Joseph V. Micallef is a best-selling military history and world affairs author, and keynote speaker. Follow him on Twitter @JosephVMicallef.
We are now into Week Four of a de facto national shutdown. You can quibble on the differences between a quarantine, a shutdown or a shelter-in-place order. The net result is the same. As of April 8, 42 states and the District of Columbia have issued shelter-in-place orders covering more than 95% of Americans.
These shutdowns are driven by the strategy of "flattening the curve," slowing down the spread of the COVID-19 pandemic to ensure that the number of patients who need hospitalization do not exceed the capacity of the medical system to treat them.
Presumably, overwhelming the medical system would result in fatalities that would otherwise have been treatable had there been enough medical personal and hospital capacity.
Saving human life is laudable. The question is which strategy is optimal. How is that strategy to be framed, the debate to be conducted and, more importantly, can we forge a bipartisan consensus around that decision?
The economic carnage precipitated by the pandemic is clear. Financial markets around the world have lost on average a quarter of their value, the equivalent of trillions of dollars. Unemployment has soared. Overnight, we've gone from seemingly full employment to 10 million newly unemployed Americans. It's estimated that the de facto unemployment rate, currently around 10%, could reach 30% or more -- levels not seen since the Great Depression.
A quarter of all small businesses are in danger of failing. Businesses representing roughly 29% of economic activity are offline. The federal government has stepped in with trillions of dollars of loan guarantees and direct grants to businesses and individuals to try to stabilize the economy. In the process, Washington's deficit spending is approaching percentages of gross domestic product (GDP) not seen since World War II.
Call it what you will: this virus has done what no foreign enemy has ever accomplished. It has crippled the American economy and brought the country to its knees. This is the economic equivalent of another Pearl Harbor, but one on what hitherto would have been an unimaginable scale.
Modeling and the COVID-19 Pandemic
Epidemiologists determine how to deal with disease outbreaks. They are the strategists who develop the battle plans and mobilize the troops of medical personnel that fight the disease in the metaphorical trenches and battlefields of the war. Pandemics are the military equivalent of a world war -- one that potentially can pose an existential threat to the nation.
A variety of models have been proposed to explain the spread of the COVID-19 pandemic and to assess its ultimate lethality. To be fair, these models do not predict a specific outcome, only a range of possible scenarios depending on government policy, societal behavior and the characteristics of the pathogen.
The Imperial College in London, for example, produced a model indicating that deaths in the United Kingdom could range from the tens of thousands to half a million. Its prediction for the U.S. postulated several hundred thousand to a worst-case scenario of more than 2.2 million deaths. The most dire outcome was publicized in the press.
White House coronavirus task force adviser Dr. Deborah Birx has indicated that the White House has examined about a dozen different models of how the pandemic will progress.
The Trump administration is relying primarily on a model developed by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle (IHME), an organization with whom Birx has been previously connected.
The IHME model assumes a widespread policy of social distancing. As of April 8, it is predicting 60,415 U.S. deaths between early March to early August, with a possible range of 40,000 to 178,000. The daily mortality rate is expected to peak on April 15.
The purpose of these models is not simply to predict the ultimate number of people stricken or the mortality, but to assess logistical needs over the course of the pandemic. To do this, they have to make assumptions about the effectiveness of government policy and societal behavior. It was this model's projections of peak needs that drove adoption of the social distancing policy.
How well is social distancing working? Judging by traffic on New York City's 5th Avenue, very well. But considering the throngs on Florida's beaches during spring break, not at all.
In formulating these models, epidemiologists also must make educated guesses about transmission rates, the demographics of the sick, the number of sick who are asymptomatic and how long the pathogen has been in circulation, among other potential factors.
The problem is that our knowledge of these factors is incomplete. That can result in widely differing assumptions and models that have substantially different predictions of both peak needs and mortality.
China has the oldest data, but the Chinese data is considered suspect by many. Recently, for example, Chinese officials disclosed that people who had been infected but were asymptomatic were not counted as part of the sick. It's estimated that half of all cases are asymptomatic.
Officially, China's mortality was about 3,200 people. U.S. intelligence sources believe that the actual mortality was much higher -- as much as 40,000 or more. Anecdotal evidence suggests that the mortality was indeed higher, but how much higher is unclear. We may never know the answer.
Italy has been decimated by the pandemic. The course of the disease there is some two weeks ahead of the U.S.
Is the Italian experience a good guide to what's in store for America?
Italian medical authorities have already disclosed that the number of official deaths is inaccurate. Many of the people whose deaths were attributed to COVID-19 died from other causes, although the pathogen was a contributory factor. Alternatively, there are others who died from the pathogen that were never diagnosed because they were never formally admitted to a hospital. We will never really know how many people in Italy died from COVID-19.
Moreover, it is hard to generalize about the Italian experience because different regions followed very different strategies. The Veneto, the provinces around Venice, adopted an aggressive strategy of contact tracing, mandating a quarantine of those individuals who had contact with the sick to prevent them from infecting others. This was similar to the strategy that South Korea followed. Deaths in the Veneto region have been limited to a few hundred.
In Lombardy, on the other hand, there was little attempt at tracing the social contacts of infected people. Social distancing was mandated, but it's unclear how effectively it was enforced, at least in the early days of the pandemic. That region has been decimated, hospitals have been overwhelmed and the death toll has been in the thousands.
Moreover, Lombardy is the center of the Italian apparel industry, as is Wuhan in China. There are many Chinese apparel firms with factories in Lombardy, and there is a much larger Chinese presence, roughly 100,000 expatriates, in that region than elsewhere in Italy.
Did that play a factor in how the disease spread in Lombardy? Does the large amount of traffic between Milan and Wuhan mean that the disease was already widespread in the region before it was discovered? We don't know whether these factors are germane to understanding the progression of the disease in Lombardy or irrelevant.
What are we to make of the "Italian data" that is frequently mentioned at the White House briefings? Which Italian data should we be using, that from the Veneto or that from Lombardy? You can raise the same question for data from other countries. How different are their circumstances from those in the U.S. and how relevant will they be to understanding how the disease will progress in America?
The problem with models is that they can give a false sense of certainty, a sense of mathematical precision that is nonetheless based on a set of presumptions that are at best guesses and at worst can be completely wrong. Moreover, it is difficult to know for certain whether the policies engendered by a model's predictions successfully modified the outcomes.
Winston Churchill, who dealt with his share of global crises over his lifetime, summed it up best when he observed "scientists should be on tap, not on top."
It's likely that mortality rates in the U.S. will be far lower than the dire predictions made by the epidemiological models. Is that because the social distancing and shelter-in-place policies they precipitated changed the outcomes or because their predictions were simply incorrect?
When disease outbreaks occur, epidemiologists search for patient 0. By tracing that person's contacts, they can better understand how the disease spread. In the case of COVID-19 in the U.S., patient 0 has been identified as a 35-year-old resident of Seattle who returned from Wuhan and who was diagnosed with the disease on Jan. 20.
We will never know who the real patient 0 is, however, because it is likely that there were earlier patients who were either asymptomatic or whose affliction was simply misdiagnosed as a bad cold or flu.
Victor Davis Hanson, the distinguished military historian at the Hoover Institute at Stanford University, for example, has pointed out that California is not experiencing the same spike in infections as New York.
Hanson suggests that a possible explanation is that the disease was already rampant in California, as indicated by a spike in reports of particularly bad flu cases during November and December.
He points out that millions of Chinese tourists travel to California each year. It's possible, he reasons, that the disease has already run its course in California and that a large percentage of Californians are already immune to it, a phenomenon that epidemiologists refer to as herd immunity or tribal immunity.
Critics can point out that Hanson is not an epidemiologist and that the absence of a spike of infections in California is the result of Gavin Newsom being the first governor to issue a shelter-in-place order. Hanson could be wrong; then again, he could be right.
Not surprisingly, these models, overall, haven't been very accurate. The IHME model predicted that New York state would have a total of 56,000 hospitalizations by April 3. The actual number was 13,400. That prediction was what drove New York Gov. Andrew Cuomo's demand for 40,000 ventilators.
There were three states in which the model underestimated the rate of hospitalization. These were all states where the incidence of the disease was very low and the variation in the required hospital beds was minor.
In every other state, the model's prediction of hospitalizations was two to four times higher than the actual experience. In Louisiana, for example, likely the next hot spot, the model predicted 5,800 hospitalizations, while the actual number was 1,600.
Of course, these projections were the midpoints of possible ranges. You could argue, as in the case of California, that the lower numbers reflect the success of government actions rather than inherent flaws in the model.
Politics and Decision-Making Under Uncertainty
There is a larger issue, however, which the pandemic has underscored, one central to the future of the American republic.
Decision-makers are often called on to make decisions in an opaque environment, under conditions where information is incomplete, possibly inaccurate or unknowable. That is as true for the military battlefield as it is of the corporate boardroom and government policymaking. Napoleon famously referred to it as the "fog of war." Crafting a response to the COVID-19 pandemic is no different.
What does the Trump administration's response to the coronavirus pandemic tell us about how public policy is formulated in this country? It tells us that public policymaking has become so polarizing, so politically divisive, so antagonistic, that it makes a rational, dispassionate, objective policy formulation all but impossible.
The last few weeks have showcased the best and the worst of contemporary American life.
On the positive side, individuals and industry have rallied to deal with a national crisis -- in the process, showcasing the ingenuity, determination and brilliance that has made America great.
Whether it's innovative therapies, new vaccines or repurposing private industry to make everything from hand sanitizer to face masks to ventilators, Americans have responded with equal measures of creativity and a steadfast determination to crush the pandemic.
What can you say of the thousands of medical personnel who knowingly and willingly put themselves in harm's way to care for the sick with the same selfless devotion of the Americans who fought for their country from Guadalcanal to the Syrian desert? "Thank you for your service" seems hopelessly inadequate.
But there is also the worst of America.
I am not a fan of the Trump administration. I have often criticized its policies. That doesn't mean I disagree with everything it has done. Trump was right, for example, to insist that NATO's members live up to their commitment to spend 2% of GDP on defense. He was equally right to insist that the U.S. needs to control its borders, even though I disagreed with the anti-immigrant rhetoric.
Notwithstanding those disagreements, as an American, I am appalled by the open contempt and disdain that some members of the White House press corps exhibit at the daily press briefings, especially because their behavior underscores a much deeper problem with how the media reports news.
In the middle of a national crisis, which has many Americans terrified about both their health and their economic future, most of the press corps can do little more than preen for the cameras, as they recite the same pointless gotcha-questions in a never-ending quest to showcase some mistake the Trump administration has made. Their performance does little to clarify issues or advance a rational debate.
Let's face it, the Trump administration is going to make lots of mistakes in how it deals with the pandemic. So would any other administration, regardless of its political affiliation. Given the nature of the crisis, and the imperfect information on which decisions are made, mistakes are inevitable. What matters is to fix them when they're discovered and move on. If perfection is the standard we intend to apply to our government, then we will be hard-pressed to find qualified candidates for public office, and we will be perpetually disappointed.
Congress isn't much better. Here again, it is appalling that a national crisis is reduced to a zero-sum game of political calculus or that partisan political agendas would supersede it. The fact that the Cares Act became an opportunity to fund a whole stable of special interests that had nothing to do with the crisis is unconscionable.
Last week, Speaker of House Nancy Pelosi announced that she would impanel a special oversight committee to investigate the Trump administration's handling of the COVID-19 pandemic. Is this a prelude to Impeachment 2.0? If the founding fathers had wanted Congress to pick the president, they would have opted for a parliamentary system of government. They did not!
There will be a time to take stock of how the Trump administration handled the pandemic, just like there will be time to write the definitive history of the great pandemic of 2020. But now is not that time.
Can you imagine if the Roosevelt administration's conduct of WWII had been subjected to this sort of ceaseless, real-time scrutiny? If every reversal, and there were many, had been subjected to endless congressional investigations designed to find the White House culpable?
America entered WWII sharply divided across a political chasm that pitted conservative Republicans against what they saw as the Socialist roots of Roosevelt's New Deal, America First isolationists against internationalists in a landscape of racial conflict and labor versus business unrest. Indeed, at the time, the 1930s was widely considered the most polarized era in American history since the Civil War. Yet over the course of the war, these divisions were put aside to create a bipartisan Arsenal of Democracy. Sadly, a repeat of such bipartisanship seems beyond reach today.
Paradoxically, in neighborhood after neighborhood, Americans have come together while tone-deaf political and media elites continue to preach a gospel of perpetual rage and divisiveness. Is there an underlying economic driver to the politics of perpetual rage? After all, rage makes for good television, and good television makes for better ratings. The perpetual escalation of rage that dominates the national media really is "MAD," because it creates a climate of mutually assured destruction that is shredding the social fabric of America.
I am not convinced that shutting down the U.S. economy was the correct response to the pandemic. It is increasingly clear that many of the direst predictions were based on flawed data, and that the inherently imperfect nature of those models should make us hesitant to be overly reliant on them or to use them as the basis for crafting a national policy, especially one with such enormous financial consequences.
At the same time, in the absence of a rational, bipartisan policy formulation, it may have been the only option. Had the Trump administration opted to follow Sweden's example of protecting those groups most at risk, but otherwise letting the epidemic burn itself out in a quest for quickly building herd immunity, it would have been subject to relentless opposition in Congress and in the media, accused of "sacrificing American lives to save the Dow Jones."
We will likely never know whether an alternative strategy would have been both less destabilizing economically and ultimately would have saved more lives in the long term. Like the misguided policy of stamping out yearly forest fires only to ultimately create deadlier, more destructive fires, our unwillingness to accept short-term pain in return for a greater long-term good will inevitably lead us to accept policy alternatives that in the long run will do more harm.
More importantly, our inability to have a rational national dialogue and forge a bipartisan consensus on how to proceed in the face of a national crisis exposes a weakness that goes to the very viability of the American republic.
We will survive the pandemic of 2020, though at great human and economic cost. We will be the poorer for it, perhaps unnecessarily so. Our inability to have a rational, bipartisan discussion, however, will be our undoing.
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