Super Cities №277—The Cost of Beating COVID

Brendan Hart

Last year, I described three strategies cities are using to understand, manage, and deal with climate change. Researchers at Imperial College just released a report on the global pandemic that outlines similar strategies for beating COVID:

(a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely.

Mitigation – self-quarantines and social distancing for the most at-risk populations – is unrealistic and ineffective. It is unrealistic because it would likely result in "hundreds of thousands of deaths." It is ineffective because intensive care units would be overwhelmed "many times over." Mitigation would result in a lot of pain, but not solve the underlying problem.

That leaves suppression, a more radical intervention, as the proposed pathway for defeating the "most serious respiratory virus since the 1918 H1N1 influenza." This approach would include mandatory state-enforced quarantines, widespread school and business closures, and country-wide social distancing.

If that sounds extreme, here's the kicker: suppression would not be a short-term intervention.

It would not, as most people commonly assume, last days, weeks, or even months. Transmissions could quickly rebound, so until a COVID-19 vaccine is developed, tested, and made available to everyone, government would need to enforce the terms. Suppression, as outlined in this paper, describes nothing short of mandatory, state-enforced isolation that lasts 18 months or, more plausibly, much longer.

Lest you think this is some worst-case scenario plan, we are starting to see the medical community support smaller versions of suppression. Dr. Ashish Jha, director of Harvard's Global Health Institute, just called for a weeks-long "national quarantine."

Jha's plan has two objectives. First, it would slow transmission from person to person. Second, it would buy time for the US to fix its original sin of limited testing. Both goals aim to "flatten the curve."

While I'm in favor of erring on the side of doing more now, it's worth considering the social cost of such dramatic government action.

How will the US feel under government-enforced isolation? What would be the medium- and long-term implications for a society that was willing to accept government-enforced separation? What would be the unintended consequences?

No one knows, of course, but I'm sure people believe the Master of Horror, Stephen King, when he says that COVID-19 is "going to change America, long-term."

The question is ... how?

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