Friday, April 17, 2020

COVID-19 and the US Reopening

Yesterday, I gave my off-the-cuff quick reaction to the presidential reopening plan.  My primary problem was the criteria to move to the first or next phase.  My second problem is anticipated issues with a pseudo-random (I exaggerate) regional reopening.

Before I get into the problems with the plan, I want to present a few ideas to think about.

  1. The original goal was to flatten the curve.  This was to slow the spread of the virus so that hospitals were not overrun and people would not die for lack of care or ICU beds or ventilators.  The goal was not to reduce the number of cases or to eliminate the virus.  I think the 'flattening' goal has gone by the wayside, and Governors are trying to eliminate the virus.
  2. How about a simple reopening plan like everyone without serious illnesses under the age of 45 go back to work now (except for hot spots).  Compare the risks of that simple plan to one were we have a patchwork of regional or state plans as in the President's proposal.
  3. I've seen reports that the chemicals needed to do testing are about to run out due to the worldwide run on the items.  If that's true, we'll have to scale back testing instead of expanding it.


Let's look more closely at the gating criteria.  There's one for symptoms, one for cases, and one for hospitals.

  • SYMPTOMS:  "Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period AND Downward trajectory of covid-like syndromic cases reported within a 14-day period."
  • CASES:  "Downward trajectory of documented cases within a 14-day period OR Downward trajectory of positives tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)."
  • HOSPITALS:  "Treat all patients without crisis care AND Robust testing program in place for at-risk healthcare workers, including emerging antibody testing."
According to the President's plan, you need to meet all three criteria before entering Phase 1, Phase 2, and Phase 3.

I'm not too worried about the HOSPITALS gate criteria.  Protecting hospital workers should be doable.  I'm not sure what they mean by "without crisis care."  Is this not a crisis?  Are not all COVID-19 patients being treated under the states' crisis plans?  Maybe they mean without withholding care to those least likely to survive because care has to be rationed?  That seems most likely to me.  But the wording is just horribly ambiguous.

The SYMPTOMS and CASES criteria are also poorly worded.  What is a "Downward trajectory ... within a 14-day period?"  In physics/ballistics, a downward trajectory means the item drops continuously throughout the path.  So the most common usage would mean a continuous drop in [cases] over a 14-day period.  I would assume you could throw out a couple of days where you had increases.  But that is a truly idiotic criteria--until you get near saturation, it's very difficult for a spreading virus to produce ever smaller numbers of cases and symptoms. Either they are using another interpretation, or they are idiots that don't want the economy to reopen.

Let's take SYMPTOMS.  This is essentially the reported number of cases with flu-like symptoms AND the reported number of cases with COVID-19 symptoms.  If testing keeps rising and more people interact, you almost cannot, under any circumstances, meet this gate criteria until herd immunity is reached.  Though, it might happen if summer causes the virus to recede.  That's why I think they don't mean a downward trajectory for 14 days.  Maybe they mean at the end of any 14-day window, the end number is less than the starting number.  But that too is ridiculous, since it looks only at instantaneous values that may not represent a trend.

The CASES gate criteria is a little better.  You still have problems with the "downward trajectory" terminology, but this time it's an OR situation; i.e. either of two situations is enough to meet the criteria.  The first criteria is just a downward trajectory of documented cases.  I expect that means cases where the patient has tested positive for COVID-19.  But again, if testing increases as the virus spreads, this one is hard to meet.

The second criteria is a downward trajectory of positive tests as a percent of total tests, but they add a parenthetical of flat or increasing volume of tests.  The parenthetical suggests that if the number of tests executed drops, you cannot meet this criteria.    Except for the parenthetical, I kind of like this criteria.  Testing and cases can still increase (what you might expect), but if the percent of tests that are positive drops, you can still go into the next phase.

My take away is that the SYMPTOMS criteria is tough to meet.  The CASES criteria might be a little easier.  The HOSPITALS criteria should be fine anywhere except a small county hospital.  But the terminology, if taken literally, would make the criteria almost impossible to meet.

Also, there is no criteria that requires a state, region, or locality to fall back to a previous phase.  Yet that would seem pretty likely if hot spots break out.

I would assess a grade of D- for the gating criteria.  The ridiculously ambiguous terminology means every decision maker will read them however they want.  If they try to use them rigidly, they won't be able to open their economies.


Let's start by thinking about an option that the President did not present.  Opening the entire country using a consistent set of criteria.  An example would be Scott Adam's "everyone under 45 without serious illness could go back to work now."  You would have problems with senior managers not being available--giving companies a lot of second thoughts.  And he didn't describe how/when the others would go back to work.  But his 'all under 45' plan has the benefit of all businesses potentially restarting at once except for those in hot spot break out areas.  Manufacturers, wholesalers, distributors, retailers, service industries and consumers all start back together.  There are no major supply chain issues except for an initial delay.  Products and services start flowing and most consumers start buying.

Now we go to the President's plan.  Let's make some assumptions that may or may not be true.  Either way, they will be representative of what could happen.  Let's say the northeast states maintain their lock downs for another month and a half, maybe through mid summer.  They've been hit the hardest and are afraid to open up.  The west coast does a partial opening.  They want to be safe, and they are used to telling their citizens what they can and cannot do with endless freedom-crimping laws.  They keep closed what they call non-essential businesses.  Florida has so many elderly residents that they keep some kind of lock down.  The rest of the country goes lighter, and opens more, but it's hit and miss.  Big cities stay locked down.  Blue states tend to retain tighter restrictions.

Now let's go into businesses in some of those states.  Assume you are a retail shop that is reopening, and you get your key items from a manufacturer in the northeast.  That manufacturer is closed because his state either retains a lock down or considers those products non-essential.  The retail shop has no product to sell until the manufacturer reopens or they can find an alternate supplier.

Let's look at a bigger business.  Say one that produces military aircraft.  The big business is an integrator.  They sourced parts from around the country so that every senator and many congress persons would all have something to lose if they cancel the aircraft program.  But their suppliers in the northeast and on the west coast cannot deliver.  The big business cannot keep their production line open.

Now turn to the leisure travel industry -- people on vacation.  I'll only look at in-country travel for this issue.  You cannot go to Disney World or Disney Land or any of the theme parks near them.  I didn't make an assumption about national parks, but let's assume they open or close depending on their state and it's phases.  So some parks will be open.  But most people are going to drive to get to them.  What happens if they are starting from a locked down state or need to go through one?  It's probably safe if you stay on the interstates (for tickets), but try and get a hotel room in a locked down state (ha).  Most of the popular beaches will also be closed.  Will Las Vegas open?  It's in a blue state near California.  Vegas has lots of crowds.  I doubt it.  Camping at your local state park seems the most likely option.  If your state doesn't think that hookups and picnic tables present too big of a risk of spreading the virus (Texas thought so).

My conclusions are that this plan has the potential for chaos where supply chains are broken and the public is very limited in how they can use their vacation time.

If I were a governor, I might use the Phases approach to specify what people and businesses should do.  But I would make my own gate criteria.  Most people won't have access to the data to tell whether the gate criteria are being met anyway.  And the President didn't try to make his plan mandatory for anybody.

It looks some regional groupings of governors are going to try and do a coordinated reopening (or continued lock down).   My guess is it's going to be a chaotic free-for-all that makes no one happy. 

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