Can We Afford To "Reopen America?" What The Numbers Show

Excerpt: "Trump keeps comparing Covid-19 to the seasonal flu, so I highlight three essential differences: Covid-19 is at least 50 percent more infectious, requires hospitalization at least 5 times as often and results in death 10 times more often.  Think of it this way. A single person with the flu will lead to 386 people with the flu over two months, and a handful will require hospitalization. But a single person with Covid-19 will result in 99,000 Covid-19 infections in the same period, and up to 20,000 will require hospitalization."

"Can we afford to ‘reopen America’?" Nicholas Kristof

By Nicholas Kristof Opinion Columnist

President Trump says he wants the United States “raring to go” in two and a half weeks, with “packed churches all over our country” on Easter. He and many others suggest that we are responding to something like the flu with remedies that may be more devastating than the disease.

He’s wrong, public-health experts say. We created this interactive model with epidemiologists to show why quickly returning to normal could be a historic mistake that would lead to an explosion of infections, hospitalizations and deaths. You can see from the graphic above the difference in fatalities between a brief and a sustained period of social distancing.

But I want to be clear: There’s no easy solution. The model suggests that when we ease up on social distancing, infections will surge once again. Still, this pause gives us time to buttress our hospitals for the storm and it allows us to flatten the curve so that hospitals are not overwhelmed. The difference between the case fatality rate in Germany, 0.5 percent, and in Italy, 10 percent, is in part that Italian hospitals are overwhelmed and ventilators worth their weight in gold.

So some epidemiologists are suggesting that we may go through a year or so in which we are alternately clamping down and relaxing social distancing controls. So maybe in a month or so, if we’ve brought infections down, we can carefully ease up, especially in parts of the country with less of a problem. Then cases will rise, and after a time we’ll clamp down. They’ll subside, and we’ll relax again, and so on and so on. That’s more sustainable than a yearlong freeze of activity.

At The Times, all this has also become personal. Alan Finder, a longtime reporter and editor here, died on Tuesday after testing positive for Covid-19. And while my family is doing just fine (Sheryl and I are holed up at home), I have many friends who are sick with the coronavirus.

In any case, please visit the column and play with the model of the virus. I worked on this with my colleague Stuart A. Thompson, who is the Einstein of visual journalism, and with two epidemiologists at the University of Toronto, David N. Fisman and Ashleigh Tuite.

Trump keeps comparing Covid-19 to the seasonal flu, so I highlight three essential differences: Covid-19 is at least 50 percent more infectious, requires hospitalization at least 5 times as often and results in death 10 times more often.

Think of it this way. A single person with the flu will lead to 386 people with the flu over two months, and a handful will require hospitalization. But a single person with Covid-19 will result in 99,000 Covid-19 infections in the same period, and up to 20,000 will require hospitalization.

There are of course counter-views that this won’t be as bad as people warned, or that we are unnecessarily sacrificing the economy. But I’m struck by how the experts in infectious diseases, public health and epidemiology are virtually united in resisting our president’s call for churches to be full on Easter.

I hope you’ll read the column and play with the model to see how much difference a sustained shutdown makes in terms of saving lives.

Trump’s Approval Rating

President Trump’s approval rating has shot up in the polls, with most Americans endorsing his handling of Covid-19. I find this staggering. I’ve reported on global health for decades, and it’s difficult to think of major leaders who have handled an epidemic so poorly. South Africa’s president in the early 2000s in responding to H.I.V./AIDS comes to mind, and Iran’s supreme leader handling Covid-19, but not many others.

Trump was right to curb flights from China early on (for which he did receive criticism), but he undermined the National Security Council architecture to respond to pandemics, and he repeatedly downplayed the risks. The bungling of testing may have reflected his scorn for the risks. I think voters will figure this out.

Meanwhile, in Poor Countries

Those of us in the rich world fret about Covid-19, but at least our hospitals have ventilators. I worry a good deal about what happens when Covid-19 strikes Congo, Bangladesh and Syria. Many years ago in Karachi, Pakistan, I saw a hospital struggle with a crisis: Both a mother and her newborn needed oxygen, and the ward could offer oxygen to only one patient. The mother got it, and when she woke up her baby was dead.

Or think of our admonitions to wash hands. Some 3 billion people worldwide don’t even have a place at home where they can wash their hands with soap.

That said, there are a few mitigating factors. One is that populations in developing countries are younger, with few of the octogenarians who are most at risk. Only 2 percent of Nigerians are over 65, compared to 23 percent of Italians. Another is that many of the poor countries are in the tropics, and there are theories that Covid-19 doesn’t spread as well in high temperatures.