It seems that the world has a collective inability to think long-term about the COVID-19. Everybody seems to assume that after the first quarantine is lifted, that life will go back to normal, but that is not very likely. It will take 1 to 2 years to develop a vaccine and probably another year to mass produce it and vaccinate most people on the planet, so we are facing 2 to 3 years of dealing with the coronavirus, known as SARS-CoV-2.
A few countries have developed more effective strategies to deal with the coronavirus. South Korea is the only country which has managed to stop the number of COVID-19 cases from growing. It uses wide-spread testing, rapid response and contact tracing, which is expensive and requires an effective government to hunt down every case and test every person who came into contact with the infected. Japan has kept its number of cases low, through social norms based on cleaniness, hand washing, mask wearing and people following the rules when authorities impose quarantines in an area, but its number of cases is still growing. Singapore has imposes strict quarantine rules and contact tracing. Hong Kong has basically shut down, by closing the schools and imposing a strict quarantine, and closing the border with China. A number of countries like Taiwan and Vietnam have so far managed to keep the coronavirus out of their country by catching the cases at the border.
Nonetheless, I doubt that these tactics will contain the virus for the next 2 to 3 years. Once businesses start operating normally and social gatherings take place, it is likely that many of the countries that have been able to do rapid response and border catching will have to go into quarantine and start shutting down their economies just like other countries are doing.
For countries where the coronavirus has already become wide-spread, the goal is now to “flatten the curve” in order to not overwhelm the medical system and give each country enough time to buy or manufacture enough respirators, masks, gloves, gowns and add enough hospital beds and extra personnel, so that they are ready to deal with more cases. Plus, it provides more time to gain valuable experience dealing with the virus and test out the best treatment methods to lower the fatality rate.
Once the initial quarantines are lifted, however, we are basically back in the same position as before, and will have to keep applying new quarantines as new outbreaks occur. Going in and out of quarantine over and over for the next 2 to 3 years will likely destroy the economy and cause a global depression with 20% to 30% unemployment rates. At the same time, there will be a massive disruption of social and political life and there will be massive repression of people’s civil liberties to implement the quarantines and repress the inevitable uprising caused by millions of people being unable to work and unable to adequately feed their families. Countries will print money to pay for their massive government expenditures, because it will be the only thing sustaining the economy when spending in the private sector collapses, but it will likely lead to hyperinflation in many countries.
Most people are focused on the deaths caused by COVID-19, but it is important to also focus on the non-COVID-19 deaths that may occur due to the response to the coronavirus. People who lose their jobs and have no health insurance are unlikely to go to the doctor to catch medical problems early, so they more likely to die prematurely. Quarantines and economic shutdowns also hinder the normal checkups and preventive medicine that help catch medical conditions early, so measures to hinder the spread of the coronavirus may lead to more deaths from other causes.
The quarantines and economic shutdowns to slow the spread of the coronavirus will cause large portions of the population to lose their jobs. The children of the unemployed are more likely to suffer from malnutrition, which leads to poor development of the brain and life-long health problems. They are also less likely to excel in school or be able to pay for college or trade school. Unemployed people are more likely to commit suicide, have drug addiction problems and get divorced, which has socioeconomic consequences for entire families. Research shows that economic recessions generally lead to lower fatality rates in developed nations, but it largely depends on the response of governments. If governments aren’t able to adequately support the unemployed, there may be more deaths from the effects of the quarantines and the collapse of the economy than the coronavirus itself.
Eventually we are going to figure out that going in and out of quarantine over and over is simply not sustainable. Sadly, we will probably only figure it out that the current strategy of dealing with the coronavirus doesn’t work after we have collapsed the global economy and governments have to pay a basic income to the unemployed to keep people alive.
It seems to me that the only viable solution for countries that already have wide-spread infection inside their borders is create herd immunity by strategically infecting roughly 60% of the population, and trying to quarantine the high-risk population such as the elderly, smokers, immunodeficients, etc. which are more vulnerable to COVID-19. Of course, this won’t be easy and millions will likely die, but the current strategy will likely lead to even more deaths.
No political leader wants to be the first to stand up and say that the current strategy won’t work, because he/she will be vilified as trying to kill people by purposely infecting them. The country that goes first and implements a plan to infect 60% of its population to gain herd immunity and selective containment of the high risk population will be ostracized, because that country will be seen as risking the health of other countries. It takes courage to stand up and tell people that there are no good options, and the best available option will probably mean millions of dead around the planet.
The Dutch Prime Minister, Mark Rutte, who is a right-wing ultra-nationalist, has talked publicly about a strategy of herd immunity. British Prime Minister Boris Johnson has also suggested it. Sweden’s state epidemiologist Anders Tegnell and Britain’s chief scientific adviser Patrick Vallance are advocated it, but most governments are keeping quiet about a strategy herd immunity, if they are considering it at all.
Unfortunately, the way that Rutte and Johnson are talking about herd immunity is totally irresponsible, because they aren’t mentioning any way to protect the people who are at high risk. The web site virusncov.com estimates that the coronavirus kills 14.8% of people who are infected over the age of 80 and 10.5% of people with cardiovascular disease. It would be criminal to expose people who at high risk to the coronavirus. Johnson and Vallance are being especially irresponsible by thinking that the UK can control the coronavirus through nudge theory, rather than the state imposing strict rules and government plans. Johnson’s approach to the coronavirus has been rightly pilloried by The Guardian as “callous and dangerous”.
The World Health Organization (WHO) has questioned the basis of herd immunity in the evidence. At this point, we don’t know enough to be sure that strategic infection for herd immunity is the best available option. We need to know for sure that people can’t be reinfected after having COVID-19 and how long people can infect others after catching the disease. We need to have a better idea of the fatality rate for different groups to know who can be infected and who should be isolated to avoid infection. We need to know what percentage needs to have contracted the disease in order for herd immunity to work.
Nonetheless, the evidence thus far points to herd immunity as the least worst option for the countries where the coronavirus is already wide-spread. We need to have the courage to start talking about it and trying to plan how it could be implemented. It is going to take a great deal of political courage to implement it preemptively, but it will probably be the path that saves the most lives when containing the virus is no longer a viable option. Unfortunately, what will most likely happen is that most countries will try to follow the current path of containment through quarantines and economic shutdowns. This path will not only prove ineffective at stopping the coronavirus, but it will also destroy most nations’ economies, which will limit their ability to deal effectively with COVID-19. It is likely that most countries will arrive at the painful conclusion over the next six to twelve months that general quarantines and economic shutdowns are causing more damage than good.
At that point, most countries will decide that herd immunity through mass infection is better than no strategy at all, but the infection won’t be well planned to only target the low-risk population, so large percentages of the high risk population will be infected and millions will die. Due to the poor economy, countries will have less resources to treat those who do get sick, and less resources to help the vulnerable who can’t work, so millions more around the globe will die due to the poor economy.
Another hard truth that we need to face is that we are going to have to employ state control of the economy on a massive scale in order to feed and shelter large portions of the population. Those countries which cling the longest to the erstwhile system of Capitalism are likely to have the highest amounts of suffering and death, since they are the least able to adjust to the new reality. This ideological ossification among the political leadership is likely to lead to political turmoil and even revolution. Sadly, revolution in desperate times often leads to the worst repression of civil and human rights.
For people who fear Socialism, it should be clear that strategic infection for herd immunity is the best option, because at least the majority of the population can carry on participating in the economy and their economic activity can be taxed to maintain the high-risk population that needs to be isolated. In contrast, the current strategy of periodic quarantine and shutdown to flatten the curve every time there is a major outbreak is going to so destroy the economy that states will be forced to start implementing Socialism just to feed and shelter large portions of their populations.
In order to try to understand what is the best course for humanity to choose, it is helpful to lay out the possible scenarios for dealing with the coronavirus:
- Scenario 0: Contain and eliminate the virus.
This scenario might have been possible if China had acted early rather than denying the problem and had alerted the rest of the world. However, it would have also required that every country detain and check travelers from China at the early stages of the outbreak in order to prevent its spread. This scenario is no longer possible now that the coronavirus has reached most countries on the planet and is wide-spread in many places.
- Scenario 1: Let COVID-19 run its course like the Spanish flu did in 1918-20.
This will lead to a very high fatality rate for the disease because every medical system will be overrun and there will be little ability to treat the sick. The global economy will shut down briefly, but then it will bounce back quickly, so there will probably be a spike in non-COVID-19 deaths, but it will cause the least disruption of the social and economic system, so the total number of non-COVID-19 deaths will be less. In this scenario, 1% – 2% of the world’s population will die, mostly among the elderly and people with respiratory ailments and immunodeficiencies.
- Scenario 2: Hypervigence to track down cases and/or prevent foreign infection.
Utilize wide-spread testing, contact tracing and rapid response to contain every case of the coronavirus (e.g. South Korea) and/or border inspection to catch all infection coming from abroad (e.g. Taiwan). For the countries that have low numbers of infections, this is the most logical route for the time being, but hypervigilence against the coronavirus will require devoting substantial resources and suppressing economic, social and political activity. Because the economy still functions to some degree, economic recession instead of depression can be expected. There are serious questions whether the coronavirus can be contained long-term under this scenario and many countries using these tactics will eventually pass to scenario 3 below.
- Scenario 3: Quarantine and economic shutdown.
The coronavirus can’t be contained, so periodic quarantine and economic shutdown are employed to slow its spread. The strategy is to “flatten the curve” to avoid overrunning the medical system, so it is possible to adequately treat people suffering from COVID-19. This scenario provides time to acquire medical supplies (masks, gloves, gowns, COVID-19 test kits, etc.), add medical capacity (more respirators, extra hospital beds, etc.), train personnel and gain treatment experience, but it means that new quarantines and economic shutdowns have to occur every time there is a major outbreak, so there will be 2-3 years of severe economic depression with very high unemployment rates. In places where the state doesn’t take charge through either state Socialism or massive assistance to the unemployed, expect higher numbers of non-COVID-19 deaths, especially among the lower classes and among children.In the short term, stimulus from the government can be used to jump start the economy after each economic shutdown, but it will only work if directed toward the lower-classes who will immediately spend it. However, stimulus won’t work over the long run, because private enterprise won’t see much benefit to new spending in a bad economy, so the state will have to employ large numbers of people or take over parts of the economy to keep it functioning. Political upheaval and revolution are likely in states that don’t take care of those who can’t work, and existing governments are likely to employ increasingly repressive and autocratic measures to not only enforce quarantines, but also suppress political insurgency. I doubt this scenario will be sustainable in many countries and it will likely lead to scenario 5 below.
- Scenario 4: General infection for herd immunity and self-isolation for the high risk.
Strategically infect low-risk populations to gain herd immunity and isolate high-risk populations. The population that has immunity can continue working normally and taxing their activity will pay for the cost of maintaining the high-risk population which can’t work. High taxation of the wealthy and the immune population will be required to pay for isolating the high-risk population, but economic shutdown will be avoided and there will be less disruption of the economic, social and political systems. The number of non-COVID-19 deaths will be minimized since there is less economic disruption. The number of COVID-19 deaths is likely to be higher than in scenario 3 during strategic infection, but once herd immunity is gained, the high-risk population will probably be safer.
- Scenario 5: General infection as a last resort with improved medical treatment and some self-isolation of high risk populations
After scenarios 2 and 3 fail, allow wide-spread infection to take place as a last resort since large-scale quarantine and economic shutdown is no longer deemed feasible. The effects will be mitigated to some degree by beefing up the medical capacity and trying to treat the sick as best as possible. Support will be given to people who want to try to self-isolate by staying in their homes or special communities like nursing homes, but it won’t be an option for the vast majority. Because the infections aren’t targeted and there is little immunity in the general population, large outbreaks are likely and higher percentages of the high-risk population will be infected when those outbreaks occur. The lack of planning since this is a last resort means that the medical system will likely be less prepared to handle the large numbers. There will be high numbers of COVID-19 deaths and non-COVID-19 deaths will also be higher because massive disruption of the economy will have occurred.
Clearly scenario 5 would be dire, but it looks likely that most countries will eventually end up there, regardless whether they resist it or plan it. The economic situation and politic exigencies will force many countries to eventually accept mass infection. The states like South Korea that have been the most organized in their response to the COVID-19 might avoid it, especially if they are island nations or have controlled borders. However, most countries aren’t willing or able to isolate themselves from the rest of the world and most don’t have a state apparatus in place which is organized to hunt down every case and isolate it like South Korea.
Scenario 3, which is the current situation in much of Europe and North America, is unlikely to be a viable option in the long term. Like China, most countries in scenario 3 seem to be hoping that they will be able to contain the coronavirus enough that they will be able to move from scenario 3 to scenario 2. It might be possible in China, but it is looking increasingly unlikely in Europe and North America. The coronavirus is now too deeply rooted that it can’t be contained in many countries, even with extensive testing and tracking. For countries like India, Vietnam, Taiwan and Australia where the coronavirus hasn’t yet entered their populations, catching all foreign infections is certainly the best strategy, but it is questionable whether hyper-vigilance and border containment will work for 2-3 years as long as these countries want to participate in the world economy. It seems inevitable that many countries in scenario 2 will eventually pass to scenario 3.
Let’s assume for the sake of argument that countries will be able to stay in scenario 3, and avoid ever sliding into scenario 5. Staying in Scenario 3 means either a massive reorganization of the economy and society in order to feed and shelter people when they can’t work or it means causing lots of non-COVID-19 deaths and impacting people’s futures.
If we take the US as an example of what might happen under scenario 3, its private health care system will likely collapse and large parts of the American medical system will either have be socialized or heavily subsidized by the government to keep it afloat. The stimulus bills that have been passed so far in the US are unlikely to prevent large-scale unemployment and they will also lead to a greater market oligopoly, because large businesses will have access to funding to buy up their smaller competitors. Since the government’s current response isn’t designed to cover all people who will need assistance, but there will likely be a rise in the general mortality rate.
Even if countries manage to avoid scenario 5 and can stay in scenario 3, we still have to ask who will be effected. Under scenario 3, it will be the poor and the children who suffer the most. If we don’t want them to suffer, we have to be willing to dramatically change how the economic system works, which frankly won’t happen in many countries, mostly because the political system won’t allow it. In some developing countries, it is questionable whether there are the necessary resources to support everyone who will need assistance.
In contrast, most of the suffering under scenario 4 will be born by the high-risk and their families who have to isolate themselves. It is hard to know at this point what percentage of the population will suffer from economic privation under scenario 3 versus the percentage of the population which will need to quarantine themselves under scenario 4 because they or their family members are at high risk to COVID-19. However, the people who suffer don’t have any choice under scenario 3, whereas they do have a choice whether to self-isolate themselves or not under scenario 4, so from the perspective of human freedom, scenario 4 is better. I suspect that many elderly people who at high risk will decide that they would rather take the risk of being infected than spend the last years of their lives in isolation, which is a choice that should be respected.
There are too many unknown variables to estimate whether scenario 3 or scenario 4 will cause more fatalities, but we do have to think about the moral implications of who will die or have their lives damaged. Under scenario 3, we will be negatively impacting lives of the poor and the children, whereas the elderly and people with respiratory problems and immunodeficiencies are the ones who are most impacted under scenario 4. There is a moral case to be made that we should prioritize children and their futures over the elderly, who have already lived most of their lives. There is also the fact that once herd immunity is achieved under scenario 4, the high risk population is safer than under scenario 3, where there is the constant risk of sliding into scenario 5.
The big question about scenario 4 is whether it is possible to only infect the people who at low-risk, while protecting the high risk from infection. Unfortunately, some of the high-risk population will be infected by the coronavirus during the phase of targeted infection under scenario 4, but there are ways to minimize the numbers.
Here is how I envision scenario 4 taking place. There will be a phase 1 where the goal is to infect 1% of the population, so they will be immune from the virus and can’t infect others in the future. The coronavirus is contagious for between 8 and 37 days, with the medium time of 20 days. The government could offer to pay the cost of the self-quarantine for 40 days for those who volunteer to get infected in phase 1. The government will pay their normal salary for the time when they can’t work, and they will be given promises that either their employer will take them back or the government will find them another job. Since these volunteers won’t be subject to future quarantines, most employers will be eager to take them back. During the self-quarantine, the government will deliver food and anything else that they order to their doorstep, so they never have to leave their house. Governments that are more authoritarian will probably compel the infected to wear tracking bracelets.
People will voluntarily take this risk, because it means that they will be able to work and move freely for the next 2-3 years, which makes them more employable, plus people who take the risk will be lauded as patriots who are helping their country (which unlike most government propaganda is actually true). For people who are 39 years or younger, the current death rate from COVID-19 is 0.2% or 1 out of every 500 of those infected. However, once every hospital is equipped with respirators and the medical profession has figured out the best treatment methods, that death rate will probably be closer to 1 in every couple thousand. Considering the number of youth who were violating quarantine even when knowing the risks and the number of people who volunteer to go to war with similar odds of death, it should be possible to get 1% of the population to volunteer to be infected.
Then, phase 2 will follow where the general population will be allowed to be infected. People who want to self-isolate will register for a free delivery service from the government, so they won’t have to leave their homes. The government will offer financial assistance to the self-isolating households who need it, but it will be much less generous than what was offered to the phase 1 volunteers. People who choose to self-isolate will probably want to put signs on their doors, telling people to leave items on the doorstep or giving instructions how to contact them if they want to talk over telephone, Skype, Telegram, etc. Separate facilities for essential services will have to be designated for the self-isolating. For example, some hospitals and medical clinics will be designated for the self-isolating.
The people who volunteered to be infected during phase 1 will be essential personnel during phase 2, because they are the only ones who can interact with both the general population and the self-isolated. People like medical personnel, religious ministers, police and delivery drivers will see the benefit of being phase 1 volunteers.
A final phase will come where there is lower risk for the self-isolated because the majority of the population is immune and can’t pass on the coronavirus. Many of the self-isolated will chose to interact more with the general population, but the government should continue to offer free home delivery services and financial assistance to those who choose to keep self-isolating. In this phase, governments can employ many of the tactics used in scenario 2, to prevent outbreaks among the self-isolated.
As it stands now, most countries are likely to pass from scenario 2 to scenario 3 and then to scenario 5. Once in scenario 5, many will realize that a scenario 4 is much better and they will try to implement it. At that point, their economies will be in bad shape and many of the high-risk will already be infected, but so it will be less effective. It is better to plan to implement scenario 4 from the very beginning.
If planned from the beginning, scenario 4 will cause the least disruption of people’s lives, the economy and the existing social, political and cultural systems. For example, people won’t be scared to serve as religious ministers or call them for counseling if they know that the ministers are immune and don’t have the coronavirus in their lungs.
Unfortunately, I’m extremely pessimistic that any country will be able to talk honestly and openly about the problem. Every country that doesn’t yet have a wide-spread outbreak will employ scenario 2 to avoid an outbreak, and every country where the coronavirus is already wide-spread will employ scenario 3 with the hope that it will eventually be able to get to scenario 2. Nobody will want to talk about scenario 4, since even discussing it is likely to get people branded as moral monsters. It is only when countries slide into scenario 5 that they will be willing to talk about scenario 4, much less plan for it. At that point, most of the benefits of implementing scenario 4 will be lost, but it is still better than simply accepting scenario 5.
COVID-19 is going to be a painful experience for humanity, and frankly all the options are bad, once a country gets to scenario 3. I’m pessimistic that many countries will be able to continue with scenario 2 for the next 2 to 3 years, but hopefully I will be proven wrong. I’m even more pessimistic that any nations will be able to successfully move from scenario 3 to scenario 2. The coronavirus is much more contagious than other diseases that have been successfully contained in the past.
The question is when will countries develop the political will to start seriously considering scenario 4. I don’t see it happening until after a country has already slid into scenario 5, and there is effectively no better option on the table. If countries which are in scenario 3 can see scenario 4 being implemented in other countries, then they might consider it, but it will probably take 6 to 12 months of economic hard times under scenario 3 to get to honest discussion of scenario 4.
The prospects for good planning and implementation of scenario 4 don’t look good since it will likely be rolled out as a last resort when all options are dire. Humanity will just have to struggle through the coronavirus crisis and hopefully learn from its mistakes.