I keep hearing the argument that suppression will cause an economic depression, and that that is not worth it to save some old people. In this article, I argue that even if we attempted a lower-impact mitigation strategy, the death toll would be so horrific that the reaction of the market would be similar to the effect of a suppression strategy — except with many unnecessary deaths.

If you’ve been wondering, “What made Trump do this sudden 180? What finally convinced him that COVID-19 is real, and important?” — the answer, apparently, is new report by Imperial College, which uses new data from Europe to run simulations of what will happen in the UK and the US. What it says about the severity of COVID-19 is not new, but what it says about what we’re going to do in response is staggering.

According to the report, if we do nothing, 80% of Americans will get the disease, with cases needing ICU care overwhelming the medical system and exceeding available beds by as early as the second week of April. The need for ventilators will be 30 times the number available, which means 97% of people with severe cases will die. That would mean that 4 million people will die over 3 months. That is almost twice the population of Chicago, dead in the next 3 months. (You can see why the “it’s just a flu” approach is not acceptable.)

“This is fine” meme remade for 2020

So they tried simulating “mitigation,” meaning quarantining those who test positive, and their families, and forced social distancing for those most at risk (70 +). This strategy slows the progression of the disease through the population, but would still cause a surge that will exceed capacity by 8 times the number of beds available, still resulting in a horrific death toll.

Then they simulate “suppression,” a combination of social distancing of the *entire* population, plus home isolation of positive cases and household quarantine of their family members. Suppression actually works; that is to say, in only this simulation, we stay more or less within the number of ventilators we have; some people still die, but it’s not the horrific preventable tragedy that the other approaches create.

Mitigation scenario modeling. The red line is ICU capacity.

Quoting the report: “…We therefore conclude that epidemic suppression is the only viable strategy at the current time. The social and economic effects of the measures which are needed to achieve this policy goal will be profound.”

However — here’s the kicker — for suppression to succeed, we would have to keep the strategy in place for 12–18 months.

“The major challenge of suppression is that this type of intensive intervention package… will need to be maintained until a vaccine becomes available (potentially 18 months or more) — given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing — triggered by trends in disease surveillance — may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound.”

So… what are we going to do?

I live in San Francisco, which is currently in lockdown, supposedly until April 7. Even if we tried to go back to normal at that time, tried to go back to shopping in malls and going to schools and all the rest, the ensuing wave of sickness, death, and terror would doubtless send us back into some form of avoidance that would still disrupt the economy.

I keep hearing the argument that suppression will cause an economic depression, and that that is not worth it to save some old people. What I am arguing here is that there is no such choice. Not just that there’s an ethical imperative do pursue suppression; rather, that even if we attempted to allow the economy to go on, business as usual, that once the reality of the disease hits, people who can will choose to pull themselves and their money out of the economy anyway, and businesses being shut down proactively will instead simply fail.

I’ve never seen 3rd Street so empty; pic by Reddit user vkostyukov

There is no question that people will not be able to handle a full lockdown for 18 months. But, solutions to help with long-term social distancing are already cropping up. People are already forming all kinds of virtual groups: hosting yoga and meditation classes, playing board games, having group conversations, all over Zoom and other virtual platforms.

And it’s just not possible for San Francisco to function the way it has while COVID-19 is a threat; mass transit will no longer be an option for many people. That includes the fancy private busses that took people to their tech jobs down peninsula. People are not going to be wiling to do those things anymore, not until we have a vaccine. Will people keep working remotely? Will people leave the city, and its ridiculously high rents?

And some of these changes will happen nation-wide. Will people be willing to send their kids back to in-person schools, those petri dishes for the spread of pathogens, or will other solutions take hold?

Will people go back to shopping in malls, or will we adapt to a new world of social distancing, putting the old ways out of business? Retail has been in trouble for a long time; it’s easy to imagine that those who adapt now by creating online solutions will have a chance to stick around, and those who don’t will fall by the wayside.

Everyone, even the sticklers for doing things in person, are going to have to find ways to accomplish tasks online instead. Once they’ve made the change… will they ever go back?

A lot of things are going to change, and stay changed.

My hope is that we can manage to think ahead as we adapt, and design this brave new world to be accessible, humane, and equitable. To do this, we will need to think about what sorts of places (music venues, for one; many independent restaurants, bars, etc) and jobs (musicians; performance artists; much of the service industry) are unlikely to survive the next 18 months and recognize that the places are probably going to get bought up by rich capitalists, and the people are going to need new employment.

We will need to have some sort of plan to keep the fabric of the city from being destroyed. We will need to come up with transportation solutions for people who once relied on shared resources (I’m pulling for bicycles to be a big part of it!).

And we will need to look out for each other, for the thousands and thousands who will lose jobs that aren’t coming back; the parents who suddenly face questions of child-care and home-schooling; the people who can no longer take trains to work; and more.

We will need to create something new. Will we be able to step up to the task?