A look at how we find a return to normal in a COVID-19 world
This is first part of the third installment in a series of pieces related to COVID-19. Click here for the first installment, "WE not ME." Click here for the second installment, "What's Next?"
By now we've probably well established that I'm a big nerd, which doesn't usually mean much on most days. However, when it comes to matters of S.T.E.M. "nerds gonna nerd" (that's the nerd version of playas gonna play).
I have degrees in Economics, Public Health, and Data Science, which is simply to say that as you read this please keep in mind the perspective from which I'm writing. If you disagree with me, feel free to reach out and let me know! Just be ready to backup your position with facts, data, and citations.
(Yes this sounds totally annoying and arrogant - please know it's not intended to come out that way).
For the better part of the past month or so, the question on everyone's mind seems to be some version of the following, "will we ever get back to normal?"
My answer is YES. So let's all take a deep breath, give ourselves a minute to be hopeful, and look forward to when that day comes. Things will get better, but we need to have patience till they do. The more impatient we are, the longer we will have to wait till we return to normal.
Now, I know many of you already have a million more questions, and probably some complaints with the first few sentences I've written so far.
For starters there are assuredly a lot of questions about what "normal" means, whether it was ever a good thing to begin with, and nuanced questions about the socioeconomic inequity contained within our old definition of normal. Those discussions, though worthwhile, would take up endless amount of time and space and are probably better left for another day.
Then there are likely those of you who know enough of this heinous virus to doubt whether we can ever get back to the old normal. You all are likely shaking your head and thinking to yourself that we will need to move to a new normal that includes social distancing, obsessive hand washing, masks, etc. for years to come.
I completely understand where you're coming from. This was my gut reaction as well, and it well may be what's in our cards for the next year or two.
So the question is - why? Why do I think we'll be able to get back to a pre-COVID sense of normal someday? Because history tells me so. Over the past several centuries, mankind has endured various plagues, poxes, and public health pandemics. Though some of those diseases wreaked global havoc for years, we always found a way onward and upward.
Even the Spanish Flu gave way (eventually) to the roaring 20's.
To me the significant questions should be "when?" and "how?" do we find our way back to normal?
I will attempt to tackle those questions over the next few installments of this piece.
In 2008, the global financial system was nearly brought to its knees as a result of the collapse of the synthetic subprime mortgage back securities market. In 2009, I was part of a Big Five Consulting team tasked to create content around a "Recession Playbook" for CFOs to help them navigate their organizations through the aftermath of the crisis.
Over the past few weeks I've been thinking a lot about that playbook and have wondered what a COVID public policy playbook would look like today.
What's our silver linings playbook?
The road to normal begins with a plan that contains the following broad steps:
Step 1: Calm the anxiety
Step 2: Fortify your defenses
Step 3: Attack
Sounds reasonable enough, right? Also sounds fairly broad and vague, no? What does this look like exactly in specific terms? Well, to better understand that, it helps if you're a fan of the underdog sports film genre. So if you've seen the Mighty Ducks (or Hoosiers, Wildcats, the Replacements, Major League, etc.) you know what I'm talking about.
DUCKS FLY TOGETHER
If you've ever seen one of these sports underdogs films you know the formula well. You start with a rag tag bunch of rejects from the wrong side of the tracks and you turn them into champions. How do you do this?
First you get a coach that can calm the chaos and anxiety. Whether that be Gordon Bombay in the Ducks franchise or Gene Hackman's characters in Hoosiers and the Replacements, the turnaround starts at the top.
Second you fortify the defenses. Maybe that means you teach Goldberg how not to be afraid of the puck as goalie in the Mighty Ducks, or maybe that means Jon Favreau is your new linebacker in the Replacements, but you have to stop the bleeding somehow on defense before you can go on the offensive.
Third you attack by adding to your firepower. In the movies this means you bring in a ringer or two. In the Ducks that ringer came in the form of Adam Banks. In the Replacements that ringer was Keanu Reeves' Shane Falco.
Once the pieces are in place, you're ready to attack. That attack requires a strategy to best utilize your assets. Maybe that means you implement the Flying V. Maybe that means you implement the picket fence as in Hoosiers. Maybe it means you let "Sunshine" throw all over the field and then switch back to the veer in the final play of the championship game as in Remember the Titans.
Whatever the case....when the time comes....you have to know your opponent, know yourself, and then design a strategy to attack. Winning requires that you have executed step 1-3 well.
Over the course of the next few installments of this piece, I'll breakdown in detail what these "Mighty Ducks" steps look like in the context of a COVID policy playbook.
If we can execute these steps with precision and patience, we can implement a policy that will have us singing "we are the champions" in the end.
But, and here's the key, we have to remember that when things get tough..."Ducks Fly Together."
We are all in this together. Our individual and collective health depends not only on our willingness to patiently stick to the plan, but on everyone's willingness to do so. When it comes to public health we are only as strong as our weakest link.
CONTEXT AND NUMBERS
While I'll delve into the details of how we get back to normal in future installments of this piece, what I'd like to focus on right now is the current scientific context of COVID-19, because that context will inform our assumptions, which in turn will be the basis for our plan forward.
There appears to be a high level of confusion and misinformation that is circulating daily about where we currently stand in our fight against COVID-19 and I think it is worth spending our time focusing on the factual science of where we are today.
COVID-19 has mutated more than 30 times in the past few months. The version of COVID-19 that is hitting the East Coast of the United States is far more transmissible and more lethal than the version that hit Wuhan China.
When COVID-19 first hit Wuhan China, scientists believe the virus was a single strain.
When I wrote "WE not ME" nearly two months ago we discussed the two known strains of SARS-CoV-2. One was type "L" and one was type "S." Those strains were found by Scientists with Pekin University's School of Life Sciences and the Institut Pasteur of Shanghai.
Roughly 3 weeks later, by March 27, 2020 the USA Today reported that the number of strains had risen to at least 8. As recently as April 21 (so about three weeks after the USA Today piece) the number of strains had exceeded 30 and may be increasing in strength, viral load, and severity.
The virus is rapidly mutating, which is just another complicating factor scientists have to account for in determining if and how we can attack the virus. What it also indicates is that we cannot solely rely on the original COVID data out of China to serve as a predictor of how it will react in America.
When the United States first initiated its two week social distancing policy it was modeling its data on the Wuhan version of the virus. That version was believed to have a 3.4% case fatality rate. For contrast, the US is currently experiencing an approximate 5.8% case fatality rate.
Scientists now believe that the Wuhan version of COVID-19 was milder in severity than the European version. The Wuhan version spread to the West Coast of the US through travel between China and states like California and Washington. Meanwhile, the European strain hit America via travel to the East Coast resulting in far more heinous outcomes in NY, NJ, Massachusetts and so on.
"The mutation Spike D614G is of urgent concern; it began spreading in Europe in early February, and when introduced to new regions it rapidly becomes the dominant form." It is now the dominant form in the US.
Generally speaking, not all virus mutations are a bad thing. In fact, researchers believe that the Spanish Flu pandemic finally subsided because the virus ultimately mutated into a less harmful form putting an end to the mass fatalities caused by its previous incarnation. However, before the Spanish Flu mutated for the better, it first mutated for the worse.
It's like having to put up with a George Clooney and Val Kilmer Batman before you get to see Christian Bale's Dark Knight.
The US strain of COVID is resulting in symptoms and fatalities that are surprising physicians and scientists alike.
Whereas COVID-19 was primarily thought to be a respiratory illness, physicians are now seeing severe clotting, and there's been an uptick in 30 and 40 year olds stroking out from COVID. Separately, COVID toe has become a new symptom, as has accelerated dementia like symptoms or delirium.
All of this is to say the following:
1 - The COVID-19 we are facing in the US today is far more transmissable and lethal that the COVID-19 we thought we were facing when the lockdowns began. We are looking at a case fatality rate, post-lockdown, of roughly 70% higher than expected pre-lockdown. COVID-19 is currently 58 times more lethal than the ordinary flu and almost 2.5 times more lethal than the Spanish Flu.
2 - It also is more of an enigma than previously thought and is constantly evolving. There's so much we still don't know.
In fact, we previously thought COVID-19 was only dangerous to those who were well into their senior years. We are now seeing the disease severely impact those in their 20s-50s as well as the very young.
Nearly 40% of those hospitalized with COVID were under the age of 54.
Anecdotally speaking, we've seen multiple COVID fatalities in infants under 1 (1 in Illinois) year old and as young as a 5 month old baby in NY, as well as a teen under 18 in California.
There is just a lot we don't know yet about the US strain of COVID-19.
Growing up, I would watch the Benny Hill Show. One particular episode has stuck with me. In it, Benny Hill was doing a sketch comedy bit about how one should never assume anything because doing so would make an "ass" out of "u" and "me."
And so here I am, decades later, telling you all about the assumptions we must make with respect to our return to normal and hoping we don't look like asses for it later.
The increased mutations of COVID-19 further call into question whether or not there is an acquired immunity to the disease once you've gotten it and whether or not a vaccine would actually be long term preventative or act more like a flu shot where you hope you guessed the right strain and may still get the flu on a recurring basis no matter how many years in a row you got your flu shot.
Recently, the World Health Organization, stated they have no evidence yet to determine whether or not you can get COVID-19 more than once - meaning they don't know yet if there's any prolonged acquired immunity for those who already have recovered from the disease.
There also is no evidence to suggest a vaccine would be preventative in a long term permanent sense versus act like a flu shot that you would need to take seasonally and hope that you picked the right strain.
Having said all that, Dr. Fauci believes that it is more likely than not that there will be an acquired immunity of some sort and that you cannot likely get COVID-19 more than once and that is the assumption we will need to rely on as we move forward in our analysis of how we find normal.
Without this assumption we will likely be in for a much longer more arduous journey.
So as we move forward in this discussion about how we find normal, keep in mind that our core assumptions are that the COVID-19 mutations will not get worse, will not prohibit long term acquired immunity to those that have already recovered from the disease, and that a vaccine can give long term preventative protection.
If we can get these assumptions right, we can certainly find our way back to normal.