As a mathematically inclined engineer, I like to see things discussed in terms of Pareto efficiency. A Pareto efficient (or optimal) policy can be thought of as follows: if you have multiple goals, a new policy cannot improve one goal over the current policy without hurting at least one other goal. Basically, you are at a point where you have to trade off one goal for another goal.
In the COVID-19 pandemic, and especially in the United States, it is common to think of the following two goals as being opposed to each other:
- minimizing COVID-19 hospitalizations/deaths
- doing damage to the economy
However, such a view is misguided. Safety and economic health are not in opposition. They are a tradeoff, and a tradeoff can be efficient or inefficient.
How do we find an efficient point along the COVID-19 tradeoff curve?
Let’s take a look at how several countries implemented different responses that provided an efficient tradeoff between economy and safety.
How some countries successfully handled the virus
China took draconian measures to do contact tracing and required most people to stay at home. Rather than having shoppers crowd into a store like Costco, China was able to efficiently deliver food and groceries to people’s doorsteps. By late February, the reproduction rate R of the virus was far below one in many major cities (Some estimated it to be as low as 0.3.), and by early March, daily cases were well below 100. By April, grand plans were already in progress for the economy to safely reopen. The approach used by China was incredibly efficient, but would not work in a country like the United States as it requires an authoritarian regime that can keep its citizens locked down.
What about a democratic nation such as Taiwan? Taiwan owes its success and preparedness not only to a culture of mask wearing, but to its digital health care infrastructure, which could be quickly adapted to test, trace, and isolate covid cases in real time. Careful contact tracing of visitors also helped Taiwan maintain its absurdly low case count. As a result, Taiwan never had to close its economy! However, the US is way beyond the case count of Taiwan, its health care infrastructure is a mess, and Americans have a hard time trusting contact tracing, so this is out of the question too.
Japan is a promising country to emulate. It has had several mild ebbs and flows, but its success is likely attributed to a strong mask wearing culture, as well as special attention to scientific research that helped them quickly identify the three C’s to avoid:
- En(c)losed spaces with poor ventilation
- Crowded places with many people
- Close contact settings such as face-to-face conversations
Japan never issued a national lockdown, but it did declare a state of emergency that affected its export-oriented economy, which caused a mild recession on track for 3.4% annual GDP loss. However, during this time, Japan was able to quickly reduce the prevalence of the virus through the month of May with a reproduction rate close to 0.7. It has since lifted its state of emergency, and with its economy fully reopened and increased testing, it is still seeing daily COVID-19 deaths averaging 1 to 2 only. Japan, interestingly, counts on its citizens to voluntarily take advice and act cooperatively to suppress the virus.
A stronger approach was implemented by New Zealand, which closed its borders, implementing tight lockdowns, and performed a whole lot of testing and quarantining. New Zealand took an approach similar to the US using phased reopening, but they made sure not to reopen until the case count was near zero! Their messaging was very clear. Their export-based economy suffered a bigger loss than Japan (10% GDP), and they had a temporary unemployment rate of 15%, similar to the US during lockdown. However, having gotten rid of the virus completely, they can now breathe a big sigh of relief and reopen fully thanks their government’s aggressive strategy.
As such, it should be clear that Japan and New Zealand are perhaps, two near Pareto optimal points on different ends of the curve which democratic countries like the United States can emulate. Japan allowed low but non-zero death counts, but was able to keep its economy open, while New Zealand took a harder hit to its economy (albeit temporarily) to drive its cases down to zero.
So where is the US compared to Japan and New Zealand?
The United States is terribly Pareto inefficient.
If Japan and New Zealand have fairly efficient strategies, then the US is extremely inefficient. The United States’s response is extremely scattered as the result of mixed messaging from authorities. While Dr. Fauci and other scientists are advising to suppress the virus, the White House is falsely claiming that we are safer than ever, and telling states to reopen everything. The pandemic is heavily politicized, with Democrats and Republicans often believing very different things about the virus. False information about masks and remedies continue to creep up everywhere. There is no comprehensive strategy at the national level or at state levels. States are even carrying out their own policies in disarray, with states even fighting their own local jurisdictions over mandating masks. Through all of this, unemployment rates are in double digits.
US citizens are confused, scared, and angry. The average citizen’s trust in authority, and in science, has eroded to the point where death threats have been made to county officials over mask mandates.
Rather than acting with foresight and thinking a few months down the line, many officials are now reacting to their local constituents’ whims. “Deaths are going up. Shut down!” “Deaths are going down. Reopen!”
California’s Split-Minded Approach
California is a prime example of having a split-minded response. While residents of many other states commend California for not overwhelming the health care system, not overwhelming the system should be a minimum requirement, not something to be praised. As a resident of California, I was quite disappointed that California went for a mitigation strategy rather than a suppression strategy, meaning that it would keep the economy partly open as long as hospitalizations didn’t surge out of control. Essentially, California decided to walk along the edge of a cliff for 3 months with a reproduction rate R = 1.
As a result, deaths didn’t spike, but it also never really went down except for a couple weeks in May, which were immediately followed up with REOPENING. This brought R to 1 again, and deaths remained stable. However, without a clear end in sight, the mitigation strategy was so painful that California eventually REOPENED again in June, even while R was already 1. This caused a surge in hospitalizations that required the governor to shut down the economy again. The last 3 months turned out to be an exercise in masochistic futility, with daily deaths in July higher than it was in early April, and the economy in a great deal of pain.
However, California’s strategy was not nearly as bad as that of Texas or Florida, which abandoned mitigation and decided to reopen quickly, overwhelming their health care systems. As Texas started stocking up body bags for the anticipated rise in deaths, Governor Abbott continued to refuse shutting down for some time. The only state that is headed in the right direction, probably as a result of having already overwhelmed their health care system once and not wanting to repeat the same mistake twice, is New York. New York is also in the final stages of passing a contact tracing bill, which would allow them to further suppress the virus without widespread damage to people’s sanity or the economy.
This brings me to the following illustration.
The Shark and the Water Slide
As Japan and New Zealand have both proven (and hopefully New York will soon prove), it is far more optimal for BOTH public health and the economy to focus on crushing the virus first, and then applying targeted, surgical techniques such as contact tracing, quarantine, and testing to prevent future outbreaks. The real discussion of Pareto efficiency should come down to how quickly we should crush the virus at the expense of a temporary slowdown in the economy. When the US is losing over 6,000 people to the virus weekly as of the end of July 2020, there should be no question that we should only be reopening as long as we are constantly reducing the number of deaths and hospitalizations in the process!
Here’s a graphic I made back in late April talking about the 3 options, inspired by a medium article called “The hammer and the dance”. The hammer refers to a combination of policies (such as lockdown, sheltering in place, mask wearing, etc.) to drive the prevalence of COVID-19 down. The dance is, through a combination of methods such as contact tracing and widespread testing, a less detrimental way to suppress any outbreaks as soon as they are about to happen.
States like California are taking the option in the top row. The economy is usually only partially opened, but can never fully reopen because we have no intention to crush the virus. We’re ok as long as deaths and hospitalizations aren’t exploding. Other states end up in row 2 because they ignore science altogether, and their economy pays a toll in human suffering and deaths. Countries that are now safely reopened implemented row 3, where they’ve either driven infections to such a low level that it is easy for their CDC to track, trace, and contain individual cases, or their citizens are so voluntarily cooperative and responsive that they can change their behaviors whenever the COVID threat rises.
For additional emphasis, here’s a shark with a friggin’ laser.
The dumbest option is to swim toward the shark. (Hello Texas and Florida.) A dumb option is to try to swim away from the shark. (Hello California.) The shark is always following you, so you’ll have to keep swimming, and eventually you’ll get tired and burn out.
The smartest and only option to victory is to take the water slide to freedom.
But how do we ride the slide when reopening?
So we tried to reopen in many states, and deaths went up! How can we possibly reopen while bringing COVID-19 cases and deaths down? Do we really have to shut down even longer to take the slide? As our governments seem to have lost hope in us and are flailing their arms without a solid strategy, the answer really depends on citizen response.
As trying of a time as this is, I still have faith in our ability to adapt, innovate, cooperate, and self-organize for the common good. After all, we’ve been able to organize mass movements with social media alone. If other democratic countries can suppress the virus, then we Americans can do it too.
Here are a few suggestions on steps each of us can take to fight the good fight.
1) Cherry Pick with Pareto Improvements
Even if your state has no mask mandate, wear a mask anyway (according to science, it’s effective and perfectly safe!). Decrease potential viral load by avoiding public bathrooms whenever you can; they’re crawling with nasty germs anyway. Wash your hands before you touch your face; it’s good hygiene in general. And stop touching your nose all the time; it makes you unattractive.
These are all examples of Pareto improvements. Pareto improvement means making a change that improves one goal without harming the other goal. For example, wearing face masks suppresses viral transmission without hurting the economy. In fact, some of these simple lifestyle changes can even bring additional benefits. The common cold and the flu are also coronaviruses that can be prevented by wearing masks. Being kind to a fellow stranger and not spreading our germs helps keep our neighborhoods healthier, and healthy people can further boost the economy.
2) Get creative, but keep it grounded in science.
Here’s just one idea: Suppose you really want to go hang out with people. Here is an example of safe socializing using “clique hopping”.
Instead of attending large social gatherings with strangers, try smaller social cliques of trusted individuals. Social distancing does not need to be enforced within cliques, but masking up and social distancing should be carefully observed outside the clique. Any time “clique hopping” is considered (i.e. you’re switching the group of people with whom you want to hang out), then regardless of whether you have symptoms or not, make sure to either quarantine, or mask up and socially distance around the new clique, for 14 days. (Research shows that 99% of infected individuals show symptoms by the 14th day, meaning that if you don’t have symptoms by the 14th day of social distancing / mask wearing, then you have minimal chance of spreading COVID-19 from your previous clique to your new clique.) This simple protocol is nearly risk-free and can provide social butterflies a level of sanity in these trying times.
3) Stay humble and be kind to others.
Humility goes a long way. We all want to believe that we are safe and healthy, but COVID-19 is most contagious 1–2 days before we develop symptoms, if we even develop symptoms at all. Recent research has discovered that most adults are 50% likely to be asymptomatic, and children/teenagers from 10–19 year olds may be almost 80% likely to be asymptomatic! This means that 4 out of 5 teenagers with COVID-19 will not show any symptoms at all.
Because we don’t know if we are silent carriers, we should not take for granted that we could be silently transmitting the virus to someone else. Even someone who lives an incredibly safe lifestyle is not risk free. The virus propagates at random, and the more opportunity we give it to propagate, the more chance someone is going to get sick. The less chance we give it to propagate, the more likely the virus dies with us if we happen to unknowingly contract it.
Stay humble. Take preventative measures seriously.
4) Self-Organize and Start a Movement
I always hope that someone with a knack for hashtags will bring about a grass roots movement and organize large scale cooperative behavior to save lives. It has certainly happened around BLM, and it is unlikely to be any more divisive or confusing than the already contradictory messages coming from different states, the CDC, and the White House.
I would volunteer something along the lines of #freedomslide or #sharkwithlasers, but I’m sure there is something way catchier out there. Maybe YOU can be the one to start a viral meme.
Conclusion
Once we understand why it is insufficient to simply keep cases and deaths steady, we can start coming up with creative ways to organize, cooperate, and innovate to quickly drive cases and deaths down to a point where techniques such as contact tracing can be used to keep future outbreak from happening. Let’s use the slide. Wear our masks, stay away from crowds, avoid poorly ventilated spaces. Self-quarantine if you are showing symptoms, and let those who have been in close contact with you know to quarantine until you get tested. Let’s do everything we were doing back in April when we were taking the virus seriously. Maybe then, we can actually crush the virus and reopen for good.
And let’s keep praying for America. Don’t give up. We can overcome!