“When we see ourselves in a situation which must be endured and gone through, it is best to make up our minds to it. Meet it with firmness, and accommodate everything to it in the best way practicable. This lessens the evil, while fretting and fuming only serves to increase your own torment.” — Thomas Jefferson
We are fretting and we are fuming. As a country, we have been caught miserably flat-footed after receiving warnings about what lay ahead when cases of COVID-19 began exploding in Wuhan, China. Messages from local and state leaders about how to respond to the pandemic change almost daily — a sure sign they have no idea what they are doing. Shutdowns are happening here in California and in New York, and will probably spread to the rest of the nation.
I spent the past week taking care of patients with COVID-19 at UCLA’s flagship hospital, and the atmosphere there is, appropriately, one of crisis — like other hospitals around the country. Before we bend to the next reactionary spasms of our political leaders, let’s take a look at what we know.
Epidemiologists around the world have studied patterns of our social contacts, studied our population density and studied the COVID-19 virus’ transmission characteristics. For better or worse, we actually have a lot of data to work with, thanks to the countries that have already been struck hard. Additionally, epidemiologists have been accurately modeling disease outbreaks for years. As someone who spent extra time in medical school to earn a Ph.D. focused on economics, statistics and decision analysis, I feel confident about the epidemiologists’ projections.
Shutdowns can't save overwhelmed hospitals
Here’s the problem: Because of the (understandable) fear and hysteria of the moment, few U.S. leaders are seriously talking about the endgame. The epidemiologic models I’ve seen indicate that the shutdowns and school closures will temporarily slow the virus’ spread, but when they’re lifted, we will essentially emerge right back where we started. And, by the way, no matter what, our hospitals will still be overwhelmed. There has already been too much community spread to prevent this inevitability.
We don’t have a totalitarian government like China, and we value our civil liberties too much to take the measures (i.e., total lockdown) that would be needed to rapidly decrease the infection rate to zero. This means that, even with shutdowns, the virus will still spread. Unfortunately, this also means that rates of “community immunity,” often referred to as “herd immunity,” will slow. As a result, we will always be vulnerable to the virus spreading rapidly again as soon as shutdown measures are lifted, unless they are immediately reimplemented — over and over and over again.
The only potential savior that would prevent this scenario is an effective vaccine, but the estimates I’ve seen put us 12–18 months away from making that a reality. Clinical trials are underway and will hopefully yield effective treatment, but a cure is unlikely. Either way, the models indicate that our hospitals, at current capacity, will be overwhelmed, with or without shutdowns.
As Americans, we could, if we set our minds to it, stay locked down for 18 months — but we won’t. Can you imagine a United States in which children are forced to forgo proper schooling, unemployment and poverty decimate millions more lives, and our economy is strangled into a persistent depression? And all for a virus that, when all is said and done, most people will recover from — even the elderly (death rates are highest in adults older than 80, at 10-20%)? The lockdown cost will be staggering — far more costly than COVID-19’s horrific wrath. This terrible trade-off is the path upon which we’ve set ourselves because our public health system was unprepared for a pandemic.
Please don’t believe politicians who say we can control this pandemic with a few weeks of shutdown. None of the models I’ve seen (or history’s teachings, or common sense) supports this as a possibility. As soon as restrictions are lifted, the virus will once again tear through our communities with abandon, until one day (hopefully) we have an effective vaccine. To contain a virus with shutdowns, you must either go big — which is what China did — or you don’t go at all. In this country, we hold liberty too dearly to go big; eventually, citizens will push back — hard.
Focus on economy and health care system
Tragically, over the coming weeks, as the numbers of people sickened and killed by COVID-19 increase — and they will — the resulting fear and the hysteria will be used to try to prolong the shutdowns. This move might work in some states that lean left, but states that lean right will resist. Short of a miracle, expect to see a tragedy unlike anything we’ve seen in generations. Heartbreakingly, people you know will die. Celebrities and politicians we all know will die. Hospitals will be overwhelmed and helpless.
Here is my prescription for local and state leaders: Keep shutdowns short, keep the economy going, keep schools in session, keep jobs intact, and focus single-mindedly on building the capacity we need to survive this into our health care system.
We desperately need more intensive care unit beds and ventilators to give the severely ill a chance of survival: Borrow them, buy them, build them, convert structures to coronavirus-dedicated centers, etc. We must do whatever is necessary — and do it yesterday. And for heaven’s sake, where on earth are the COVID-19 tests?
At this point, no matter what we do, we tragically will lose many Americans. Short of a miracle treatment, it’s too late for any other outcome. However, our economy, people’s jobs and livelihoods, and the education of our children should not become collateral damage. We must not let ill-informed, fear-fueled policy compound the casualties of COVID-19.
Dr. Joseph A. Ladapo is an associate professor of medicine in the division of General Internal Medicine and Health Services Research at David Geffen School of Medicine at UCLA. The views expressed are those of the author and not necessarily those of UCLA.
You can read diverse opinions from our Board of Contributors and other writers on the Opinion front page, on Twitter @usatodayopinion and in our daily Opinion newsletter. To respond to a column, submit a comment to firstname.lastname@example.org.
This article originally appeared on USA TODAY: Are coronavirus shutdowns worth it if public health system unprepared?