How to Optimize the Lives/Jobs Tradeoff in the COVID-19 Epidemic

by James. B. Murray, Jr.

The debate now raging over the tradeoffs between saving lives and economic disruption is clouded by oversimplification. The solutions we ultimately adopt will not be some groundless elimination of protective measures on Easter Sunday, any more than they will call for quarantining everyone, everywhere until some arbitrary date in July or September. The answer must be much more nuanced.

America has three strategic goals to address, in this order: First, buy time until we can get our health care system capacity upgraded to handle the flood of cases that epidemiologists can predict are coming to each city and region of the country. Second, get our testing capacity and the infrastructure needed to deploy it, distributed across America so we can tell who is infected and begin the random testing needed to model mathematically where and when the virus will spread. Third, quickly develop a set of protocols that can be used to identify those who can go back to work and who may circulate publicly without risk to the most vulnerable.

We need only look at New York City, Italy and Spain to see what happens when the virus peaks in a community before the health care system is prepared. Everywhere across America, including here in Virginia, our hospitals are running low on personal protective equipment (“PPE” – like N-95 face masks, gowns, and gloves). Our doctors and nurses can’t care for the critically ill if they themselves are infected.

Equally important, nationwide we need hundreds of thousands more ventilators to treat the coming tide. The long-hyped era of “death panels” could soon be upon us. A hospital with only 25 respirators, all in use, must not ask its ER physicians to decide what to tell the 26th patient. Today, we have numerous hospitals who can clearly see these unacceptable quandaries coming. We must keep protective measures in place just long enough to solve the worst of the PPE and ventilator shortages. Only then can we risk raising the infection rate.

The second shortage we must address is testing. Everywhere outside a few of the best managed health systems (like Singapore’s) we have epidemiologists “flying blind.” Nowhere in America do we have any accurate data on the percentage of infected people (the “carriers’) or the rate at which the virus is multiplying across the population on a local scale. Further, we have no reliable data to suggest the relative level of risk across different cohorts of the public. We have only anecdotal evidence about differences between genders, ages, blood types and people with certain co-morbidity conditions like COPD.

Only with broad randomized testing can we accurately predict where and when the virus will spread and who we can safely release to get back to rebuilding our economy. We must get testing equipment out to our communities in weeks not months, before the economic damage is catastrophic. Scientists at the University of Virginia have shown the way, developing their own custom-designed testing equipment that is already capable of testing hundreds of patients per day.

Third, we must call on our experts across multiple fields – virology, epidemiology, medicine and data science – to immediately begin developing a list of protocols that will allow us to soon apply protective measures vertically across segments of the population instead of horizontally, indiscriminately quarantining the sick, the well and the immune with blanket denial of access to work and society. We already know that those who have been infected, have recovered, and have been isolated for (scientists now estimate) 14 days should be safe to go out together to dinner and a movie tonight. Today brings news of a simple blood test that will allow us to identify anyone with COVID-19 antibodies. Identifying these people who have likely been infected but are asymptomatic and now immune could increase the number of people going back to work by multiples of the number of recovered patients.

Similarly, testing data and analytics should allow us to identify broad numbers of people who are yet uninfected, but at low risk of severe, life-threatening illness. Two hypothetical examples: every woman, under the age of 60 with Type O or B blood and no chronic underlying illness from a short list might be in one cohort; while another cohort might include men, under the age of 55 with Type O blood and absolutely no chronic underlying illnesses from a longer list; and so on. Or, experts might develop a “score” that produced a sum from a longer list of each individual’s conditions. If we can develop such protocols and empower family physicians and primary care doctors to certify each of their patients, we can put hundreds of thousands of Americans back to work – as soon as our hospitals are adequately supplied to deal with the inevitable increase in case loads.

This more nuanced approach should save many lives in the short term, get a large number of Americans back to work in May or June, and buy us the time needed to clinically test both new therapies and vaccines. Epidemiologists and data scientists, like those at UVA’s Biocomplexity Institute and Initiative can predict now a second wave of infections coming late this fall. With a proven set of protocols that can keep our businesses running, with hospitals fully prepared, and hopefully with approved therapies ready to treat the sick we can avoid a repeat of the current crisis and keep our economy climbing back out of the deep hole we’ve created. If, by this time next spring we have a vaccine then the COVID 19 Depression could yet be “V” shaped.

Jim Murray, a Charlottesville resident, is founder of the Court Square venture capital firm and Rector of the University of Virginia Board of Visitors.

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25 responses to “How to Optimize the Lives/Jobs Tradeoff in the COVID-19 Epidemic

  1. I just re-watched Gov Northam’s Coronavirus press conference from yesterday. Testing was not a topic of his presentation nor was it the subject of any question raised by the assembled journalists.

    You write …

    “The second shortage we must address is testing. Everywhere outside a few of the best managed health systems (like Singapore’s) we have epidemiologists “flying blind.” Nowhere in America do we have any accurate data on the percentage of infected people (the “carriers’) or the rate at which the virus is multiplying across the population on a local scale. Further, we have no reliable data to suggest the relative level of risk across different cohorts of the public. We have only anecdotal evidence about differences between genders, ages, blood types and people with certain co-morbidity conditions like COPD.”

    Why the disconnect? The Northam press conference contained some useful information such as the governor’s prediction that this epidemic and related lockdown would last “two or three months, perhaps even longer”. He pointed out that Virginia prison inmates are making medical masks. Good. But nothing about testing. As far as I can recall not even a word.

    To date Virginia has conducted Coronavirus testing at 58% of the per-capita national average. Why?

  2. There is a great deal of excellent commentary, including letters to editors, on what got us here, and how to fix these myriad of problems short, mid and long term, in Wall Street Journal. Here are a few snippets from two of many published today under the rubric:

    “U.S. Leads the World in Acute-Care Quality
    America’s more complex health-care system is criticized for being too expensive, but the coronavirus response may show that we get what we pay for and redundancy in critical-care capabilities is a blessing, not a curse, in a pandemic.”

    Here are parts of two letters:

    “Your editorial “America’s Intensive-Care Dividend” (March 17) points out that the U.S. mix of private medical care and health insurance combined with Medicare and Medicaid produces an abundance of intensive-care units and beds.

    Other countries with government-run health systems have fewer ICU beds, which are crucial for treating respiratory stress brought on by the coronavirus; and that shortage of beds is, in large part, a result of rationing of intensive care in socialized systems.

    America’s more complex system is criticized for being too expensive and having too many uninsured people visiting emergency rooms, but the coronavirus response may show that we get what we pay for and redundancy in critical-care capabilities is a blessing, not a curse, in a pandemic …”

    Versus this counter-point in another letter to editor:

    “The U.S. spends a far greater portion of its GDP on acute care than any other developed country, yet it has some of the worst public-health outcomes for a developed country.

    The overspending on acute care crowds out expenditures for public health. Decision makers in government tend to see public-health threats as more remote threats. The neglect of public-health initiatives leads to poorer outcomes in acute care …”

    For more to WSJ generally, including for example here:
    https://www.wsj.com/articles/u-s-leads-the-world-in-acute-care-quality-11585071457

  3. It would be useful if our Governor spoke to his perspective on these issues, but only in the context. He must have parallel objectives to deal with the epidemic, to get the economy back up and running and to deal with the social science consequences of the epidemiology measures. I recommend he provide context in all three objectives for every measure he takes to make sure we understand his thinking and that he is setting priorities daily that take all three into account.

    • The closest Northam came to providing such context in his news conference yesterday was to say that the health issues were more important than the economic issues. He then made sure to spit out his chewing gum before attempting to walk off the stage.

      • Have you ever considered that the problem might be the voters as much as it is the politicians? Clearly, a majority of Virginia voters thought it was a good idea to elect Ernest P. Worrell for Governor.

        • A lot of it is the voters fault. However, a state with off year elections is designed to keep voter turnout down. Unlimited campaign contributions makes it hard for challengers to raise enough money to mount a challenge. The Democrats get the majority of out of state funding these days. Shadowy concerns like Virginia Mercury keep up a steady drumbeat of leftist “news” and left leaning operations like VPAP only promote news from outlets like the Virginia Mercury. Our political elite in the General Assembly are still running a machine but the voters could upend the machine if the situation got desperate enough.

          There are some good potential candidates for governor in the state. Sen Chap Petersen is one. However, Chap seems willing to overturn the “Virginia Way” applecart and would need some serious backlash against the status quo to make a credible run. Barring a backlash I’d predict that the 2021 race will come down to the Democratic primary of Herring vs McAullife. Of course, a Democratic presidential win in November might see The Macker as Secretary of Commerce or Ambassador to Ireland. Who knows? The Republicans seem to have no bench at all. Return of Cuccinelli?

          • Dick Hall-Sizemore

            The voters did “upend the machine”, at least in the House, in 2017 and 2019.

  4. Not sure why the Rector at UVa.. a venture capitalist, is tasked to make this sudden appearance on Bacon’s Rebellion to issue series of generalities, and prognostications such as this one:

    “Epidemiologists and data scientists, like those at UVA’s Biocomplexity Institute and Initiative can predict now a second wave of infections coming late this fall.”

    So again where is the beef on UVa.’s testing program now asked twice on Bacon’s Rebellion, first earlier this afternoon at post covid-19-update-ignore-what-i-said-yesterday-its-going-exponential.

    Like Don just said “To date Virginia has conducted Coronavirus testing at 58% of the per-capita national average. Why?”

    Why?

    • The man is credible based on his resume. However, the article should have been categorized as commentary. As for his specific expertise … people write commentary on this blog without having detailed credentials in a particular area all the time. My biggest issue is his lack of references for his assertions. For example, “We already know that those who have been infected, have recovered, and have been isolated for (scientists now estimate) 14 days should be safe to go out together to dinner and a movie tonight.” That may be correct but I’d expect a reference to the 14 days that scientists “now estimate”.

      • Your MIT article linked in was highly useful. I have subscribed to that service. Also the New Yorker came out yesterday with interesting article “Why Widespread CoronaVirus Testing Isn’t Coming Anytime Soon.” It is worth reading, and their coverage of CoronaVirus is free.

  5. I just posted this on an earlier thread. It applies here and may answer Reed’s question above by suggesting the governor may not know the answer.

    The daily press conference of the White House task force updates the national status of test availability daily. Tests are growing exponentially in number, in convenience of use and in speed of results. The White House is properly in my view prioritizing distribution of tests, equipment and supplies the federal government controls to the biggest hotspots.

    As for Virginia, I just went back through https://www.virginia.gov/coronavirus-updates/ and can’t find any update on the availability of tests, supplies and equipment.
    Would like from the Governor is the status of such availability in various parts of his state and whether he is taking action to prioritize their distribution to the Virginia hot spots or spreading them around. Either answer would be OK with me, but I’d like to know – and to know if he knows.

    From http://www.vdh.virginia.gov/coronavirus/ it is clear that the confirmed cases are concentrated in Northern Virginia, Richmond area, James City County and Virginia Beach health districts. The status was updated at noon. Does that reflect the priority and availability of testing or just the relative populations?

    From that same site: “VDH is no longer reporting the pending number of tests as testing capacity has expanded to include commercial laboratories. Commercial laboratories report all results to VDH. COVID-19 case data will be updated daily at noon”. So it appears that accurate data on the availability of testing may not be available to the Governor, but rather just the results. If so, say so. Same with the current status of supplies and equipment. Share that information with us if you have it. If not, get it.

    Regardless, the Governor’s constant references to “a national problem” in answer to any question is not helpful and makes him look weak.

  6. Two countries have had good success. Germany and South Korea.

    Can we not learn from them or have we gone past that chance?

  7. To be clear, this note was posted in my personal capacity and is unrelated to my official role at UVA. Nevertheless see: https://biocomplexity.virginia.edu/nsf-awards-biocomplexity-institute-10-million-collaborative-grant-global-pervasive-computational

  8. In both Germany and South Korea, massive, widespread testing was — and remains — the key to saving lives and getting people back to work.

    Larry Summers — not always a favorite on this blog, but a respected economist nonetheless — has this to say in an op-ed today’s WaPo about the tradeoffs between public health and the economy: https://www.washingtonpost.com/opinions/2020/03/24/trump-is-missing-big-picture-economy/

    This is a subtle, nuanced debate but it is not about equivocation or compromise on social distancing at the front end; it is about how quickly we can determine from accurate testing data that it is safe to lift these restrictions after the worst of the crisis. I won’t try to summarize Summers’ argument but here is a quote:

    “Prematurely abandoning or relaxing social distancing will be disastrous on both economic and health grounds. If restrictions are lifted prematurely, the result will be a follow-on pandemic surge. More people will die. What will the policy choice be then? If it is a return to restriction, starting from a much less favorable point and much more disease spread, then the cumulative economic loss will be greatly magnified. The costs we have already borne will have been totally in vain. . . .
    “The president and the business leaders who urge him to abandon a public health orientation to pandemic policy are nonetheless correct to want to move through the current difficult period rapidly as possible. The right focus is not on false hopes. It is on realistic strategies that permit a targeted approach to reducing transmission. That means more testing, more contact tracing, and more and better facilities for those who need to be separated from others or treated.

    Again, there it is: “More testing.” Where are the damned tests? Get them out there, Mr. Northam, in the hospitals, in the clinics, in the drive through stations, without charge to those who take them. Require anyone with a fever to have a test, and to be isolated if positive. Now.

  9. Germany and South Korea were largely based on testing and protocols based on testing results, i.e. find the infected, separate them , check who had contact…. repeat…

    For some reason – we do not seem to be making that the focus.

    Also, South Korea and Germany seemed to have adequately provisioned masks, ventilators, swabs, etc… and tests.

  10. “The voters did “upend the machine”, at least in the House, in 2017 and 2019.”

    Not at all.

    As Jeff Thomas notes in his excellent book, “The Virginia Way” the political machine in Virginia has nothing to do with Democrats or Republicans. It is a philosophy of arrogance, condescension and anti-democratic corruption on the part of our political elite. The new machine is the same as the old machine with the abominable behavior of Saslaw and Filler-Corn as Exhibit 1.

    • All due respect – that’s grade A balderdash.

      Especially when we see a lot of NoVa folks now in leadership as well as minorities and women in leadership. It may not be completely “transformed” but it’s a helluva lot different than it was when Byrd controlled it.

      It’s kinda hard to make the “plantation elite” thing stick to a lot of the makeup up the GA anymore.

      DJ is just on this kick that NoVa should be it’s own independent state – like a Maryland II or something.

      • W/ all due respect back, that’s a popular view up here. From the in-between perspective of Spotsylvania, which side of the new state line between these two would you like to be on, NoVa or RoVa?

        • That’s not as easy an answer as one might expect.

          First, there are lots of MSAs that are multi-state … so like people that work in Charlotte actually live in South Carolina! Many more.

          So what if RoVa was like South Carolina and NoVa was Greater Washington?

          I suspect Virginia would get more serious about ED like SC did…
          and more of RoVa would be more like … say… Iowa or Kentucky which have some urban but a lot of rural – a lot of poor rural.

          Spotsylvania before I-95 was a county of 15K and most all farms and not exactly prosperous and upscale. We’re still not at 115K – we got all these folks with their kids who want NoVa style schools all the bells and whistles… subdivisions with dead-end cul-de-sacs and other “amenities” that all cost higher taxes, much higher than before!

          I don’t see it as a tragedy.

          NoVa folks are pushy and aggressive as far as I’m concerned. They’re the same way in Costco as they are on the roadways… “get out my effing way!”.

        • ED?

          I’m not knocking Spotsylvania. Now Stafford and Prince William have identity issues big time, but you’ve just had to deal with Lake Anna and Carl D. Silver.

          • Spotsylvania and Stafford have always been associated with Fredericksburg. Our Planning District and Transportation planning district (MPO) are all this region.

            The region is rich in Civil War history – totally apart from Prince William and north also.

            This region was disconnected from NoVa until I-95 came through in about 1965. That changed everything.

            And our region is not alone. Places all over the country changed when the interstates and beltways enabled longer distance commuting and white flight.

            Lake Anna also changed things but not as much as one thinks because they do not have a municipal water/sewer system and that means not much commercial.. it’s basically a big upscale homes place. Louisa on the other side managed to get a wastewater permit for a small creek feeding into the South Anna river and that got them a Food Lion which serves a lot of the lake area.

  11. Virginia’s coin of the realm build on an old boy network is imbued with secrecy and deep suspicion of those outside the old boy Virginia cult. Now, in this age of mutation, and with its new leftist toxin, the Old Dominion is morphing into a mutant racked by fetishes of all sorts and varieties, a kind of Hugo Chavez Venezuela saddled with chronic depression ravaged seasonally with coronavirus, dirty money, corrupt Pols, weed and bourbon, gambling casinos, bladed whirling wind towers, monster traffic and solar panels.

  12. RF, we can call the present situation “corrupt” but it’s more than that, maybe much worse than that. I think DJR and his ilk are on to something fundamental about the “Virginia Way” that has always given it such authority and staying power: it claims to be about good manners and cooperation and compromise, and this is invoked endlessly to blunt criticism; but all too often when you scratch the surface it seems to be more about hypocrisy and raw power and arrogance and purchased votes. I’ve done a bit of regulatory work involving New York and New England, and more than a bit around Virginia, Maryland, DC, North Carolina and West Virginia, and nowhere else have I seen a major regulatory commission deliberately and comprehensively hamstrung by its own legislature like our SCC. In most states the GA is smart enough to recognize that a good regulatory commission shields the legislature from walking the political tightrope itself on so many of these gas and electric utility issues — and often from making hurried, wrong decisions by providing analysis and grounds and time for thoughtful inquiry — but these GA preeners want to “dance where angels fear to tread” as though there won’t ever be a political day of reckoning. That day is coming fast. Dominion used to be a low-cost utility; now its retail rates are climbing fast not just in absolute price but relative to other electrics including Virginia’s electric cooperatives, and nothing the GA did this year is going to reverse that growing disparity.

    • The “Virginia Way” has always felt a little like the way Virginia was ruled by the landed gentry and before that the British. My county’s namesake is Governor Spotswood – Spotsylvania – get it?

      So in the early days – there were the educated leaders from England and Virginia has a LOT of famous ones like Jefferson, Monroe, Patrick Henry, etc and they presided over a lot of basically uneducated folks – indentured servants, etc and so they saw themselves as the proper care takers of the state.

      That attitude has endured for a long time. It has lessened but is still in the minds of some but I suspect that elected folks from NoVa and elected women and minorities are as enamored of it and times are changing, if gradual.

      Yes.. we have an awful situation with the SCC and utility but I’m not sure it’s reall related to the “Virginia Way”… convince me of that.

      In terms of really bad “corruption” – I’m looking at places like New York and Chicago and others where leaders were on the take from the Mafia and union leaders stole pension funds and that style of corruption. Tea Pot Dome and other such scandals…

      I just don’t think we have that kind. We DO have very loose money “rules” and some things that are perfectly legal in Va will gets you jail time in other places.

      DJ is just bound up over NoVa being able to run it’s own affairs. He’d be that way in just about any state that has Dillon…

      And I’d NOT want to live in a state that does not have some form of Dillon that has uniform laws and regs… and requires localities to get approval from voters on taxes.

      And I’d rather Virginia citizens have the right of referenda – to be able to force referenda to be held and not just let the legislature decide when and what – more like California and Colorado.

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