Coronavirus will win. America needs to make a plan for failure.
The United States has failed in its response to the coronavirus.
I don't simply mean the United States has suffered the world's worst outbreak — by far the most total confirmed cases, as well the most deaths, both figures surely underestimates of the true total — because there are counterarguments ready to hand on that score. The per-capita death rate for the U.S. still trails a host of European countries, including Belgium, Spain, Italy, the U.K., and France, and while many of the worst-hit European countries have seen their death rates plummet in recent weeks, other countries, like Canada and Sweden, have failed to bring their death rates down, and new cases are cropping up in countries that previously had been highlighted for their successful containment of the virus, like South Korea and Germany. The fact is, apart from island nations like New Zealand, we really don't know which countries have done the best job of combating the pandemic.
Nonetheless, we can say the United States has failed for a simple reason: We have not done what we needed to do and said we needed to do while we shut down our economy, and now we are reversing course with no coherent strategy remaining for victory.
The original purpose of the orders to shelter in place was not to eliminate the virus entirely, but to buy time. Time to slow the rate of infection so our health-care system would not be overwhelmed. Time to expand our health-care system's capacity to handle future surges of cases, and to retool manufacturing toward necessary medical supplies. Time to ramp up a testing and contact-tracing infrastructure that would enable us to rapidly contain future outbreaks without having to shut down much of the economy once again. That time was largely wasted. None of the key pieces of infrastructure are in place to allow us to relax restrictions while still containing the spread of the virus. We have taken an enormous hit to our economic well-being with very little to show for it.
So what do we do now?
We could extend the lockdowns indefinitely without any clear exit strategy — but eventually we will reach the fiscal or psychological breaking point, if we haven't already, and then we'd be right where we are now but with even greater economic and human costs accrued. We could simply give up the collective fight, and leave individuals to their own devices — but the only way for most individuals to protect themselves is to continue to hunker down, which will turn our still-temporary economic crisis into a semi-permanent depression.
Or we could do what we so rarely do in our foreign policy: make a plan for failure.
By failure I mean a collective recognition that we will not successfully contain the virus, and will have to learn how to live under its deadly shadow. That requires a strategy, because without one neither our economy nor our society will recover their resiliency. We can reopen the restaurants and the stores, but as we're already seeing in Texas, not enough people will come out to eat and shop in caldrons of contagion. We can reopen the factories, but if workers don't feel safe the result will be rampant absenteeism and even wildcat strikes. And we can let hospitals perform elective surgeries and other non-emergency procedures again, but when people with heart attacks are avoiding emergency rooms, how likely is it that patients will risk their lives to seek non-emergency medical care? A plan for failure would address each of these issues, not with a view to defeating the virus — we failed at that — so much as with a view to keeping our society functioning despite the virus.
Take health care. As restrictions loosen, we should expect the number of COVID-19 cases to rise — including serious cases that require medical attention. That will discourage people who need other health care from accessing the medical system for fear of contracting the virus. To restore people's confidence in the safety of the health-care system, we're going to have to largely take coronavirus patients out of it. COVID-19 sufferers are already strongly discouraged from going to hospitals; those who can't recover at home may need to be routed to sanatoria specifically dedicated to such patients, leaving most hospitals exclusively for non-coronavirus patients. This isn't going to be easy to do for a host of reasons, including the inability to screen perfectly for asymptomatic or pre-symptomatic carriers and a lack of health-care redundancy in rural areas. And as socioeconomically vulnerable populations suffer the worst from the epidemic, the optics of segregation are going to be awful. But it's hard to see how routine health-care provision can resume so long as patients fear that hospitals are huge vectors for transmission.
Getting people to feel safe going back to work is going to require a complicated balancing act between the interests of workers and employers. Republicans have a point in arguing that businesses cannot be exposed to open-ended liability for infecting employees or customers, especially given how little we still know about virus transmission. But a blanket immunity from being sued will create the opposite problem, leaving customers and employees out in the cold, reluctant to trust that businesses will invest in their protection. Moreover, a great many essential jobs are going to be very hard to ever make truly safe.
If we want to rebuild trust, we'll need to provide extra compensation — hazard pay for employees doing those jobs, and since businesses likely won't be able to afford it, the taxpayers will need to foot the bill. Meanwhile, we'll need to codify a set of best practices for infection risk reduction for different types of workplaces, continually revise them as new evidence about the mechanics of transmission comes in, and tie liability relief to rigorous compliance, which will have to be regularly assessed. Even if a great deal of these requirements amount to a coronavirus version of "security theater," they'll be performing the vital function of convincing people to take risks they might otherwise avoid. And that's what failing well ultimately means.
Schools and vulnerable populations present more intractable problems. On the one hand, schools might seem easier to open than many other venues, because children are less vulnerable than adults to death or serious illness from the virus. Moreover, we still don't know the degree to which children — who rarely manifest symptoms — can even spread the virus. Keeping schools closed for an extended period will do enormous long-term harm to the future of this generation of children, and in the short term we'll also be trapping many parents at home, out of the workforce — and parents are surely desperate to get their kids out of the house and back in school anyway. But parents are also extremely risk-averse when it comes to threats to their kids' health, and children can still occasionally become gravely ill as a consequence of the virus. Reopening the schools without the kind of rigorous testing regime being experimented with in Europe will likely mean that those socially and financially able to keep their kids home will continue do so, while most parents will have no choice but to take the risk.
Protecting the most-vulnerable is similarly intractable. Nursing homes are places where elderly and infirm are already isolated, and they have generally done a poor job of keeping infection out. But elderly relatives being cared for in multigenerational households are also highly vulnerable to infection from other household members — a big factor in the high death toll in Italy. And a huge number of non-elderly Americans are rendered more vulnerable to the virus' depredations by underlying conditions like diabetes, heart disease and obesity. It's impossible to imagine that they could all be adequately protected under even semi-normal conditions. Nonetheless, a plan for failure means a plan for managing this higher risk: supporting programs, such as a vastly expanded corps of visiting nurses and other aides, to make it more practical for individuals who need to be isolated to achieve that isolation.
None of these ideas, or the dozens of others that would need to be contemplated, would be cheap and simple to implement. And they wouldn't prevent the virus from eventually sweeping through the population. That wouldn't be the goal. The goal, rather, would be to reduce the toll of the virus somewhat, in terms of lives lost and economic damage, and in terms of the functioning of our society.
Will we make the effort? Our national lethargy of the past four months does not inspire optimism. Failing well could take as much work as victory would have. Failing badly — and inflicting worse suffering — would be so much easier.
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