Part 2 - The Solutions

As you may have seen in my first post about the Science, in the US we’re currently about 11 days “behind” Italy’s outbreak. Even though the US population is younger and more spread out than Italy’s population, we are still following their pattern closely as a country. Individual states are, too, just a few days farther behind: (remember these are only confirmed cases, and the number of real cases is likely about 20 times higher across the board):

And, as a reminder, Italy’s medical systems are currently breaking down, forcing their doctors to make wartime-like decisions about who deserves to live.

So to put it bluntly, most of the United States is on pace to have thousands of people die in our overwhelmed hospitals by late March.

By this point, some of this can’t be stopped. People are already dying, and will continue to die, especially if they are elderly or have compromised immune systems. But much of the death can be stopped, depending on how we all act right now.

 

There are two goals here:

  1. Delay getting the virus for as long as possible

  2. Avoid giving the virus to others

 

In short, the strategy for each goal is the same: practice excellent hygiene and strongly limit your contact with others.

But notice that I said “delay.” That’s because it’s highly likely that 40-70% of us will get the virus at some point. However, the when is crucial. If 40% of America gets the virus over the course of 2 weeks, the medical system will be swamped and fatalities will skyrocket. When you hear, “most people will be fine and have mild symptoms,” that’s true. But it’s a big country, and even the small percentages really add up to some rough math:

The US population is around 327 million

If 40% of those people get the virus, that’s 130 million people

If only about 18% of those people need hospitalization (13.8% who have severe cases, and 4.7% who have very severe cases and need intensive care), that’s 23.4 million people

 

Again: the US will likely need to hospitalize 23 million people (at least!) from the coronavirus. And of those, around 5 million may need ventilators.  

Unfortunately, the US doesn’t even have 1 million hospital beds, and we only have around 170,000 ventilators. That’s why the goal is to “delay” people getting the virus. We can handle 23 million hospital patients, but not if they all come in at once. Spreading it out over 4 weeks is better than 2 weeks, and spreading it out over a few months is even better. The public health term for this is to “flatten the curve:”

In the red scenario, we’re Italy and have to make terrible decisions about who deserves life-saving medical care. In the gray scenario, we’re more like Taiwan, who’s been perhaps the best in the world at combatting the virus and won’t have nearly as many deaths as its neighbors. Every day we can delay the peak of the virus, the lower the peak will be and the easier it will be for our medical workers to save lives (of coronavirus victims, as well as all the other medical crises like heart attacks, strokes, car crashes, etc.). To do this, we have to slow the spread of the virus, even if many people will eventually get it.

Which brings us back to the two goals:

  1. Delay getting the virus for as long as possible → basically, behave as if everyone else has it

  2. Avoid giving the virus to others → basically, behave as if you already have it

Hygiene is key. That’s why everyone is telling you to avoid touching your face and to wash your hands. Remember, soap literally rips the virus apart:

Hand sanitizer is good to use, but soap and warm water is better. So use hand sanitizer if you have it, but don’t panic if you aren’t able to buy any. You should wash your hands as soon as you come home, before you go to bed, and before you eat (at a minimum). Experts recommend 20 seconds (there’s plenty of pop songs with choruses that are long enough), and be sure to get between all the fingers and under the nails. However, these all focus on what to do if you already have contaminated hands. Hygiene is necessary, but not good enough. To really flatten the curve, we have to avoid contamination in the first place. This is hard, because thousands of people in your state are infected right now and don’t even know it. So we must avoid all of them. This is called “social distancing,” and it effectively cuts yourself off from all other people.

It’s worth sharing a brief historical example about why this is so important. The Spanish influenza of 1918 was a similar outbreak to the coronavirus. St. Louis did a great job at social distancing, quickly closing their schools, churches, libraries, etc., and their death rate stayed low. Philadelphia refused to cancel a massive parade, and their death rate skyrocketed:

source: Proceedings of the National Academy of Sciences paper, 2007.

source: Proceedings of the National Academy of Sciences paper, 2007.

This is why everything is being cancelled, from college classes to conferences like South by Southwest to NCAA Basketball’s March Madness tournament and all sports; as a reminder, the first NBA player to test positive was also joking about the threat and touching as many public surfaces as possible a few days ago (he’s since repented).

And this is why the President restricted flights last month from China and last week from Europe. These were smart moves, but not nearly enough. Other countries with similar numbers to us are already moving into a nation-wide lockdown, like Italy, Spain, and France, who are banning public events and non-essential jobs. Nearly every federal government in the world is in the middle of shutting down their societies, besides ours. States are stepping up to fill the gap in leadership, like California, Ohio, Illinois, Massachusetts, and Washington, who are closing all bars and restaurants. This is exactly the kind of thing that the federal government should be enforcing nation-wide, and the Centers for Disease Control (the American group that runs pandemic responses) has recommended that we cancel all in-person events with more than 50 people for the next eight weeks. That means school, church, sports, everything. If Ireland cancels St. Patrick’s Day, you know it’s serious.

Churches are especially contagious hotspots, unfortunately. South Korea provides a painful example: they successfully kept close tabs on their first 30 cases, but case #31 went to a big church twice before getting tested. She had contact with well over 1,000 people, kicking off Korea’s pandemic. That’s why it’s crucial to behave as if you have the disease, because you very easily could.

The Washington Post just released an excellent simulation that you can play with that demonstrates why public health people are putting so much emphasis on social distance, and you should definitely click around on it. This clip pulls the most relevant charts:

Social Distancing

So, what does social distancing actually look like? It means your daily life should be disrupted. If you’re in charge of a school, you need to send students home now and work on remote learning. If you’re a boss, send employees home now and start prepping work-from-home options. If you typically have a handful of social gatherings a week, you need to cut back on them now, to only see a few people a week (if that). You should try to stay at least 6 feet away from all other people at all times, since that’s about as far as airborne particles can travel. A helpful visual for keeping your distance:

This means no more hugs, handshakes, or high-fives. Even an elbow bump is probably bringing you too close to others, so try a bow or a wave. No more grabbing doorknobs, hitting elevator buttons, or holding handrails with your hands if at all possible. It means you shouldn’t go out to get groceries as much, so get an extra week’s worth of food the next time you go (but not an extra six months’ worth, which strains the system and limits other people’s food supply). When you do leave the house, clean your keys, phone, and hands as soon as you get back. While you’re at it, sanitizing your door and kitchen handles is a good daily practice. Overall, you want to be acting as if you and everyone else has the disease and is contagious.  

At the same time, it’s important to pace yourself and realize that this won’t go away soon. We’re in this for the long haul. The President just announced that we could be in some form of social distancing through the summer, and many colleges are already cancelling their graduation ceremonies outright. Recognize that stress and loneliness are real dangers. Keeping that in mind, I’ve made a list of suggestions to keep some order and peace in our lives:

Some to-do’s:

  • Follow scientific voices on social media, like this list on Twitter or the Centers for Disease Control’s Facebook page. (However, don’t obsess over social media. Yes, stay informed. But hours and hours online isn’t the best for your mental health during a pandemic. Put your phone/laptop away for stretches.)

  • Make a list of people you’ve been meaning to call and check up on, especially the older folks and immune-compromised people in your life, and go through a few of them each day.

  • Recognize that people in part-time or service jobs are likely being laid off right now. If you know anyone whose job might be in danger, reach out to them and make sure they’re okay. Now’s also a good time to buy gift cards online for places you frequent, since you’ll use them eventually and the cash flow will really help the businesses.

  • Take long walks, if you can avoid populous areas.

  • Check in on the medical professionals in your life (like doctors, nurses, and chaplains), whose lives are in the process of blowing up.

  • If you’re working from home, try to keep some structure in your life, both in time and space. Get dressed in the morning, and let as much natural light in as you can. Pick a place in your home to be your work space, and only do your work there, and only during work hours. You have to have some boundaries, or your work/personal life will all bleed together. (As a fun reminder, you can change your background on Zoom calls.)

  • Look into productive ways to spend your time, so it doesn’t just become screen time:

    • Crush your to-read list (reminder that public libraries have plenty of ebooks and audio-books available through the app Libby.) (Some of my recent recommendations from the past few years)

    • Plant a garden (even if you only have a balcony space)

    • Make a list of the deep cleaning you’ve been meaning to get to, and tackle one each day

    • Try art and music (drawing, picking up an instrument you have laying around, etc)

    • Writing letters to old friends or grandparents

    • Experiment with some new recipes you’ve never had time to try

    • Clean out your closet for a Goodwill donation when this blows over

    • Teach your pet some new tricks

    • Look over your personal/family finances and make a budget if you never have

    • Work on a second language through Duolingo

    • Ask friends for their favorite albums or podcasts you can listen through

  • But some screen time will inevitably happen. Try to keep movies/shows to the evening hours, to preserve some sense of a daily schedule. Taste.io is a smart movie/show recommender, and RottenTomatoes has a good list of its favorite movies you can stream for free if you don’t have a subscription.

  • If you have kids, here’s a few recommendations:


Some to-don’ts:

  • Don’t travel, between countries or really even between counties at this point. It’s time to hunker down.

  • Don’t hoard masks (medical professionals need them, and they won’t necessarily help you keep from getting sick), or toilet paper:

 
 

  • If you feel sick, don’t drive to the doctor. Instead, call your doctor. If you aren’t seriously ill, they probably don’t have time to deal with you in the office and can give you some tips from a distance. And if you are seriously ill with it, they want to be prepared for you to come in so you won’t infect other patients as you arrive.

  • Don’t be racist. (Ever, but also right now). Chinese-Americans and Asian-Americans in general aren’t any more susceptible, responsible, or contagious than anybody else. Purely on the numbers, you’re most likely to get the disease from people coming back from overseas trips anywhere, regardless of their ethnicity (like college kids coming back from Europe spring break trips, which is why Vanderbilt University shut down). It’s okay and good to ask your Asian/Asian-American friends how they’re doing, and how their family is doing. But it’s not okay to target Asian/Asian-American people in public.

  • Don’t say things like, “well, most people will be fine, and it’s only old people and people who are already sick that are in danger.” When you say something like this, you’re effectively saying, “I don’t really care about the lives of people who are over 60, who have gotten an organ transplant, have diabetes, or have respiratory problems.” The technical term for this is ableist, where you’re privileging people who are able-bodied. Think about how someone in a high-risk demographic would hear that comment:  You’re saying that not all lives are equally valuable. As an aside, it’s also profoundly opposing to the teachings of Jesus that we ought to care for those most at risk, as well as the Biblical concept of the image of God.

  • Don’t make jokes about how people you don’t like will die from this, no matter how frustrated you are politically. Do, however, make jokes about the rest of this mess, since humor is great for morale.

The situation is grim, scary, and sad. Lots of people will die. People reading history books in a hundred years will likely see this as the most important event of 2020, and perhaps since 9/11.  As Thomas Paine wrote long ago, these are the times that try our souls.

However. We have more scientific knowledge, communication, and tools than during any other outbreak during history. We have a strong understanding of how the virus spreads, and a roadmap for how to prevent further spread.

And as a reminder, in the grand scheme of American crises, the demands on individuals are pretty low here. You aren’t being asked to enlist in the military, or to keep your lights off at night to avoid being bombed, or to melt down family heirlooms for metal for the war effort, or ration food in any painful way, or hide persecuted people under pain of death. You’re being asked to stay home and sit on your couch. This can be done.

Wash your hands and stay away from other people. Call to check on each other often. Spread kindness, not germs. And remember that this, too, shall pass.

In the next day or two I’ll be pulling together advice/resources specifically for Christians or clergy. As a brief preview, see what CS Lewis had to say about the development of the atom bomb in the 1940s, and what it might say to our present situation.

In one way we think a great deal too much of the atomic bomb. “How are we to live in an atomic age?” I am tempted to reply: “Why, as you would have lived in the sixteenth century when the plague visited London almost every year, or as you would have lived in a Viking age when raiders from Scandinavia might land and cut your throat any night; or indeed, as you are already living in an age of cancer, an age of syphilis, an age of paralysis, an age of air raids, an age of railway accidents, an age of motor accidents.”

In other words, do not let us begin by exaggerating the novelty of our situation. Believe me, dear sir or madam, you and all whom you love were already sentenced to death before the atomic bomb was invented: and quite a high percentage of us were going to die in unpleasant ways. We had, indeed, one very great advantage over our ancestors—anesthetics; but we have that still. It is perfectly ridiculous to go about whimpering and drawing long faces because the scientists have added one more chance of painful and premature death to a world which already bristled with such chances and in which death itself was not a chance at all, but a certainty.

This is the first point to be made: and the first action to be taken is to pull ourselves together. If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things—praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts—not huddled together like frightened sheep and thinking about bombs. They may break our bodies (a microbe can do that) but they need not dominate our minds.

Be back soon,
Matthew 

Deeper dives for further reading:

  • Julie McMurry, a professor at Oregon State, wrote a lengthy guide called “Flatten The Curve” about social distancing and is a champion of Flatten The Curve

  • A good piece in the Atlantic that interviewed a handful of experts last week on specific social situations. Note that this was on March 12, so we’re already in a more serious scenario than when these experts answered the questions, so you should lean towards the harsher end of the spectrum of their answers.

  • Tips for working from home here and here.

  • Some more advice on social distancing.

  • A much deeper look at China’s social distancing policies.

Matthew GrovesComment