New maps: We are re-opening the economy too soon
Our dangerous plans will lead to health risks and extended lockdowns
Happy Thursday everyone,
I’ve spent the last few weeks looking at the maps we’re building to re-open our economy.
I’m dismayed. These maps are reckless and will put us farther from our goal of a safe re-opening.
We have all the information at our fingertips to build a better map, but why aren’t we?
This is a longer read, but it’s a critical one – because everyone’s health depends on it.
-Kapil
The maps we’re using to re-open our economies are dangerously wrong. They will lead to recurring cycles of outbreaks, unnecessary deaths, and put us even further from our goal of re-opening the economy.
We’ve always used maps to guide our journeys – from the physical maps of exploration, to the mental maps of our own lives.
Maps simplify what we encounter and help us make sense of a complex world.
But it’s critical that these collective maps are built well – because otherwise they can take us to dangerous places. As the events of COVID-19 have revealed, the maps we’ve used to guide our journey over the last decade have led to a health care system that’s dangerously under-capacity, an economically fragile middle class, and a pandemic response that didn’t incorporate all the learnings from our experience with SARS in 2003.
As we speak, a new map is being built – and in some places put into action. It’s the map to re-open our economy. And it is dangerously flawed.
Let’s take a deeper look at the building blocks of this map, the dangerous destination it is leading us to, and how we might build a better one
To prevent the spread of COVID-19, we’ve had to shut down a huge part of our economy and isolate ourselves from each other.
As our lockdown starts to show results, it’s only natural to turn our thoughts to the eventual re-opening of our economy.
There have been enormous economic impacts. 3-million Canadians (out of a population of 37m) are unemployed. The shutdown has disproportionately affected our service economy – places such as restaurants and retail stores. The shutdown has disproportionately affected women. The shutdown has also disproportionately affected those earning less than $16/hr. The word ‘devastating’ is not an exaggeration.
The shutdown has also deeply affected our mental health. Humans didn’t evolve to shelter-in-place for weeks on end.
But our decisive actions have worked. The chart below shows new COVID-19 cases in Canada, by day.
You’ll notice that this isn’t an exponential curve, as we saw from Mar 22 to Apr 26. The curve has flattened. It might even be declining.
And thank goodness. Just look at the disaster that unfolded in Italy and New York City to see what could have happened if we hadn’t taken enough action.
After 8 weeks of lockdown and now seeing results, it’s natural to turn our thoughts to the re-opening of our economy.
Except that’s not how infectious diseases work. They don’t care about the economy, or our psyches. They don’t care that we’re bored at home.
They either reproduce, or they don’t.
Our map to re-open the economy is overlooking this one simple fact.
There is so much news about COVID-19 out there that sometimes it’s easy to forget that the scope of the crisis boils down to a simple question: is COVID-19 able to reproduce and spread?
To answer this question, we have to ask three more:
What is the reproductive rate of the virus?
How many cases are currently out there?
Do we have effective testing and contact tracing in order understand #1 and #2 in real time?
When it comes to building a map to re-open the economy, the answers to these three questions form our compass.
The reproductive rate.
The ability of COVID-19 to spread hinges on one single number: the reproductive rate, or R0.
An R0 of X means that every infected individual infects – on average – X others.
There are only 2 states that matter. With an R0 greater than 1, the virus is spreading. With an R0 less than 1, the virus is dying out.
An R0 that is greater than 1 means that every infected individual infects more than one other. This leads to the kind of exponential curve we’ve seen in cities like New York. The higher the R0, the steeper the exponential curve.
For example, at an R0 of 2, if 10 people are infected, they will infect 20, who in turn will infect 40, then 80, and so on.
An R0 of less than 1 means that every infected individual infects less than one other. This will lead to the virus disappearing.
For example, at an R0 of 0.5, if 10 people are infected, they will infect 5, who in turn will infect 2.5, then 1.25, and so on.
If R0 is greater than 1, eventually everyone gets sick.
If R0 is less than 1, eventually the virus dies out.
COVID-19’s reproductive rate is estimated to be between 2.0-2.5
By shutting down our economy, we’ve reduced COVID-19’s reproductive rate to below 1. That’s why the curve has flattened. Everyone is socially isolated and infected people can’t spread the virus - COVID-19 is slowly dying out.
But what happens when you relax social distancing measures? The reproductive rate shoots back up, from below 1, all the way to 2.0-2.5.
Any infected people infect more and more people, which brings us to our next question.
How many cases are out there?
Remember this chart?
It shows that we’ve flattened the curve. But we haven’t succeeded just yet.
This chart measures ‘daily new cases’. Meaning that every day, there are approximately 1,200 new cases across Canada. This adds to the 32,000 active cases that have not yet recovered.
The number of COVID-19 cases in Canada (and the vast majority of all other countries) is still growing – not shrinking.
We say we’ve flattened the curve, because the ‘daily growth’ appears to have declined from a high of 1,600 new cases a day.
That means the lockdown is working. COVID-19’s reproductive rate is below 1, and the virus is slowly dying out.
But it’s not gone.
Under lockdown, those 1,200 new cases that occurred today will go on to infect fewer and fewer people – because COVID-19’s reproductive rate is below zero.
But if you lift the lockdown – and COVID-19’s reproductive rate shoots back up above 1 – those 1,200 new cases will infect more and more people.
And here’s the catch: COVID-19 has a long asymptomatic period. You can be infected and transmitting the virus for 5-14 days before you show any symptoms. Which brings us to our next question:
Can we test and contact trace effectively?
Rapid and widespread testing paired with effective contact tracing is critical. It allows us to keep COVID-19’s reproductive rate down once our economy re-opens.
You can be infected, not aware of this, and infecting other people for up to 14 days. That means every single person you’ve been in close contact with could have been infected. All of those people will need tests (and to be isolated). But to figure out who those people are, an army of contact tracers needs to interview you and then track them down. And that all needs to happen as quickly as possible. We’re talking hours, not days.
If those things don’t happen effectively, then all of those contacts who were infected by you will start infecting other people. This is what causes exponential growth.
So, how good are we at testing and contact tracing?
We’ve gotten a lot better in the last two months, but we’re nowhere near the level we need to be. Take South Korea for example. This first person account demonstrates the remarkable level of infrastructure they have in place. South Korea has implemented a system to rapidly identify and completely isolate new cases using a combination of huge testing capacity, location-based technology, and human contact tracers.
Our Chief Public Health Officer has stated that we need to triple our testing capacity before we can safely re-open our economy.
But testing capacity is just one variable. Can we turn around tests quickly enough? Do we have the contact tracing capacity to rapidly identify and isolate suspected carriers?
That these questions have to be asked should be proof enough that we don’t have the infrastructure ready just yet.
So how is our compass faring?
COVID-19’s reproductive rate is being held below zero by our lock down. Check.
We’re still reporting 1,200 new cases a day, with 32,000 active cases in the country. Good progress, but not there yet.
We don’t yet have the testing and contact tracing infrastructure to enable rapid identification of new cases and isolate at-risk individuals. Good progress, but not there yet.
The compass isn’t pointing in the right direction, just yet.
Yet, we’re building maps to re-open our economy – and in Manitoba, Saskatchewan, and Quebec, already putting them into action.
Based on our compass, we know what will happen.
As the economy re-opens, COVID-19’s reproductive rate will increase to above 1.0.
Because there are still active COVID-19 cases in these regions, infected persons will infect more people.
Because our testing and contact tracing infrastructure isn’t strong enough, those transmissions will go undetected for a long time. Chains of infection will occur.
And we go right back to the exponential path that will result in everyone getting sick.
So we will have to lock things down again.
And our plan to re-open the economy will have led to another lockdown and extended economic hardship.
That’s the map we’re building.
Scientists at Columbia University have conducted analysis that estimates just a 10% increase in the number of people we see on a daily basis will lead to a doubling of new cases.
We won’t notice it at first. Remember that the incubation period for COVID-19 is long: 5-14 days.
At first, it will feel like everything is ok, because the virus will be spreading silently.
And then a few cases will start appearing. Just a few more than normal at first, then a few more, then a few more, and then all of sudden we’ll realize an outbreak is occurring.
Does that sound familiar? That’s exactly what happened when COVID-19 first made landfall in Canada.
Why are we building this map?
Our leaders think that we can re-start our economy while keeping the reproductive rate, R0, below 1.
It’s a great theory. If we can keep R0 below 1 the virus will die out while the economy restarts.
Here’s how that thinking works: if COVID-19’s natural R0 is 2.0-2.5, maybe there’s a bunch of things we can do to keep R0 below 1.0. Let’s say wearing masks will chip off 0.2, only congregating in groups of 5 will chip of another 0.3… and eventually we get to less than 1.0.
But it’s just that: a theory. There is no science backing it up, because this is all so new.
Ask yourself this: what’s the expected R0 impact of permitting gatherings of up to 10 people? Of allowing coffee-shops to fully open? Of letting restaurants open with half-capacity? Your guess is as good as mine.
This isn’t a plan so much as it is an experiment, with all of us as guinea pigs.
Don’t forget our experience with SARS - the first novel coronavirus - in 2003. We declared victory too early and relaxed our precautionary measures. But SARS was still present in one of our hospitals. With precautionary measures relaxed, it jumped back to its natural reproductive rate and caused a second outbreak. That second outbreak was responsible for 40% of SARS deaths in Canada.
This second outbreak now seems to be occurring in countries that have opened too soon. A surge of cases was reported in Germany only a few days after lockdown restrictions ended.
There’s another dangerous reason why some leaders want to re-open our economy.
They don’t think COVID-19 can be eliminated and want us to achieve herd immunity.
That means we let the virus spread until enough of us have antibodies so that it can’t spread any longer. Herd immunity requires around 60% of the population to get infected. At a 0.5-1.0% mortality rate, that’s up to 200,000 deaths in Canada.
And let’s not forget about the emerging evidence of scary long-term health effects of people who survive – such as lung scarring.
We don’t even know if people who get COVID-19 have immunity, or how long it lasts – because this is all so new.
A report from a consortium of Australia’s leading universities rejected herd immunity due to the enormous cost of lives it would entail.
Let’s remember the most important lesson from SARS: the precautionary principle. In the absence of science, it’s better to take all the precautions we need. For example, don’t wait for the science: just wear a mask. Or, don’t make assumptions about herd immunity: choose a different course.
Two months into this pandemic, how have we already lost our way?
This is a story about all of us, and the maps we use to guide our collective journey. Maps that have led to this very moment: a dangerous set of plans to re-open global economies, which will lead to recurring cycles of infection, unnecessary deaths and extended economic hardship.
Our maps are built from a set of values. But often, we’re not presented with a clear view of the values at play before we embark on our journey.
For example, over the last decade, did we really want to build a dangerously under-funded health system? It’s not like anyone presented us with a map that laid out this destination, and we all said ‘yes’.
Instead, it happened bit by bit, with the foundational values of this map obscured.
That’s what’s happening here.
We’ve somehow sleepwalked into an odd set of values: our economy matters more than our lives. Let’s re-open the economy: we’re ok with the health consequences.
Are these really our values?
The economic effects of COVID-19 have been devastating. But what’s more devastating: lost income, or losing your life?
I know that we can build a better map to re-open our economy.
It starts with a simple foundational value: our lives matter more than our economy. There are some things that we should never sacrifice. We should not let people die unnecessarily in order to start generating personal and corporate income again.
The next step is understanding the purpose of the map. Scientists around the world are racing to develop a vaccine. They estimate they are 12-24 months away. We need a map to last us through this period. One that ensures as few people are infected as possible and allows us to re-start our economy responsibly.
From there, a map can be built. We will need to stay locked down, with COVID-19’s reproductive rate kept well under 1.0 until the virus dies out. It can be done. Australia is now reporting fewer than 25 new cases a day. We just have to stay the course.
The government will need to do more to ensure that we can all stay in our homes and afford life’s necessities. These measures will be extraordinary – but we are already living through extraordinary times.
This map already exists. Australia’s Group of Eight Universities has laid out exactly how this would work. Lock down until new cases fall to zero. Build extensive testing and contact tracing infrastructure. Maintain strict international border control measures.
And this elimination strategy would combat the biggest risk of our economy restarting: our individual sense of safety. Would you want to go to a restaurant when there’s a virus circulating, and you don’t know exactly who has it? Or would you first want to know that your country hadn’t reported any new cases in several weeks?
What’s better for the economy: a fast re-open, followed by cycles of outbreak and lockdown – or a longer lock-down, followed by a smooth re-opening?
Let’s go slow now to go faster later.
Should you live in a region that is already opening up its economy: stay home. Let others choose to be the guinea pigs in this scary experiment.
Pay attention what the heads of our public health agencies are saying. Depending on where you live, they may not be able to speak openly - as they have to work within the confines of government policy. But we are fortunate in Canada to have experts who will offer candid opinions.
It’s really tough out there right now. We’re cut off from each other, and so many of the things that we love about our lives. So many of us are rightly worried about our finances. We want our old lives back.
In our hope to put COVID-19 behind us as quickly as possible, let us not reach in haste for a map that is based on the wrong values – one that puts our economy ahead of our lives.
Let’s instead reach for a map that reflects a better set of collective values – one that puts our health above all else.