by James A. Bacon
Two days ago, Peter Galuszka posted an interview he conducted with state epidemiologist Lilian Peake, a key functionary in Virginia’s response to the COVID-19 crisis. I found her responses appalling. The degree of passivity cannot be overstated. Her responses to most of Peter’s questions amounted to: “We’re tracking and monitoring the situation.” If the Northam administration was actually doing anything, it wasn’t evident from this interview. (Here’s my snarky summary of what little she had to say.)
One can glean from media accounts that the administration is working behind the scenes on some things, though to what effect it is impossible to tell. The only clearly visible leadership emanating from Richmond has been Governor Ralph Northam’s move to take strong — some might say excessive — action to enforce social distancing (and shut down much of the economy in the process).
Meanwhile, testing kits remain in short supply, making it impossible to accurately track the spread of the coronavirus; the commonwealth still has yet to develop an epidemiological model to help it forecast the spread of the disease; and the healthcare industry is in a state of panic over the looming shortage of hospital beds, personal protective equipment, and ventilators. As for taking measures to put people back to work, I’ve seen nothing. Zippo.
Broadly speaking, there are three main clusters of issues, and we need clarity of thinking about each one: (1) implementing social-distancing measures to slow the spread of the virus; (2) expanding the capacity of hospitals and healthcare practitioners to care for the inevitable surge in COVID-19 patients; and (3) getting people back to work as quickly as possible without undermining measures to counteract the virus. Let’s look at each one.
Social distancing measures. This is the area where the Northam administration has acted most forcefully. In the early stages of the epidemic, the Governor ordered the cancellation of large events, extended K-12 spring vacations, and urged people to work from home. Measures have grown progressively more restrictive. Now public gatherings of more than 10 people have been banned, public schools and college campuses have been shut down, and non-essential businesses have been ordered closed unless they can operate on a virtual basis.
To the extent that Northam is responding much the same as other state and provincial figures around the world, he can’t be singled out for criticism. Clearly, something must be done to hold back the spread of the virus. However, it is intrinsic to the nature of things that some policy alternatives are more effective than others. To put it another way, some options provide a greater social return on investment. In the instance of fighting COVID-19, some social-distancing measures provide more public health protection than others as a ratio of the economic damage they cause.
I have not seen anyone analyze the cost-benefit tradeoffs, so I’m flying blind here. But, for example, one could hypothesize that measures designed to quarantine nursing homes packed with frail elderly residents will offer superior cost/benefit tradeoffs than, to pick an extreme example, shutting down all restaurants. In any rational calculus, quarantining nursing homes will make sense — we know for a fact that many nursing home patients have died from the disease, we can reasonably conclude that such an action will save many lives. Likewise, canceling large events where a single infected individual could spread the disease to dozens of others is another worthwhile tradeoff, despite the harm it does to the hotel and convention sector.
It is less clear that closing all restaurants (save home or curbside delivery) will achieve any greater public good than Northam’s previous restriction limiting patronage to 10 people. After all, restaurants were taking the same aggressive sanitary measures used in grocery stores, pharmacies and other “essential” institutions. Is there any empirical evidence to suggest that restaurants limited to 10 patients were vectors of the disease? Perhaps such evidence exists, but I haven’t seen it. Conversely, we have hard proof that restaurants are closing and thousands of restaurant workers are losing their jobs.
If we accept the philosophical proposition that we don’t want the cure to be worse than the disease, we should consider loosening social-distancing restrictions that cause extensive economic damage while contributing only negligibly to the spread of the disease.
Expanding hospital and healthcare capacity. If COVID-19 continues spreading at a geometric rate in Virginia as it has in many other places, Virginia hospitals likely will be overwhelmed by late April. There are too few testing kits, too few acute-care beds, too few ICU units, too few ventilators, and too little personal protective equipment. It is within the Governor’s power to address some of these issues, while other matters are out of his hands.
There has been a shortage of COVID-19 testing kits in Virginia. That is not Northam’s fault. The problem is national in scope, and the problem can be traced to decisions made by the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA). The federal regulatory issues have been addressed, and the supply of testing kits, supplemented by universities (such as the University of Virginia) and private labs, is expanding rapidly. As a consequence, the number of tests conducted in Virginia has surged from less than 100 daily in early March to almost 2,000 two days ago. The availability of tests will cease to be a bottleneck.
However, a new bottleneck will emerge — the availability of personal protective equipment (PPE). Health care practitioners are required to wear protective gear when they administer the tests. That gear, too, is in short supply. The federal government maintains a stockpile of PPE, but the process for allocating the masks, gowns, goggles, and other gear appears to be driven by bureaucratic criteria. For understandable reasons, “hot spots” such as New York are getting preferential access over places like Virginia where the coronavirus crisis is, at the moment, less dire. Likewise, private supply chains undoubtedly are giving priority to locations where the need is most acute. It is not reasonable to hold Northam accountable for local PPE shortages. Even if the Governor could do something, hoarding protective gear in anticipation of needing it in the future while other states desperately need it now would raise significant ethical issues.
The shortage of ventilators is similar — the federal government controls the dispensation of ventilators from the national stockpile, and the ventilator-manufacturing supply chain will likely prioritize areas where the need is most acute. It is not within Northam’s power to butt ahead in line when hundreds of people are dying in New York.
On the other hand, Virginia appears to have been slow to address the looming shortage of hospital beds. As a root cause, we can look to Certificate of Public Need (COPN) regulation for throttling the supply of hospital beds, especially in Northern Virginia. However, Northam had plenty of warning that a problem exists, and the administration was slow to act. For an outrageous length of time, the administration couldn’t even tell the public how many acute-care beds existed in Virginia, much less how many could be converted into ICU units for the most severe cases. And it was only a few days ago that Northam informed the public that he had asked the Army Corps of Engineers to look into building overflow medical-treatment facilities. When the crisis subsides and the state conducts a post mortem of its response, I suspect that the slow response to the bed shortage will prove to be one of the greatest failures.
Getting back to work. Mitigating the economic damage of mandatory social measures also should be a top priority. The Northam administration has done a few things, such as cutting red tape in the unemployment insurance program so laid-off workers can access unemployment benefits more quickly. But there is no substitute for getting people back to work.
One measure seems obvious. Once someone has contracted COVID-19 and developed an immunity — experts differ on how long the immunity will last, but one or two years seems likely — they should be exempt from the social-distancing crackdown. Tests will be coming soon that detect the presence of COVID-19 antibodies indicating immunity in a person’s bloodstream. Reports Science:
Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai, and his colleagues posted a preprint [March 18] describing a SARS-CoV-2 antibody test they have developed, and directions for replicating it. It’s one of the first such detailed protocols to be widely distributed, and the procedure is simple enough, he says, that other labs could easily scale it up “to screen a few thousand people a day.”
Other labs and companies around the world are developing their own tests. The idea is touted as a way to measure the prevalence of the disease for epidemiological purposes. (As of March 28, 739 cases had been detected — the most severe. The total number of Virginians infected could be 10 times higher, maybe more, and unidentified cases will increase exponentially along with the confirmed cases.) But serum tests have a dual use: Assuming people with antibodies are resistant to the virus, they can be put back to work.
Virginia reportedly will get about $1.5 billion in state aid to deal with the coronavirus. Here’s my humble suggestion: Legislators should allocate $50 million or more to acquire the capacity for large-scale serum testing. The results can be used for epidemiological analysis, but more importantly to qualify people to be exempt from quarantines. Perhaps COVID-19 survivors can be issued proof-of-immunity cards. The pandemic could last for months, the experts say. But we don’t have to wait months before putting people back to work.
