After the Pandemic: Coming to Grips with the New Normal

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A sample is collected during enhanced screening for COVID-19 testing at a drive-up checkpoint at Madigan Army Medical Center.
A sample is collected during enhanced screening for COVID-19 testing at a drive-up checkpoint at Madigan Army Medical Center on Friday, March 27, 2020 on Joint Base Lewis-McChord in Tacoma, Wash. (U.S. Army John Wayne Liston)

Joseph V. Micallef is a best-selling military history and world affairs author, and keynote speaker. Follow him on Twitter @JosephVMicallef.

It took SARS-CoV-2, or COVID-19, roughly 100 days to travel from its epicenter in Wuhan, China, to more than 180 countries around the world. In the process, it unleashed the greatest pandemic since the 1968 Hong Kong flu.

The social distancing and shelter-in-place policies adopted by many countries have been in force, on average, about 60 to 100 days. Those policies are now starting to be relaxed as economies in much of the developed world begin transitioning to what has been dubbed the "new normal."

What exactly is the new normal? If the media pundits are to be believed, in the new normal you will never shake hands again; your season tickets are probably worthless since attendance at live sporting events or concerts are a thing of the past; an ocean cruise is the equivalent of Russian roulette; and Plexiglass is your new best friend.

Face masks and temperature checks will be ubiquitous and often mandatory, and everyone, both consumers and businesses, will have an obsession with cleanliness.

Is this what the new normal has in store? Is this outcome inevitable, necessary or desirable?

Do We Need a New Normal?

Let's start with some definitions and a review of some recent history. Social distancing refers to the practice of maintaining a minimum distance from others to avoid the risk of contact with the COVID-19 virus. Shelter in place refers to the practice of self-quarantining, typically in your home, unless you are friendly with a billionaire who has space on his megayacht.

The two terms are often used interchangeably to describe the same policy response. They are, in fact, quite different. Sheltering in place is an extreme form of social distancing and comes at a considerably higher economic cost.

The rationale for both policies was to "flatten the curve" and stretch out the incidence of disease outbreak so patients would not overwhelm the ability of the medical system to care for them. Doing so, it was argued, would prevent otherwise treatable patients from dying from lack of care. It was recognized that flattening the curve would not reduce the extent of the disease outbreak, just the speed at which it would spread and the peak level or spike of infections.

That objective was achieved. The curve was flattened. Regardless of how you feel about the efficacy of the Trump administration's response, Donald Trump is correct in pointing out that, notwithstanding some 80,000 deaths, no one died because they lacked access to a ICU bed or for lack of a ventilator.

Hospitals in New York City and a handful of other cities were strained to their limits but proved resilient. The surge capacity that the U.S. military could bring to bear proved more than sufficient to shore up those hospitals. In fact, it turned out to be overkill, as little if any of that additional capacity ended up getting used.

Initial shortages of ventilators, face masks and other personal protective equipment were overcome through a combination of American technical and entrepreneurial ingenuity backed up with that universal solvent, cold hard cash. Even personnel shortages and crushing work schedules were, eventually, alleviated by bringing in military and out-of-state medical personnel.

In short, putting aside the question of whether the initial projections were overstated, the strategy worked. So why are so many governors reluctant to end those policies?

Along the way, in a phenomenon that military personnel are all too familiar with, the mission changed. Mission creep set in. Suddenly, shelter-in-place and social distancing policies were not just about flattening the curve but about preventing additional infections and deaths.

That is not what those policies were designed to do. They will ultimately be ineffective in achieving those objectives, and the economic cost of continuing to implement them will crush the American economy and eventually erode its military power. Much of what is being called the new normal is the direct result of continuing these policies to achieve objectives they were never designed for.

There is a great deal about the SARS-CoV-2 that we still do not know, and this makes crafting a strategy for reopening the economy difficult. Most viral pandemics tend to abate in the summertime. Will that also hold true of the COVID-19 pandemic? Viral pathogens also tend to become less virulent with the passage of time. Will the SARS-CoV-2 do the same?

Enormous resources and talent are being devoted to developing a COVID-19 vaccine. Will we ever have a vaccine? Much of the presumption of the new normal assumes that no return to normality is possible unless a vaccine is available and that, until then, some measure of social distancing will continue.

Viral vaccines are tricky to develop because the simple genetic structure of viruses makes them highly prone to mutation. That's one of the primary reasons why vaccines to prevent influenza outbreaks are so difficult to create. We may never have a COVID-19 vaccine. Even if we do, it may not be 100% effective -- it may reduce the risk of contagion, but not eliminate it.

Lessons from the Past

Viral pandemics are nothing new. Major pandemics seem to occur about once a generation. In addition, the yearly influenza outbreaks have many pandemic-like features. They affect millions of people around the world, and result in the deaths of hundreds of thousands. To be clear, COVID-19 is not the same as influenza. The ravages on the body that it inflicts are much more extensive. It may be more contagious. On the other hand, while its lethality is higher than the average flu pandemic, it is much lower than initially believed and not much higher than a very severe flu outbreak.

Yearly influenza outbreaks produce mortality rates of between .1% to .2% among those infected, with up to 5% to 20% of the population falling ill. This rate of contagion and lethality correspond to a yearly death rate of roughly 150 deaths per million people -- about 50,000 people. Bear in mind that the Centers for Disease Control doesn't actually count deaths attributable to the flu.

The numbers are based on models that look at the increase in deaths during flu season.

The most recent estimate is that the lethality of COVID-19 is about .4% to as much as .6% of those infected -- about 500 deaths per million people. That means that the lethality of COVID-19, if there is no vaccine and if going forward the SARS-CoV-2 mutates sufficiently to produce new pandemics each year and maintains its current virulence -- admittedly an extremely pessimistic scenario -- is upward of 160,000 deaths a year. This is about 20% higher than the current estimates from the Institute of Health Metrics and Evaluation (IHME) model developed by the School of Medicine at the University of Washington.

Mortality rates depend on which variant of the SARS-CoV-2 virus we examine. It is believed that there may be as many as 30 different variants of this virus. The type most prevalent on the West Coast of the U.S. is like the variant found in Wuhan. The main version in New York City, which arrived via Italy, is more virulent and appears to have mutated, in part, as a result of its exposure to the Italian viral fauna. This is typical of how viruses mutate and why they change both during a pandemic and over subsequent years.

This scenario assumes that shelter-in-place and social distancing policies, for the most part, end. That would make recurring COVID-19 pandemics the equivalent of two to four times as lethal as the yearly flu pandemics. That is not an insignificant number, but it is one that would be manageable in the context of the size of the American population and economy and the existing medical infrastructure.

Moreover, these assumptions greatly overstate the likely lethality. For one thing, some sort of shelter-in-place and social distancing rules would likely be imposed on at-risk populations. Moreover, there is bound to be a significant overlap in mortality between influenza and COVID-19 victims. You can die from either one, but you cannot die twice. Some percentage of the deaths attributed to COVID-19 would have occurred from influenza anyway.

The point is, that with precautions for at-risk populations and the continuation of the less intrusive forms of social distancing, there is no need for a new normal to be defined by the continuation of the present broad scope of social distancing and shelter-in-place policies. The old normal will, to a large degree, work just fine, albeit with ever present face masks, temperature monitoring and incessant cleaning.

Continuing sheltering in place until a vaccine can be administered is not a realistic option. The economy can and must open up. That does not mean that there won't be flare-ups or localized infection outbreaks. The virus is now widely established in the U.S. Short of putting everyone in a plastic bubble, we are not going to eliminate it. The mortality associated with it, however regrettable, is now a fact of life.

So-called second waves are inevitable and will occur regardless of whether sheltering in place is continued. It's estimated that some two-thirds of infections in New York City, for example, occurred among people already following shelter-in-place directives.

Local flare-ups, regional spikes, and ebbs and flows in hospitalization and mortality do not mean that the economy was opened up too quickly or that government health policy has failed. These types of developments were going to happen regardless of when the economy reopened. The reopening schedule determined the pace and amplitudes of those developments, not their existence.

In times of crisis, it's common to look for historical antecedents, both for a guide to potential responses and for visibility of what might happen next. Historical examples also give reassurance that if past crises were successfully dealt with, the current one can be also. The example most often cited is the 1918-19 Influenza Pandemic. The 1918 pandemic is not directly applicable, however, and the lessons derived from it are misapplied in the present situation.

The influenza pandemic of 1918-19 is being extensively studied for insights into how the COVID-19 pandemic will play out and what the long-term consequences may be. The suggested outcomes range from a repeat of the hedonistic Roaring 1920s, to mounting barriers to world trade, a rise in nationalist sentiment and growing isolationism.

Approximately 50 million people died worldwide from that pandemic. Most of those deaths, however, were from secondary bacterial infections, like pneumonia. The availability of a broad range of antibiotics, however, means that such secondary infections are far less lethal and much more manageable today than a century ago.

The 1968 Hong Kong flu is a more applicable example to the COVID-19 pandemic. The 1968 flu pandemic was caused by the H3N2 influenza virus. It infected between 200 million and 400 million people worldwide. Fatalities were around one million globally, and approximately 100,000 in the U.S.

To date, the U.S. has lost approximately 80,000 people to COVID-19 -- the equivalent of about 45,000 people in 1968. The 100,000 deaths in 1968 would be the equivalent of around 160,000 deaths today. That's at the high end of current projections of deaths from the COVID-19 pandemic. We may never know the true number. We probably undercounted some early deaths and misattributed recent ones.

Based on current testing in the U.S., it appears that approximately 10% of the U.S. population is carrying COVID-19 antibodies. That number is likely overstated, since the testing is focusing on individuals more at risk, but is generally consistent with the 1968 Hong Kong flu. Adjusting for population growth in the U.S. and around the world, the current lethality of COVID-19 and the Hong Kong flu have similar trajectories, even if the pathogens are different and COVID-19 turns out to be more contagious.

What happened to the H3N2 influenza virus? It's still around, significantly less lethal than in the past. Periodically, it flares up as one of the virus strains in the annual flu outbreak. What is most significant about the 1968 pandemic, however, is that we did not shut down the U.S. economy as a result. Even music concerts continued. This was, after all, 1968, the year before the summer of love and of the infamous Woodstock music festival.

Health and Big Brother

There is one aspect of the anticipated new normal that is deeply troublesome -- one that will survive both the end of social distancing and shelter-in-place policies.

The COVID-19 pandemic has produced an enormous expansion of governmental authority at both the state and federal levels. On the premise of regulating public health, many state governors have taken it upon themselves to determine what businesses can stay open and which must close and, in some cases, even what retailers are allowed to sell.

Shelter-in-place directives have been used to regulate public gatherings like church services, determine how many people can go on a boat (regardless of its size), or to prohibit individuals from leaving their homes for a walk.

Some elected officials, in a move that would have made the East German Secret Police, the STASI, proud, have called on citizens to spy on their neighbors and to report to police those who violate shelter-in-place directives.

Even more worrisome are proposals by companies like Apple or Google to track the movement of individual Americans in order to facilitate social tracing -- the identification of people who have been in close proximity to infected individuals. In Hong Kong, leaders of the pro-democracy movement have already accused Chinese security authorities of using social tracing to identify supporters of the group.

Additionally, social media sites like YouTube, Twitter and Facebook have announced that they will censor posts that they believe constitute misinformation on the COVID-19 pandemic.

The trouble with that policy is that misinformation is being defined as any posting that runs contrary to the conventional wisdom, even though events have shown that such wisdom has often been wrong. Censoring such posts is nothing less than the suppression of anything that challenges the official orthodoxy.

Equally worrisome is that many states are organizing armies of social tracers to identify the contacts of individuals who test positive for COVID-19. Social tracing plays an important role in limiting the spread of the disease. The creation of an army of social tracers, however, feels perilously close to a sort of hygienic secret police: a modern-day inquisition designed to enforce state imposed medical orthodoxy.

Experience indicates that such organizations, once created, tend to persist and their mandates to expand, even when their official purpose becomes obsolete. The potential for such organizations to become overly intrusive, especially when they have access to contact and movement information from cellphones, is very troubling.

George Orwell would have no trouble recognizing this new normal -- in which Big Brother, in the guise of protecting your health, is constantly looking over your shoulder. He described it eloquently more than 70 years ago.

Benjamin Franklin summed it up best when he observed, "Those who would give up essential liberty, to purchase a little temporary safety, deserve neither liberty nor safety."

While the context of Franklin's quote remains hotly debated, its essential message is clear.

The erosion of individual rights at the hand of big government and big tech may be the overriding legacy of the COVID-19 pandemic and the defining feature of the new normal, and that is frightening.

-- The opinions expressed in this op-ed are those of the author and do not necessarily reflect the views of Military.com. If you would like to submit your own commentary, please send your article to opinions@military.com for consideration.

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