...some experts are beginning to ask: “Wait a minute! What the hell are we doing to ourselves? To our economy? To our next generation? Is this cure — even for a short while — worse than the disease?’’
Thomas Friedman, March 23 2020, NYT
To be clear, I am not an epidemiologist, and, no, I never received a Pulitzer, but that never stopped me from criticizing those who are and have. Frankly, Tom Friedman is a fine columnist and his writing on foreign affairs, his specialty, has earned three Pulitzers. His recent column, in my opinion, “A Plan to Get America Back to Work,” may well discredit his legacy as he weighs in on a topic well out of his depth. This is apparent, as Friedman relies heavily on the opinion of Dr. David Katz, a noted public health expert. Katz had written a column two days earlier asking “Is Our Fight Against Coronavirus Worse Than the Disease?”
Clearly, these two op-eds helped form the basis of President Trump’s recent turnabout regarding the nation’s covid-19 policy. In a period of days, the president reversed his plans, against the recommendations of his medical experts and proclaimed that the nation would be going back to work after the Easter holiday. That change in plans followed the publication of the Katz and Friedman op-eds.
The point of the opinion articles is a simple one, the coronavirus is controllable—or at least our reaction to it should be. The virus is undeniably a medical disaster that has many collateral impacts on both health and economies. The Katz article which informed the Friedman piece was published on March 20 and centers on the concept of “herd immunity”— a belief that by allowing the virus to spread among less vulnerable populations could actually innoculate the nation from a prolonged course of disease lasting months. This theory was one adopted by Boris Johnson, the UK’s PM, who, days after suggesting, it was forced to abandon the plan 4 days later as Britain’s death and infection rates skyrocketed. Just as real epidemiologists had predicted, the virus was too far along to halt its spread by allowing “healthy hosts” to become infected and rebound in the one to two-week incubation and infection period. The theory suggests that the formerly infected would then be able to return to work and everyday life. Thus, the plan would allay our impatience with sheltering in place and social distancing. Once infected, the theory goes, there would be a natural immunity to the disease. Both Katz and Friedman suggest that the portion of the population who would be most vulnerable—the old and those with prior medical conditions— would be asked to stay at home and segregate themselves from the general healthy population.
As Katz published his piece, the number of infections and deaths in America stood at about 8000 confirmed cases and less than 200 deaths. Today that number exceeds 50,000 cases with over 700 deaths—163 on March 24 alone. That rate is now doubling every three days, according to WHO projections. The nature of the deaths disproved the hypothesis adopted by Katz and borrowed by Friedman in that the largest number of new infections were among the younger demographic. More importantly, the incubation period among all infected persons exceeded 4-5 days and some of the carriers were asymptomatic while still being able to pass on the virus to others. It doesn’t take a Pulitzer or a degree from a prestigious med school to figure out that “herd immunity” is an illusion and that following this prescription endangers all citizens. As Boris Johnson has discovered, it creates a situation in which both the least and most vulnerable are almost assured of infection and potential death.
In his article, Katz argues that the current protocols (sheltering in place and increased testing) is counterproductive:
“As we lay off workers, and colleges close their dorms and send all their students home, young people of indeterminate infectious status are being sent home to huddle with their families nationwide. And because we lack widespread testing, they may be carrying the virus and transmitting it to their 50-something parents, and 70- or 80-something grandparents.’’
What Katz neglects to note is that our lack of testing is precisely one of the chief factors contributing to a growing number of folks with “indeterminate infections.” Testing is also the best way to collect accurate data, which most experts, other than the two NYTimes columnists, believe are currently under-reported. Friedman jumps in at this point and makes obvious the point of Katz’s analysis and the purpose his hypothesis serves-- Friedman quotes Dr. Steven Woolfe:
“Income is one of the stronger predictors of health outcomes — and of how long we live. Lost wages and job layoffs are leaving many workers without health insurance and forcing many families to forego health care and medications to pay for food, housing, and other basic needs. People of color and the poor, who have suffered for generations with higher death rates, will be hurt the most and probably helped the least. ...”
Friedman has put his finger on his own argument for abandoning the current medical protocols that have worked in flattening the curve in other countries. It is the economy, stupid. Friedman, now 4 days of data behind the curve stipulates that his counter-intuitive suggestion, one that Trump now advocates against his own medical experts’ advice, should be tried here in order to preserve the nation’s economic health in detriment to the health of its citizens. His column is based upon a conjecture by a Stanford epidemiologist who was basing his own conclusions on data he openly admits was incomplete and unknown:
Dr. John P.A. Ioannidis, an epidemiologist and co-director of Stanford’s Meta-Research Innovation Center, pointed out in a March 17 essay on statnews.com, that we still do not have a firm grasp of the population-wide fatality rate of coronavirus.
Ioannides’ opinion was based upon data on March 17 that identified 4500 cases in the U.S. without testing. One week later, the number of cases with minimal testing has risen to more than 54,000 cases! In the same period, the death rate has risen from less than 150 to over 700. Projections based upon dates of onset and tracking data suggest that we are in the early stages of the outbreak. Comparisons with countries like China and South Korea are skewed since, again, our national rates reportedly are depressed due to the lack of adequate testing in the U.S. In fact, the U.S. is now tracking above the horrific numbers posted by Italy and Spain.
As much as Friedman tries to make this about hard data and common sense, it is really about dollars and cents. The virus spreads through human contact. It trades on irresponsible behavior which places untested hosts in close proximity to nonaffected individuals. Following Katz’s and Friedman’s plans to save the economy, the more urgent question may be “for whom?” A more proper response to the NYT opinion writers would be to follow the data and compare the results of other nations that have gone through an outbreak. Comparing the national mobilization-- the testing protocols, the preparedness, and the resolve of the political leaders to focus on the disease— of those who have successfully blunted the impact of the virus on their populations with the haphazard and willfully incompetent management of the Trump administration would inform Messers. Katz and Friedman that their analyses are flawed and endangering. At this moment an incurious despot has been advised of their writings and has used them to make pronouncements that may drive the outbreak in the United States into the lead among nations for the greatest numbers of infections and deaths.
Safe behind their keyboard, in their absurdly abstract and myopic academic environment, the two columnists have conspired to make America more dangerous. With conclusions based upon days-old data, and without caveats warning their opinions are really unproven conjecture, they have given absolution to the least fit president to adopt a policy that is designed to save markets and profit at the cost of the lives of innocent Americans. Friedman’s column is a soulless read that may demonstrate the limitations of capitalism to govern in times of crisis.
Friedman ends his column with a warning. He posits a choice between his and Katz’s solution and the costs of preserving the lives of their countrymen:
Either we let many of us get the coronavirus, recover and get back to work — while doing our utmost to protect those most vulnerable to being killed by it. Or, we shut down for months to try to save everyone everywhere from this virus — no matter their risk profile — and kill many people by other means, kill our economy and maybe kill our future.
(emphasis my own)
Letting many get the virus is a choice that brings back memories of another time when despots of another era made choices about who should be fit to live and prosper. We need no advice from pseudo economists who wax poetic about the virtues of work and regular order in times of grave threat to human life-- who measure the worth of one of us against that of Wall Street.