Opinion | If I Had a Hammer

I’d Hammer in the Morning.....

This period of social distancing is really hard. The five-minute walk to the grocery store all masked up and in battle gear to do something as simple as buy coffee and carrots just isn’t doing it for me. The 45 minutes of walking in place while binge watching is better than nothing, yes. But, it has been hard to gain perspective on the lockdown and we are only in week five so far. How much longer will the social distancing measures be in place? Prime Minister Sánchez is talking about another two-week period for the state of emergency. Is it even the right thing to do?

I was turned on to a three article series written by American Tomas Pueyo published in the last two weeks of March. As a health-care public-policy wonk, I have been looking for a balanced and thorough data-driven, historical analysis to point the way forward. In my opinion, this series nails the expected outcomes for the two basic responses to the pandemic, and the likely economic recovery that will follow. I will make a few summary points. 

A Bitter Pill

As a child, I remember my parents trying to convince me to take bitter medicine now or I would be sick much longer and suffer a great deal more. So it is today with the COVID-19 pandemic. There are basically two response strategies in play in the world. Most every country has been slow to act initially. China, Italy, Spain, England, the US. However some have used a suppression methodology (the Hammer): China and South Korea for example. While others have used a mitigation approach, gradually ramping up measures while trying to minimize or delay the economic impact, until the number of cases spikes and threatens to overwhelm the health-care system. This leaves us playing catch up, with the virus running exponentially out of control. Mr. Pueyo describes these two approaches in this way:

“Mitigation: Take some measures now but don’t be too aggressive. Just flatten the curve, go through the epidemic, build herd immunity, and go back to business as usual. This has the benefit of avoiding an economic shock early on because the economy doesn’t shut down for a few weeks or months. But during the epidemic, people will avoid going to work or consuming, for fear of getting infected. That ongoing panic can strain the economy for as long as people believe the epidemic is uncontrolled.

Suppression: Apply a 'Hammer' early on and shut down the economy for a few weeks or months. That will bring infections to nearly zero while giving time to organize everything, from testing to contact tracing. Once testing data indicates it’s safe, move towards the 'Dance,' a period during which social distancing measures are reduced, but some measures might still be needed nevertheless, depending on the situation.”

Bring Out the Hammer

Using a brilliant analysis and easy-to-understand graphs with case data from around the world over the last four months, Pueyo makes the case that the suppression strategy is the best approach. It reduces mortality significantly and—most importantly—buys time: time to prepare and outfit the health-care system, build testing and tracking capacity, develop therapies and, ultimately, a vaccine. But many leaders in the west have been reluctant to do so for numerous reasons ranging from a belief in national exceptionalism to fears of overreacting and causing an economic slow down or collapse for no legitimate reason. But, if the data from Italy and Spain aren't enough to convince you, how about what happened in the US a century ago? Looking at the 1918 “Spanish Flu” pandemic and other pandemics in this century, Pueyo makes the case that the “Hammer” is the best long-term policy for the economy with a much quicker recovery than the mitigation strategy. 

The third article of the series focuses on the US and its fractured approach of more cautious mitigation and no action strategies that have prevailed. There is still time to act more aggressively and get in front of the pandemic though admittedly after it has become out of control in many countries. It requires war-time-like coordinated sacrifice and action. Pueyo provides a clear methodology for determining the costs and effectiveness of various social distancing measures. Looking at the current state of the pandemic, there is simply no more room for timid, half steps, no more partial anything. In my opinion, the US is the example of what not to do. EU leaders would do well to take a look across the Atlantic. If they do, they will see a confusing array of mixed messaging and lack of coordination that mirrors their own, and perhaps this will spur a new-found motivation to work together to build a coordinated response and recovery plan for the entire European Union. 

I’d Hammer in the Evening....

So, as we sit in our homes patiently (or not) waiting for restrictions to be loosened in a few weeks, let’s not start dancing too early. It would be so nice. I cannot wait to walk along the beach with my mask on. Thinking of the better, long-term outcome, we must be smart and patient; we must contribute by adhering to the strict regulations put in place. There actually is a successful path forward. We must beat this virus. To do so we have to be prepared to hammer it back down as it raises its head, because it will as we loosen the restrictions. But preparedness will only be achievable with the ability to do universal testing and tracking, so we need this time to get ready. 

Sources

The links to the articles I discuss are below; Mr. Pueyo encourages readers to circulate them widely. 

Coronavirus: Why You Must Act Now Politicians, Community Leaders and Business Leaders: What Should You Do and When?

Coronavirus: The Hammer and the Dance What the Next 18 Months Can Look Like, if Leaders Buy Us Time

Coronavirus: Out of Many, One What the US Federal Government and the States Should Do to Fight the Coronavirus

Kurt Krumperman is retired from a lifelong career in Emergency Medical Services and has a PhD in Health Care Public Policy.