There are, of course, many items that could be placed in a risk register for our ongoing management of COVID-19. I find myself drawn to those categorizable as, or perhaps triggered by, human perception and behavior. By way of limiting the scope of this post to reasonable attention spans, here are my current top 3:
1. Underappreciation of Complex Payoffs
I intend “complex payoffs” in the Talebian sense, alluded to in item #6 of In Medias Res (posted all of two weeks ago, a/k/a the Bronze Age). The US encompasses such an immense variety of physical and socioeconomic environments that aggregate statistics about it are almost always misleading. State-level numbers are often no better. I’m seeing a chasm in perception between acquaintances who are either high-risk personally or live in a high-risk environment and those who are, or do, not. Thus the vehement insistence that the pandemic is killing vast numbers and is on the verge of disabling this or that crucial element of society—hospitals and the grocery supply chain are popular candidates—and the equally vehement insistence that this is no worse than a regular flu season and the response has been wildly disproportionate and is causing another Great Depression—often followed by accusations of political opportunism, escalating to full-blown conspiracy theories.
Geography matters. Population densities of the order 10,000 km⁻² and mass-transit ridership of several million on the average weekday (New York City) represent a completely different set of conditions from the well under 1,000 km⁻² and a few tens of thousands of mass transit riders per day where I live. And in turn, my environment differs just as greatly from that of rural counties in my state, which are ~10 km⁻² and have zero mass transit. The EDR (excess death rate) in NYC is stratospheric. In most rural areas it is nil.
Comorbidities are a huge variable, sometimes in conjunction with geography. Old age, interaction with blood pressure medications, diabetes, obesity, and a history of frequent infections all drive the likelihood of developing a serious case of the disease up by several hundred percent. Most of these conditions are far more prevalent in urban African-American neighborhoods than in more affluent (and less dense) suburban and exurban communities. Disease rates in both Kansas Cities reflect this, and it is probably the single greatest factor in the high EDR of New Orleans.
When the disease does strike in a rural county, though, it can quickly lead to the de facto elimination of medical care for the local populace. A single case in Henry County, MO resulted in emergency services being diverted from Golden Valley Memorial Hospital in Clinton (population 9,000) and the hospital being advised not to admit new patients.
Historical perspective can help. The EDR in Kansas City from what I like to call the Kansas Flu was 580 per 100,000. A proportionate calamity today would kill over 12,000 across the entire MSA. Taking the latest available—and, as of just yesterday, dramatically reduced—projections from healthdata.org, combining the statewide numbers for Missouri and Kansas, and dividing by 4 to get the share of deaths occurring in the KC metro, I get ~140, which is nearly 99% lower. Reiterating that all disasters are local … our local death rate is thereby projected (by me) to be ~70 per million. This is many times lower than that of NYC or New Orleans and only about a third of the national average, which is still projected to be ~200 per million.
Couple of caveats, though—one minor and one major. The minor one is that excess deaths in KC during the heat wave of 1980 were ~150 per million, and that was bad enough that no one who lived through it will ever forget. The major one is that all these numbers are for the first wave of the disease.
Strategy to address this risk: find someone whose perceptions contrast highly with yours and exercise Habit 5.
2. Reactivation of NPI
“Non-pharmaceutical interventions” is the catchall term for the variety of impositions we’ve endured over the past month or more: borderline-OCD levels of personal hygiene, somehow training yourself not to touch your face, wearing a mask whenever near other people, maintaining 2-meter separation from nearly everyone, avoiding essentially all group gatherings indoors, minimizing even local travel, and not to overlook the obvious, suspension of employment for many millions of people.
All this may have been the practice round.
Way back on Wednesday 25 March, the National Academy of Medicine and the American Public Health Association presented a webcast, a transcript and PDFs of slides from which you may find at COVID19Conversations.org under “The Science of Social Distancing, Part 1.” Presentations by Marc Lipsitch of Harvard and Howard Markel of the University of Michigan covered historical experience (Kansas Flu, referenced above) and attempts at modeling the likely rate of occurrence of COVID-19.
Briefly, further waves are a distinct possibility, with attendant applications of NPI to keep the numbers of serious cases below the capacity of our health-care system. The obvious, historically-based scenario is a double-peaked EDR, with the second peak during regular flu season, that is, starting in about another 6 months. But it may happen sooner—seasonality of the virus is still unknown. We could end up in lockdown every third month through at least early spring 2021. The presenters used the term “cycled distancing,” but I think “pumping the brakes” (which analogy I did not originate) is a more intuitive phrasing.
The problem, which to their credit they did mention, is—how to obtain cooperation? Because, make no mistake, these measures are voluntary, at least at the individual level. Keeping large gatherings from occurring in public buildings is one thing, but anything like strict enforcement of a stay-at-home order is mathematically impossible. The areal density of on-duty police in KC is such that at any given moment, any given pair of cop cars is separated by a good mile of street, minimum. No more than a handful of checkpoints could be sustained in the entire city before drawing manpower down to a dangerously low level. And the Missouri Army National Guard adds only another few hundred personnel to this, evenly distributed on a per capita basis, to cover hundreds of square miles; so much for “martial law.” It’s toothless.
This is why I don’t see the point of the protests being mounted against the various orders in effect, because “stay-at-home” is just going to dissolve over the next couple of weeks anyway. If you want to indulge in some IF/F signaling and go to one, fine, but private gatherings are going to start happening in any case—if they ever really stopped—and plenty of “non-essential” businesses will simply reopen. The moderately interesting question is whether the dissolution of the orders will be accompanied by violence.
Referring back to the “chasm of perceptions” in the first section: suppose you’re in the high-risk category and observe a near neighbor to be hosting a large gathering. You (entirely understandably) feel threatened; you call the police; and, as per the previous paragraph, nothing happens. Now what?
Well, if you feel strongly enough, you confront your neighbor, possibly with one or two other adjacent high-risk neighbors, suitably socially distanced but visibly obvious … because you’ve recalled Al Capone’s dictum that you can get much further with a kind word and a gun than with a kind word alone. After all, what are they gonna do—call the cops? They’re the ones breaking the law; you’re acting in self-defense. (And just to reiterate, as Cyrus explains, the cops are seriously outnumbered.)
To be sure, this is unlikely in an upper-middle-class setting, assuming that residence in said setting is the result of, among other things, many years of good impulse control. But there are certain sections of Kansas City that I wouldn’t advise you to try to invade. So by way of making this a falsifiable prediction, keep an eye on the homicide rate in major cities over the next month or two.
Strategy to address this risk: plan to prepare for at least one future (attempted) lockdown, possibly occurring well before late autumn.
While I’m sure everyone reading this hopes for all the recent “temporary” repeals, exemptions, waivers, and announcements of non-enforcement to be made permanent, there remains the possibility that we are descending into a deeply illiberal world order. Characteristics of such a society would include:
- massive protection for domestic industries due to near-total bans on imports
- both international and domestic air travel restricted to a wealthy, powerful elite, and always requiring a passport
- “local content” regulations severely limiting availability of even domestically-produced items from farther away than a few hours’ ground-travel time
- frequent spot shortages and/or much higher prices for many consumer goods; waves of panic buying and Soviet-style queueing for necessities
- extreme vulnerability of small businesses of all types due to sudden restrictions on service provision and consumer movement
- high structural unemployment, maintained by a combination of restrictions on labor-market entry (including a high minimum wage) and “generous” transfer payments
- a new Cabinet-level department ostensibly for the management of biomedical risk
- marginalization of religious believers due to their supposed role in spreading disease
- in the short term, escalatory rhetoric effectively calling for war with China
- furious denunciation of anyone questioning the necessity for/inevitability of any of the above
It’s painfully obvious, really; just imagine the wish lists of nativists and progressives getting combined. In this connection, I can do no better than to proffer my favorite Ayn Rand quote:
The greatest guilt of today is that of people who accept collectivism by moral default; the people who seek protection from the necessity of taking a stand, by refusing to admit to themselves the nature of that which they are accepting; the people who support plans specifically designed to achieve serfdom, but hide behind the empty assertion that they are lovers of freedom, with no concrete meaning attached to the word; the people who believe that the content of ideas need not be examined, that principles need not be defined, and that facts can be eliminated by keeping one’s eyes shut. They expect, when they find themselves in a world of bloody ruins and concentration camps, to escape moral responsibility by wailing: “But I didn’t mean this!”
And, of course, a nation divided, living in separate bubbles, with their attendant complex payoffs, makes regional or even county-level xenophobia all the more likely.
(Having said all that, I remain optimistic, partly because of the astonishing market recovery currently underway. As I post this, the Wilshire 5000, the broadest American stock market index—that is, the furthest thing from a curated collection of blue-chip or tech companies—after plummeting from over 34,500 to just above 22,000, has regained more than half its losses in the past four weeks, is above its level of as recently as January 2019, and is above its level at any time before December 2017. I expect at least half the unemployed to be back to work well before the end of the year, and possibly by the end of the summer.)
Strategy to address this risk: repent of disdain and scapegoating and utopianism, resist demagoguery, and resolve to continue the greatest political experiment in history.