do so prudently and in proper stages.

Failure to do so could lead to overwhelming our health care system, a higher amount of deaths or permanent damage to persons' vital organs than we (as a society, collectively) would be willing to accept.

I am fortunate to not be in a position to make the very difficult decisions involved in the weighing of interests involved. I can only hope that the leaders in charge of making these decisions act rationally, with as full an understanding of the benefits and risks and costs as can be achieved from trusted and reliable sources, and with proper outreach to listen to all points of view.

To all who have read this far, I would conclude that - I have hope. In the entrepreneurs and leaders and researchers who are devoting their time and talents and monies to finding therapeutics and vaccines. I have hope that we, as a society, having come together to tackle this new threat, will continue our diligent efforts as we seek to balance the threat against other forms of disruption and harm.

Some involved in making these decisions are likely to make some mistakes, but we will hopefully learn from them, so that they are not repeated.

I hope, that with rational thought and careful consideration, the actions taken by our leaders today, and tomorrow, are the correct decisions to enable America to move forward, together and united.