My uncle was born in February of 1945. By the year’s end
millions of people would be dead from the battlefields, amphibious assaults,
saturation bombing campaigns, and genocides of the last six months of World War
2. America faired well by global standards, but catastrophic suffering happened
here, too. Tens of thousands went to their deaths in the Rhineland, on Iwo Jima
and Okinawa, and in the skies over Germany and Japan. In anticipation of an
upcoming invasion of Kyushu and Honshu, more than half a million Purple Hearts
were manufactured.
My grandfather spent most of the year training young men how
to fly the B-29, America’s primary tool of annihilation used against the
Japanese home islands. He knew at some point that year his name would be called,
and he’d be ordered to ship to Guam, Tinian, or Saipan to begin serving in combat.
Perhaps it was luck, perhaps providence, perhaps fate, perhaps the simple
unfolding of the initial conditions of the universe, but he was assigned to fly
west at the end of August. The work of the Manhattan Project rendered his
orders obsolete, and in the event he went home with his wife who’d just turned
20 and his infant son.
My grandparents knew what the state of the world was when
they married and when they conceived their first child. 1945 was a low point in
world affairs in the 20th Century, and possibly all of human
history. As my grandfather transitioned from AT-6s to B-17s to B-29s, it was no
sure thing that he would keep out of combat. Many other couples were similarly
optimistic and their children grew up without a father. It’s always seemed
remarkable to me that they took this chance on life anyway.
When my wife and I conceived our third child I didn’t think we
were making any similar sort of bet. Now here we are, with a new baby at the beginning
of the worst pandemic in a century. Our daughter Mira was born a week ago
yesterday, a week after schools closed in Seattle and two days before our daycare
shut down. Nominally the schools should be open again by the middle of next
month, and our daycare in another week. What are the prospects of that happening?
I encourage you to read the report on non-pharmaceutical
interventions and COVID-19 released last week by the Imperial College team that
modelled the pandemic. The results are based on computer simulations of how the
virus spreads through the population and affects those infected, anchored to
the best available data from China’s experience with the disease so far. They
are sobering.
The virus poses no spectacular risk to myself or my family. For
those over 30 and under 40, about one in 600 who catch the disease will need
treatment in an ICU. ICU beds are readily available at the time of this writing
even in Seattle. Younger cohorts fare even better. Older cohorts fare much
worse
Taking a look at the demographics
of the United States, the authors estimate that, even if everyone who needed
intensive care could get it, unmitigated spread of COVID-19 will kill more than
two million Americans by the end of July. That, in itself, would be an unacceptable
disaster. Given the limitations of reality, nearly everyone who would need an
ICU bed in that scenario would not get one. Doubling or tripling the estimated
death toll is not unreasonable. Unacceptable indeed.
If doing nothing is unacceptable, then what else can be done?
Perhaps we can do something by doing nothing. In much of Europe and the United
States the economy has been anesthetized. Children are not at school. Toddlers
are not at daycare. Adults are not sitting in restaurants, bars, and movie
theaters. In Detroit and Fremont the factories are going quiet. If this is maintained,
the lives will not be lost. It begs the questions, how long does the lockdown
need to be maintained, and how long can it be?
The authors estimate that by the end of the summer the smashed
curve of infections will be past. Lockdown measures can be relaxed. Then, with
the virus on the loose once again, COVID cases will flare up. Within a month
the measures must be put into effect or millions will die. This will continue,
an intermittent bang-bang cycle of a frozen, broken economy and short bursts of
normal life, until a vaccine is developed. Don’t count on that for another 18
months.
If you haven’t done so already, you should start trying to
get your head around what this means. Suppose the will is maintained and everyone
sacrifices whatever it takes to beat this virus. There will be no school or
childcare for over a year. A mark will be left on the generation now coming of
age for the rest of their lives. Without government intervention much more
massive than anything now being considered, a large portion of existing small
business will fail. Non-emergency medical care will disappear for 18 months.
How many people will commit suicide while left alone and unable to reach
counseling? How many couples will divorce? Millions, maybe tens of millions, of
people will either need to be “forgiven” by their employers for leaving to care
for their children or will lose their jobs. The best-case scenario is a
recession on the scale of that which followed the 2008 financial crisis. A more
conservative expectation is something more like the Great Depression. One hopes
that the riots, decline of democracy, and rise of fascism of that epoch might
not be repeated…
Does that all seem unacceptable? It is. It’s completely unacceptable.
It’s insane that we’re even talking about this, and is probably why so much of
the discussion is focused on what’s cancelled this week and not addressing what
the long-term scope of what this crisis is. Keep that thought in your mind, and
then return to the numeric value of the number of lives lost if these measures
aren’t put into place. All of human civilization has been thrust into a dilemma
between two unacceptable choices by a virus 90 nanometers in diameter.
Maybe we’ll get lucky. Maybe the reproductive rate of the
virus will drop enough to notice as spring turns to summer. Maybe drugs will
prove effective at mitigating symptoms and keeping the disease burden
manageable. Maybe a vaccine will come along sooner than the experts expect. All
of those scenarios are possible and would be great, but there’s no indication
in the facts at hand that any will come to pass. A mentor of mine once said “Hope
is not a plan.” I recommend plans as well as hope.
In many ways my family and I are in a much better position
to weather this storm than many of my peers. My wife will spend less time on
maternity leave than is guaranteed by the state in nearly all wealthy
countries. It’s still a much longer period of leave than most mothers receive
here. Her mother is here, and with her to watch the children I can continue to
work from home. The burden of now (having to continue to make progress at work
to keep in good standing with my career, and having no help at all from daycare
we are still paying for), and imagining a future that goes on like this,
still seems intolerably great. It reminds me of our time in residency, and that
thought makes me want to go to the toilet and vomit until there’s nothing left inside
me. We are skilled, we are strong, we are educated, and we are stubborn. We’ve
done everything “right” to be in a good position in life and have families to
support us. There is still some point where it’s too much, and we’re going to
break. Many, many families will encounter this point before us. We can’t let
millions die, and we also can’t destroy millions of families with economic
warfare against a coronavirus. Unless one of the “wouldn’t it be nice” options
of the last paragraph comes along, I don’t know what will happen
If this has snuck up on you like it snuck up on me, it’s
worth acknowledging the scale of what we’re all facing. This is the greatest
crisis the world has faced since World War 2. We will need to be clever, resourceful,
and probably a bit lucky to get through this intact. The intent of this essay
is more to organize my own thoughts than to prognosticate doom. I think I’m
actually optimistic by nature, I’m just really tired. And this is scary. It’s
okay to say that.
Thinking about how much America, health care, and civilization
in general has advanced since the H1N1 pandemic of 1918-1919, I keep thinking about
the scene in Titanic just after the ship strikes the iceberg. Bruce
Ismay, the director of White Star line, listens in disbelief as the crew
informs him that, not only will Titanic not be under way soon, she will
sink, and will sink within the next couple of hours. Ismay is intimately
familiar with the safety and damage control features of the Olympic-class
ships.
“This ship can’t sink!” He scoffs.
“She’s made of iron,” Thomas Andrews, Titanic’s
designer replies. “I assure you, she can.”
