Hi all,

I thought that our session yesterday was quite good and loved the chat contributions in the first

part of the class. I have thought most though about this comment from Garrett:

00:28:15 Garrett Canterbury: “I think the issue that Trump and other officials, including state and local, are struggling with is that at what point is putting millions of people out of work worth saving X amount of lives. I think the goal should be to move to the South Korean model where there is loads of testing, the economy is mostly re-opened, and the sick and vulnerable are isolating while the healthy are back to work.”

This is to me a vital question. I heard people who should know better say on TV in the past day or two that to weigh the economic consequences of social distancing and lockdown against the lifesaving public health measures many are taking is irrelevant or unethical.

There are things that I think are unethical to debate. This is not one of them. Take a look at this short column a couple of days ago by Tom Friedman, a liberal and no supporter of Trump: https://www.nytimes.com/2020/03/22/opinion/coronavirus-economy.html (Links to an external site.)

What is happening to our economy now, what will happen soon, really really hurts people. It will kill people.

But Garrett is not suggesting we do nothing. He is suggesting the South Korea model, which means social distancing based on testing, with one eye on getting people back to work. Here’s what I have to say about the balance:

1. We must get the economy going again as soon as we safely can.

2. The projected one to two million American deaths without strong social distancing would also tank the economy and rip the hearts out of millions of families. The overwhelming of hospitals and deaths of health care workers would do the same.

3. We have missed the boat on testing at the right stage of the epidemic the way South Korea did, and we have missed the boat on timely mask and ventilator manufacturing BUT…

4. We are where we are and we have to look forward. We must social distance to flatten the curve or this will destroy our hospitals, killing nurses, doctors, and other first responders.

5. We have to hugely ramp up the things we haven’t done and still aren’t doing nearly well enough. The first is testing. We need tens of millions of tests, not tens of thousands, to follow the South Korean model as Garrett rightly suggests. We need two kinds of tests: one to find and isolate the currently infected, aggressively testing those they have been in contact with; and another one to identify those (now perhaps in the millions) who have had the virus and have successfully recovered. Those people are almost certainly no danger to anyone and can go back to work, socialize, and help others.

6. We need manufacturing that is on a war footing. In World War II we did not ask auto makers to please make tanks. We ordered them to make tanks—and planes and helmets and bullets and uniforms. And by the way that project put a lot of people to work and saved the economy, as well as winning the war.

7. We do not have medicine for COVID-19, but we have medicine for the economy, and it is being applied. The Federal Reserve bank has reduced interest rates to near-zero and is pumping unprecedented trillions into the economy. Even the dithering Congress has agreed to pass a two trillion dollar stimulus package and will do more. We know how to treat the economy when it is sick. Yesterday the Dow had its biggest increase since 1933, and another increase today. People will get paychecks in the mail that will be too small, but will help. Companies will get too much, but will be somewhat rewarded at least for not firing people and giving them paid sick leave.

McKenzie and others yesterday in saying we have the wrong kind of health care system to handle all this right. We also have the wrong kind of economy and a shameful lack of preparation. (See the previously assigned 2005 Scientific American article, “Preparing for the Next Pandemic.”  We didn’t.) But we are where we are. Go to this website to see what will happen to hospitals in your state under varying degrees of social distancing. Click on your state and see the date on which, with inadequate social distancing, your hospitals will be overwhelmed: https://covidactnow.org/ (Links to an external site.)

And please please learn the meaning of the word several of you supplied yesterday: exponential. We have more deaths from auto accidents right now, but they are not increasing exponentially. We have more deaths from seasonal flu, and this is a bad season, but they are not increasing exponentially. Our hospitals take care of patients in danger of dying from those two things every day, every year. They cannot take care of an exponentially increasing number of victims of COVID-19.

Take care of yourselves and protect yourself and others. Flatten the curve.

Dr. K

PS: If you’re curious to see how long I’ve been fighting for a better health care system, go here: https://www.melvinkonner.com/new-york-times-op-ed-page-columns/