The Hammer and the Dance

I’m giving way to Tomas Pueyo, author of the article “The Hammer and the Dance.” He has much to share with us. The original is long on scholarly research. I rewrote it to suit editorial requirements and make it reader-friendly.

Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.

What’s the situation? Covid-19 has infected 188 countries and territories in six continents. It looks like most countries won’t escape the coronavirus. It’s a matter of time before they see outbreaks and need to take measures. So, what are our options?

Option 1: Do Nothing. If we do nothing: Everybody gets infected, the healthcare system gets overwhelmed, the mortality explodes, and lot of people will die. There’s only two numbers that matter: What share of people will catch the virus and fall sick, and what share of them will die. If we don’t do anything, the number of deaths from the coronavirus will run out of control.

Collateral Damage. What happens if our healthcare system collapses due to the overwhelming number of coronavirus patients? Many more will die from other ailments. It means healthcare systems will collapse and mass death. It’s pretty clear that doing nothing is unacceptable. We should act and there are two options open to us: mitigation and suppression.

Option 2: Mitigation Strategy. Mitigation goes like this: “It’s impossible to prevent the coronavirus now, so let’s just have it run its course, while trying to reduce the peak of infections. Let’s just flatten the curve a little bit to make it more manageable for the healthcare system.”

The mitigation strategy not only assumes millions of deaths but also gambles on the fact that the virus won’t mutate too much — which we know it does. And it will give it the opportunity to mutate. So once we’re done with a few million deaths, we could be ready for a few million more — every year. This coronavirus could become a recurring fact of life, like the flu, but many times deadlier.

So if neither doing nothing and mitigation will work, what’s the alternative?

Option 3: Suppression Strategy. The Suppression Strategy tries to apply heavy measures to quickly get the epidemic under control. We cut the exponential growth of cases and the fatality rate since the healthcare system isn’t overwhelmed. But why do some governments hesitate? They fear three things:

1. This lockdown will last for months, which is unacceptable.

2. A months-long lockdown would destroy the economy.

3. Once physical distancing is lifted, people will still get infected and die.

THE VALUE OF TIME IN SAVING LIVES
Every second the world waits or hesitates to take measures, this exponential threat will continue spreading. The world’s facing an enemy it doesn’t know enough of, which leaves us with two options: Run towards it or escape to buy time to prepare. With effective suppression, the number of true cases and fatality rate would drop; and collateral damage would be minimized. Fewer people would die from other causes and the healthcare system will remain standing.

UNDERSTAND THE TRUE PROBLEM: TESTING AND TRACING
Right now, we have no idea about our true cases, how many there really are. We just know the official number isn’t right — that it could be exponentially higher — because we’re not testing and tracing enough. Once we do, we’ll have better information and know where to be more aggressive, and what communities are safe to be released from a lockdown. If we know where the virus is, we can target these places only.

BUILD UP CAPACITY
Let’s do everything to get our production humming now. Mobilize. Be inventive. We need to triple time. We also need health workers as soon as possible to replace those who fall to the virus and reinforce depleted hospitals. Where will we get them? We need to train orderlies and get medical workers out of retirement. The soonest we get our act together, the better for us in the long-run.

Here’s what a true Suppression Strategy would look like.

THE HAMMER
First, act quickly and aggressively. The time needed for the Hammer is weeks, not months. The model is South Korea. The virus there is now largely under control. They achieved it mostly with very aggressive testing, contact tracing, while enforcing targeted quarantines and isolations. They were prepared for it with stronger epidemiological authority. The population was educated on hygiene and social distancing. Early detection, isolation, discipline, execution, and obedience were crucial to the equation.

THE DANCE
How come South Korea, Singapore, Taiwan and Japan didn’t lock down? The South Korea Foreign Minister explains how her country did it. It was pretty simple: efficient testing, efficient tracing, travel bans, efficient isolating, and efficient quarantining. They complemented with economic help to those in quarantine and travel bans and delays. Even if one is infected, isolation will limit one’s capacity to spread the virus. Lessons learned:

a. If people are massively tested, they can be identified even before they have symptoms. Quarantined, they can’t spread anything.

b. If people are trained to identify their symptoms earlier, they reduce the number of days in public, and hence their overall contagiousness

c. If people are isolated as soon as they have symptoms, the contagions from the next phase disappear.

d. If people are educated about personal distance, mask-wearing, washing hands or disinfecting spaces, they spread less virus throughout the entire period.

CONCLUSION: BUY US TIME
The coronavirus is still spreading nearly everywhere. For the countries where the coronavirus is already here, the only viable option is to fight. The world needs to get its act together now and fast.

Rafael M. Alunan III is a former Secretary of Interior and Local Government and chairs the Philippine Council for Foreign Relations.

rmalunan@gmail.com