In part 1, we looked at the situation before the peak and how it might go during the peak. In part 2, we look at how things might be during the decline and ultimate end of the epidemic. This is a scenario that neither an epidemiologist nor and economist would favor in their respective perfect worlds. It attempts rather, to recognize that a balance will have to be struck. and in that pursuit, some of the key decisions that will have to be made.
As we approach the second shoulder of the bell curve, we’ll have some decisions to make. With hundreds, possibly thousands of people cured by Hydroxychloroquine, it will be time to seriously consider making the use of that drug prophylactically for medical professionals. If this were a malaria outbreak rather than a coronavirus epidemic, prophylactic use of the drug would be a no-brainer. Also, to the degree that drug treatment is used and successful, there will be a corresponding decrease in the number of ventilators needed. At this point, manufacturers can start to ramp down production of ventilators. Companies making PPE and producing drugs will still need to go flat-out in their production efforts.
Another decision we’ll have to make around this time is whether to continue with the general, lockdowns or whether to concentrate efforts to protecting the elderly and other high-risk groups, a strategy currently being employed by the Netherlands. As the drug supplies increase, this tact will become more and more viable. The hard part will be finding a governor willing to be the first guinea pig for this strategy. By this time, there will be growing pressure to reopen the economy. Eventually, that pressure will grow to be overwhelming and will become policy, its just a matter of time. At this point, there will be a demand for objective numbers for beginning to lessen restrictions. The metrics should be based upon capacity versus use. The number should not be based upon there being zero deaths, as that would put the decision-makers in an impossible position of having to say how many deaths are acceptable. If we’re being honest with ourselves, it’s not the criteria we use for controlling seasonal flu outbreaks. We don’t demand the shutting down a state until there are zero flu deaths in that state. A number to start at might be when ventilators in ICU’s are about twenty-five percent of capacity or their pre-epidemic levels. Since we should still be producing PPE and drug treatments full out, we need to look at how many weeks supply we have. Once we have an on-hand supply of those items equal to the number of weeks at the plateau phase, we can start drawing down and returning companies that have retooled back to making their original products.
After a period of time of constant decline in case numbers, we can start phasing out work and travel restrictions. People who have recovered from the disease and those who test positive for the antibodies can return to work, although certain businesses like movie theaters, bars, and restaurants will likely have to remain closed. A huge key to accelerating the pace of the phased-in return to work will be the availability of the coronavirus antibody test. Of course, the holy grail of COVID-19 tests would be an OTC at-home test, or at least one available at every corner drugstore. If we can get to that point, the crisis will be all but over.
There will be a period of time, probably through the end of the year where we’ll be out of the crisis mode, but COVID 19 will still be a huge concern. During this time we will still be practicing social distancing and hopefully the personal hygiene habits that serve to mitigate not just coronavirus, but the seasonal flu. As more people start to spend time out of the house, there will be spikes and flareups of the virus. What will keep those from reaching crisis levels will be the availability of hospital bed space and especially ventilators. Barring some complications developing with the use of certain drugs and treatments, they will be as routine as any other treatment for serious illness that has been around for a while. Now, with luck we will have thousands of successful treatments for critically ill, those treatments might start to be used earlier, at the first signs of sickness, rather than last-ditch efforts. Again, barring some reason not to, prophylactic use as prescribed by physicians, can spread beyond medical professionals to the general public.
Once we get to this post-crisis phase our stock market can be expected to skyrocket. Establishing objective goals for lessening restrictions on commerce will go a long way towards re-establishing the markets. Wall Street likes predictability and hates unpredictability. Once standards are adopted for restoring commerce are established, even if the virus is not totally eradicated, investors can work with that. Also as we lessen work and travel restrictions, there will be a tremendous pent up demand for nonessential goods and services.
The final chapter of the COVID-19 recovery will take place with the development of a vaccine. The earliest we can expect this we’re told is late 2021. Before that point that though with any luck, hospitals will be going days or even weeks without any COVID-19 patients. In this final phase, restaurants, bars, theaters, and sports arenas can get back into business. At some point, between the post-crisis phase and the final phase, public demand to have entertainment venues reopen will become overwhelming, and city by city, state by state, these places will open for business again. We will also be able to open up our borders and start to reestablish international commerce and tourism. We will then finally, have the coronavirus behind us.