Posts published in April 2020

The medicine and statistics, and medical statistics, involved with working our way out of our Covid-19 social isolation I'll leave to the physicians, epidemiologists and statisticians. But there's a simpler, more basic element to our current shutdown debate that, in a time of political trench warfare, tends to go unremarked.

The nature of the problem turned up in the last week with a series of protests at statehouses and county courthouses around the country. The rules limiting travel, work, business and social activity and large groups of people have been imposed in most states - there remain a few holdouts - and are going on their second or third weeks, a little more in some places. One Ohio protester, who said she has no worry about contracting the illness, said the whole thing has been hyped (this at a time when cases in the United States topped 700,000 after barely a month of expansion), and the restriction "enrages something inside of you."

The emotional reaction is not hard to understand, and the request the protesters are making is clear enough: Eliminate the rules imposed by various governments - mainly state and local - since Covid emerged.

That is: Just do away with the restrictions so we can all go back to normal.

The desire is perfectly rational. But the people making the demand aren't thinking the situation through.

Suppose a given state immediately dropped its social distancing requirements at this moment. Would things go back to normal?

No.

To begin with, most people do accept the evidence of their eyes and ears and the testimony of the many thousands of people who have or have had Covid-19. They do know that it is a risk, that it is serious and can be fatal, and that it spreads easily when people are grouped together. As long as most of us understand this, and recognize that the illness still is spreading and can easily reach where they live, most of us won't be very eager to jump into crowd situations or mingle with people who mingle with lots of other people.

I hate seeing the businesses and other places I like to frequent in their closed or diminished mode. But even if no governmental orders were in place, I wouldn't be going there, or going there much, anyway. I want to minimize exposing myself to risk of serious illness. When I do, for example, visit a grocery store, I get in and out as fast as I can - no shopping around. Knowing what I know about the virus, I wouldn't have been frequenting restaurant dining rooms even if they were open. That's simple self-preservation. Most people tend to operate that way most of the time.

So most of these businesses that have shut down would have been losing much of their customer and employee base even without any governmental requirements.

Not all, to be sure; some would bull through, exposing people to higher risks. (I just read an article about a nursing home firm in Idaho accused of pressuring employees to work in high-risk environments.) But many businesses, probably a large majority, already were taking safety action before governments required them to. Some of this may have owed to genuine concern about customers, employees, vendors and others; some may have been uneasy about the prospects of lawsuits or other ugly blowback if (all-too-predictable) problems happened. Either way, most businesses would rather not jump on a land mine if they can avoid it, even if the immediate consequences are - as they are for so many - extremely costly. Operating normally under the current conditions would be as risky, and maybe more so, over the longer haul.

Thomas Friedman got at some of this toward the end of his fine New York Times column today: "if this is the future, every business, restaurant, hotel, theater, sporting facility, factory, nonprofit and government office needs to ask itself: What does my business look like when, on the best days, the responsible people coming to my door will be wearing a mask, gloves, distancing six feet apart and volunteering to have their temperature taken before they enter, and the irresponsible ones won’t be? How do I handle that? Whom do I serve? What kind of business will I really have?"

If a governor told all businesses and other organizations in that state, "You all can go back to normal now!" - the reality is that many, probably most, wouldn't, much as they would love to. Not until it's safer than it is now.

And if most customers and other people thought the orders were out of bounds, they wouldn't be very widely adhered to. But most people are following the rules; they do see the point.

Once people - most people, recognizing that some out there never will believe what makes them uncomfortable - perceive that conditions are relatively safe, then likely we will return to some kind of rough normality. The experts in this field caution that this could be a dangerous time, because if that perception runs too far ahead of the reality, the virus will have a terrific opening to strike again. If it does, we'll have another (unfortunate) opportunity to learn our lesson, all over again.

But at least until then, protesting state or local orders is futile and counterproductive.

People who have fully internalized the idea that governments are the source of all problems may see regulation as the core of the problem here. It isn't. The problem is the virus. The problem will be under control, and our normal lives will resume, when the virus is squashed, and not before.

Some weeks back, when the pandemic numbers were a lot smaller, I took a look at how the Covid-19 stats were developing in Oregon, Washington and Idaho. It looked a lot different then, not least because Idaho had hardly any cases. Now it has about as many as Oregon, and Oregon has a lot more than back then. So does Washington.

Based on the numbers at the Worldometer site, which seems to have some of the best and most regularly updated statistics around (not far off from the excellent Johns Hopkins site), here are some general thoughts.

Back then, Washington state was ending its reign as the state with the largest concentration of Covid-19 cases; a string of outbreaks in the Puget Sound area was making it the nation's leading hotspot. That's changed. It now ranks 13th among the states for number of cases reported, and the number of new cases and number of deaths have slowed dramatically. States like Florida and Georgia, which barely registered nationally then, have swept past the Evergreen State.

No doubt, Washington was helped a lot by early and aggressive state action aimed at blocking the expansion of the contagion. It seems to have worked. The total number of cases per million population there now stands at 1,467, which is well below the national rate of 1,845 - a remarkable turnaround. It also has one of the best rates of testing among the states. Washington should be considered one of the leading success stories in the anti-pandemic effort, at least so far.

California, the other west coast state where the illness caught on early and in a big way, also has made a lot of progress. After a brief turn as the national hotspot, it now ranks only 6th among the states for most cases - even though it's by far the most populous and got a head start in cases - and its cases per million people amount to just 642, one of the lowest rates in the country. It's a remarkable success story.

Oregon, situated between those states, has not done badly either. It never had the really big blooms as the places to the north and south, but it seems to have bent the curve a bit from fairly early on. At this writing, it has 1,633 cases, and has seen steady but not massive expansion. Its rate of cases per million people is 400, making it 6th-best in the nation.

Idaho reported its earliest cases well after Washington and Oregon did, so when I wrote about this a few weeks back there was hardly anything to discuss. since then the Gem State's raw numbers of Covid-19 cases roared upward to catch up with and at times surpass Oregon's; in the last week, the two states have moved upward closely in tandem. At the moment, Idaho reports 1,453 cases.

That's a little less than Oregon's total, but then Idaho has a far smaller population. Its per-million rate is 861, well below Washington but more than double the rate in Oregon. On a per-capita basis, it is growing Covid-19 cases faster than almost anywhere in the west, though the growth has slowed considerably since Governor Brad Little imposed statewide shelter-in-place orders.

In fact, in all three states (and in California and elsewhere too) orders of that kind seem to coincide with a flattening of the increase of cases.

The cases do seem to have popped up all over the place: A big majority of Northwest counties have at least one case. However, it's also true that the cases are heavily concentrated in a few areas. About three-fourths of Washington's cases have appeared in the Seattle-Everett-Tacoma metro areas, with large but much smaller numbers appearing around Spokane, Yakima, the Tri-Cities and Bellingham. In Oregon, almost three-fourths of the cases appear in the Portland metro area and near Salem, in four counties. In Idaho, about half of the reported cases are in the Boise area (Ada and Canyon Counties) and about two-thirds of the rest are in the Sun Valley-Ketchum area and in the communities from there to the nearest larger city, Twin Falls, to the south.

So far, then, the bulk of the cases have been concentrated in relatively few spots. That may be because other areas only caught their early cases after people began taking protective measures.

On the plus side, there are serious indications that the contagion is slowing down, in the western states at least. But that's probably only happening because of the steps, sometimes controversial steps, that have been taken so far.

The picture is much changed but resembles the contours of what we saw a month ago. Will it look the same a month from now?