Defining success for our Coronavirus / COVID-19 response, so we better know what actions to take & why

I think it’s safe to say that the latest novel Coronavirus, and COVID-19, the disease it causes, is on the minds of pretty much everyone around the world. In a time when the success of the internet allows many to stay within their preferred bubbles of things to ponder (I sure like pondering how Visual Effects Artists React to movies!), this is a rare moment where most of us are thinking about the same thing… and what an unfortunate thing to be thinking about.

This post started by text chatting on some posts with my cousin on Facebook (hi cousin! 👋 let me know if you want your name here). Below are some general thoughts, with my opinion towards the end, of how I see things today. I’m confident my opinion will change as we all learn more about this, but as I recently read, keeping a journal in turbulent times like this helps us understand:

  • how the world around us is changing
  • how we are changing

There are both economic and human life impacts related to COVID-19. I was talking with my cousin about what sort of balance we can strike between those concerns.

Social distancing, shelter-in-place, and lockdowns – oh my!

From China to Italy, Canada to Mexico, and all corners of the USA, countries have taken a variety of measures to curb the spread of COVID-19.

Discouraging gathering of more than 250 people (which has been reduced to much smaller over time), keeping indoors except for necessary life tasks… the levels of restriction have varied greatly, and there are a ton of articles and research papers out there about them.

These restrictions come with costs, both economic and human.

If nobody can go out, a huge number of businesses now see their income drastically drop. Restaurants are being limited to only doing take-out or delivery. Bars, gyms, retail stores, and other places that require physical presence are either being extremely limited or closed completely. In the USA, the NCAA college basketball tournament will not happen, and with that stopping, a ton of economic activity around that will halt, too.

Employees of impacted businesses will have negative consequences. They will likely either lose their paycheck, or at least get paid less than before. Some – perhaps most – will become unemployed while policies like shelter-in-place are active.

And we’re talking a lot of people impacted. The US Bureau of Labor and Statistics indicates millions of people are employed in jobs that will likely be negatively impacted. (I’d like to link to their webpage, but even their website is down for maintenance on the day I’m writing this!)

So millions of people might lose their job or have serious wage reduction. Crap.

The economic costs sound awful… what about the costs in human lives?

Both the economic costs and potential number of human deaths sound awful to me.

Currently mortality rate estimates of COVID-19 are between 1% to 4%, although that will eventually change as we learn more about this novel Coronavirus.

Epidemiologists are estimating between 20% to 60% of the US population will get COVID-19. At the low-end of these death estimates, we have 1% of 20% of 350 million, which is around 700,000 people dying. At the upper end, 4% of 60% of 350 million, is 8.4 million people dying. Even if 20% get it and 3% die, we have 2.1 million dead.

That many deaths are hard to comprehend. Here’s one way to think about it (thanks to Dustin for this idea!):

How much would you pay to prevent every US military death EVER?

Around 1.4 million deaths have happened in every military engagement the US has taken since the nation’s founding, including the Revolutionary War and the US Civil War.

According to epidemiologists, Coronavirus could very likely cause 2.1 million deaths.

How much would we have paid to save all those soldiers across all of those military engagements?

We greatly upended our economies for some of these engagements, and we still ended up with that many deaths. There were plenty of other reasons we fought, of course, but the cost in lives were less than what one single virus might cause in the year 2020.

Why compare a virus’s deaths to military deaths?

The USA’s military engagements were frequently done to keep threatened people from dying. A response to COVID-19 is done with the same intent.

Millions of people may potentially die, both in the USA and globally, because of either military fighting or COVID-19.

And in both cases, there is going to be economic levers that the USA must pull to help those negatively impacted.

One difference with COVID-19 vs a military fight: COVID-19 is a threat to every nation and person on Earth.

The “us vs. them” mentality – tribalism – is common for humans.

Frequently, the “us” and “them” are two groups of people.

With Coronavirus, the “us” is the entire human race, and “them” are these viruses. I hope that means this fight can bring all of humanity a little more together in the fight against a common, non-human enemy. A little like Independence Day perhaps.

May we all be able to look celebratory over a vanquished enemy like Will Smith could

How do we define success with COVID-19?

Military engagements for hundreds of years typically had fairly clear cut definitions of success: take over a geographical area, stop an encroaching force, etc.

These days, I must admit some military engagements success criteria seem much more difficult to discern. Defining success while fighting Coronavirus seems similarly difficult.

Why is it important to define success with COVID-19?

If there is no definition of “success,” no “win” state to the situation, then we’re stuck in a truly no-win scenario.

When the US decided to send a human to the moon, the leadership did not say we were going to try their best to, say, send rockets tens of thousands of miles above the Earth.

Leadership didn’t say they hoped to have a monkey survive going into the atmosphere and back to Earth. Nor even that they hoped we could send a person to survive a few hours outside of the oxygenated atmosphere of Earth.

Nope, we said we’re going to put a man on the moon.

That was bonkers. And it was a very clear definition of success.

What might success look like for COVID-19?

Different people will have different scenarios that they consider successful.

An economist might focus on some trade-off between economic impact and lives lost.

An epidemiologist might look at getting the basic reproductive rate of the virus under 1, so the virus will largely go away in the human population.

Success for the chief scientific advisor in the UK is currently 20,000 deaths, his “best case scenario.”

My favorite current definition of success: everyone who needs health care is not denied it

Something I propose as “success” that I think many people might agree with: during this time of pandemic, nobody with urgent healthcare needs is refused service.

The biggest public health fear right now for professionals – epidemioligsts and health care professionals alike – seems to be our healthcare system being overwhelmed.

If the hospital is full of people with COVID-19, then someone coming in with a heart attack may not get treatment, or may not get it very quickly. The next COVID-19 patient that walks in the doors may also not get treatment.

In a nightmarish scenario, a nurse or doctor must decide who gets help and who must llikely sacrifice their life, by asking, “Is this new patient that walked in the door more worthy to get help than someone who is already here?”

That nightmarish scenario is reality in Italy for many days. Its hospitals could not handle the patient load, and as some doctors have reported, the healthcare professionals literally had to choose who would live and who would die because their resources were 100% utilized.

Levers we can pull

We have levers we can pull to help people deal with economic damage.

These levers exist in the government at local, state, and federal levels. There are international organiations that can help. There’s also an appetite for this in the private section, including non-profit organizations. We can use the many resources we have – money and otherwise – to help get us back to some level of “success” in the economy.

We have zero levers to bring back a dead person.

And we’re talking tens of thousands, or possibly millions, of dead people from Coronavirus. Once someone is gone, there’s no reversing that.

And because we’re still learning about just how this Coronavirus impacts people, we don’t truly know how much of a cost might happen.

We still don’t know that much about this novel Coronavirus

We’re dealing with a virus that we don’t know much about, because it’s so new.

What we do know: the mortality rate so far seems to be between 10X to 40X more than seasonal influenza. Seasonal influenza has an average .1% mortality rate across all ages, and most epidemiologists are seeing COVID-19 to be in a range of 1% to 4%.

Availability of healthcare is part of that mortality rate; we must ensure our healthcare systems are not overwhelmed to skew towards the smaller side of that percentage.

And to do that, until we know more about the virus, we have to stop the spread of this virus. And we can do that by simply staying away from each other physically… although we can still see each other virtually, either by phone or internet.

My personal thoughts as of March 21, 2020

I am neither an epidemiologist nor a medical doctor. I build software for a living.

I’ve left my opinion on these trade-offs until the end both because I’m no expert in those fields, and because I’d rather just inform and give context for why I’m thinking certain ways than advocate for one particular viewpoint. But of course, even by simply trying to inform, I’m giving you some information at the cost of others. I have other things to do, even while I’m social distancing at home 😊

This post was not written with the intent of changing opinions, but rather to give context as to my current opinions.

I respect people having a different opinion than me, and I’ve found the best way to have conversations between people with different opinions is to come at it from a place of not trying to change the other person’s opinion. Instead, I give context and insight into my own thoughts, with the intent of building empathy between us. Typically that’s done in a back-and-forth conversation, and not in a one-way blog post… but you can leave a comment here if you’d like 😄

The estimates of death rates above are some of the evidence that leads me to supporting both the social distancing that’s been encouraged, and also the government taking some major actions – including payments to people, debt & rent & mortgage suspension, etc. – to fight this. I just read the UK government might pay 80% of workers’ wages.

With many epidemioligsts estimating a million deaths or more in the US alone if we don’t take serious action, approaching this with the mindset of a war-time mobilization seems appropriate to me. I wish we could have been more proactive, but we can only change what we do going forward. Thankfully, our mobilization can involve sitting at home and reading, phoning or video chatting friends and family, playing board games, reading, writing blog posts 😅 and more relatively safe, relatively fun things.

We’re all in this together. Let’s fight this horrible virus that wants to kill civilians and military veterans alike!

Coda: we’ll never really know what the best route is

One weird part of this discussion: we will never truly know what route was best.

If we do extreme lockdowns and manage to get out of this with, say, only 5000 dead in the USA, we’ll never really know how bad it could have gotten.

If we have 1 million deaths, we’ll never know for sure how much a stronger lockdown, or different response, might have produced.

We can’t run this experiment twice.

However, no matter what we do now, there will be future experiments. New viruses will develop and spread at some point in the future, as scientists and the CDC have warned us, and attempted to get us prepared for, over many years.

Hopefully this whole experience can be a wakeup call so that next time, we can be more prepared, and we will have a faster, more proactive response.

Until then, my mind always wants to go back to those levers: we can pull levers to help people with money, but we cannot pull levers to bring people back from the dead.