As I open this post, I want to call out the fact that I hope everything you are about to read turns out to be wrong – spectacularly wrong. That’s an outcome I’ve never wanted before. Yet, here we are. I want the societal effects from COVID-19 to be minimal with as few positive cases and deaths as possible. I want the impact on our healthcare system to be mild with a quick bounce back to normal. I want the economy to rapidly return to its previous trajectory of up, up, up. Who doesn’t want those things to happen?
Unfortunately, I’m worried that the reality will prove to be much more difficult and lengthy. There has been a lot of recent talk about re-opening the country with a big bang in two to three weeks and getting everything back on track again within a month or two at most. To me, that’s magical thinking and it ignores several major problems.
The impact of COVID-19 is going to run longer than most of us are ready to admit, especially for those of us who work in the healthcare industry directly or as partners. Many things we did in the past will not go back to "normal" for some time - if at all.
Here are a few barriers that I think will get in the way of a speedy recovery.
1. COVID-19 will hit us in waves. At least 4 and maybe more
The graphic above was shared by Victor Tseng, MD on Twitter. From Dr. Tseng:
"As our friends and colleagues brave the front lines, we must also get ready for a series of aftershocks. It's very hard to plan this far ahead while we're in survival mode. We must prepare early and strategize our response to the collateral damage of COVID-19."
What Dr. Tseng outlined in his graph is a recovery taking place in multiple stages. Yes, we will eventually get through phase 1 as the number of deaths and positive cases spikes and then recedes. Thanks to strong social distancing efforts, most states might be through the worst of it by the end of April. Yet, there are major questions to resolve for our healthcare delivery system to see normal levels of patient volume resume, including:
When will people feel safe to come back to hospitals and clinics for routine care and elective procedures?
Even if the number of cases is relatively low when we get past the peak case loads, will restrictions still limit what vulnerable populations can do?
Will COVID-19 come roaring back in the fall?
Can people actually get COVID-19 more than once?
What type of financial shape will our country's healthcare system be in? Layoffs, furloughs and other cost-cutting efforts have already been put in place at systems across the country. If the government doesn’t financially backstop hospital losses, hiring and staffing will take time to recover.
The answers to any of those (and more) is either totally unknown or unclear, but there is no possible way they all get resolved in under six months.
2. At minimum, 16 million people are unemployed
Comparisons to the Great Recession of 2008 are most often used to put what’s happening on the economic side into some relative perspective. Yet, as the chart here shows, the damage is actually quite a bit more severe. As above there are questions that gnaw at me when I try to think about how fast a reset will occur under these conditions. For instance:
How many of those 16 million jobs will actually come back?
When will people feel safe returning to restaurants, movie theaters, concerts, etc.?
Will those venues even be open or available in the next 3-6 months? In California, there is speculation that pro and college sports won’t come back until Thanksgiving at the earliest. The same goes for conferences, concerts, comedy shows and more. The list goes on and on. Sure, we’ll be able to leave our houses but not nearly in the same way as before.
The results of all this will be beyond what we’ve seen before:
"Economists predict that the immediate harm to workers due to COVID-19 will be worse than the labor market woes that we saw during both the Great Recession and Great Depression. The Economic Policy Institute forecasted that COVID-19 will cause a five-month decline in total US employment of 9.2 percent between February 2020 and June 2020. Comparatively, the size of the drop in total employment during the worst year of the Great Depression was only 4.9 percent. The size of the drop was 2.2 percent for the Great Recession—far lower than EPI’s estimate for 2020." - DC Fiscal Policy Institute
It seems likely that we won’t have anywhere near a full economy until a vaccine is available. And that’s likely to be 12-18 months away at minimum.
3. We need a massively well-coordinated, national effort on testing and monitoring
There is a great podcast and article from Ezra Klein on Vox that analyzes four major plans for opening the country soon. They all rely on a level of coordination, planning and cooperation yet to materialize from the federal government. Here are a few highlights of Klein's analysis:
“Over the past few days, I’ve been reading the major plans for what comes after social distancing. You can read them, too. There’s one from the right-leaning American Enterprise Institute, the left-leaning Center for American Progress, Harvard University’s Safra Center for Ethics, and Nobel Prize-winning economist Paul Romer.
I thought, perhaps naively, that reading them would be a comfort — at least then I’d be able to imagine the path back to normal. But it wasn’t. In different ways, all these plans say the same thing: Even if you can imagine the herculean political, social, and economic changes necessary to manage our way through this crisis effectively, there is no normal for the foreseeable future. Until there’s a vaccine, the United States either needs economically ruinous levels of social distancing, a digital surveillance state of shocking size and scope, or a mass testing apparatus of even more shocking size and intrusiveness.
My point isn’t to criticize these plans when I have nothing better to offer. Indeed, my point isn’t to criticize them at all. It’s simply to note that these aren’t plans for returning to anything even approaching normal. They either envision life under a surveillance and testing state of dystopian (but perhaps necessary!) proportions, or they envision a long period of economic and public health pain, as we wrestle the disease down only to see it roar back, as seems to be happening in Singapore.
What’s even scarier to consider is that the debate between these plans is far beyond the political debate we’re actually having. As of now, the White House has neither chosen nor begun executing on a plan of its own. That’s a terrible abdication of leadership, but reading through the various proposals, you can see why it’s happened. Imagine you’re the president of the United States in an election year. Which of these futures, with all its costs and risks and pain, would you want to try and sell to the American people?” - VOX
So where do we go from here?
I don't share any of this information to be an alarmist, but I still continue to feel that we are underestimating the length of the reset. My main takeaway is hope for the best, but prepare for the worst. Long-term thinking and planning will be key. And if you want an immediate action you can take, just do this: