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

ALL POSTS PRIOR TO 2021 HAVE NOT BEEN REVIEWED NOR APPROVED BY ANY FIRM OR INSTITUTION, AND REFLECT ONLY THE PERSONAL VIEWS OF THE AUTHOR.

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:

FIRST, WE MUST ACKNOWLEDGE SO MUCH THAT REMAINS UNCERTAIN, AT PRESENT.

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.

PRINCIPLES THAT MIGHT BE FOLLOWED IN RE-OPENING THE U.S. ECONOMY.

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.