There is No Peak

People keep showing graphs of a single hump, like this:

They talk about the peak. The peak is coming in a few weeks. China has peaked. Korea has peaked. They will get R0 down below 1. Then they are on the back-side of the event.

This doesn’t make sense for three reasons:

First, the healthcare system’s extra capacity is very low. It’s all about the number of beds, ventilators, masks, gowns, healthcare workers in a given area. We have already seen body bags piled up in hospital hallways and the Pentagon is trying to source another 100,000 body bags. To flatten the curve and keep the demand on the system manageable, we would need to stretch it out ten years.

Second, there are going to be waves of viral outbreak as long as most of us are not infected. The assumption of a peak is based on no change in behavior from today. To go back to work, to go shopping, to get on a bus, we should be tested and tracked daily. That’s what they are doing in China. Taiwan’s schools are already back in session. Hong Kong and Singapore are managing rather well. To the virus, most of us are raw material. R0 will shoot up in places. Even with much more testing, there will be clusters around people who behave irresponsibly, people who don’t know they have it, places where there isn’t enough protective equipment, playgrounds, schools, stores, bars, offices, and factories. The potential for clusters is always there, because you can feel fine and still transmit.

Third, we are not out of the woods until most of us are immune. We are still “under the curve.” There will be much more quarantine and shelter-in-place than we are thinking now.

I explained this to my friend Jason the other day, saying that the rest of the year is going to be sheltering in place, staying away from other Americans, testing everyone constantly, isolating those who test positive. This will last until most of us are immunized, which might happen around the middle to end of 2021. Just because you tested negative yesterday doesn’t mean you’re not positive tomorrow.

Then, I added, remember that 78 percent of Americans live paycheck to paycheck.

Jason is a smart guy.

I had to ask Jason if he was still there.

He said he was thinking.

What Jason realized is that the United States isn’t China. The US doesn’t have the ability to manage lockdown and social distancing for the time it will take until we have immunity by vaccine.

Nor can the economy handle it.

And yet, we have no choice.

There is no peak.

Getting Across the River

Each year in East Africa, over a million wildebeest follow the rains in a cyclical migration that takes them across the Mara river, which is full of crocodiles. This is worth watching:

The Mara is home to some of the largest crocodiles in the world, many of whom eat just twice a year. Even hippos, who normally eat grass, feed on the thousands of carcasses that float down the river, providing nourishment to hundreds of species for years.

Most of them make it, of course.

Each animal, young or old, must cross the river. Some may cross in a large group, others may cross on their own. But they all must get across. There is no peak day when they all go across. They go in waves, over months, and each animal faces the same odds every time.

This is what we face now:

Image copyright David Siegel, 2020

Most of us are waiting on the bank, looking at the river, trying not to get pushed in by others, trying to keep our wits about us and not do something stupid, trying not to catch the fear that is so contagious now.

How Long Will it Last?

We have to get at least 280 million Americans across. Some will get the virus and survive — we think that will give (most of) them some kind of immunity, but we don’t really know. Most will have to wait for the ferry to take us across.

That ferry is a vaccine.

That ferry doesn’t even go into service for about a year. Still, most people will need to be immunized before we can meet for lunch again. Seven different ferries are being built now. The US reaches immunity sometime in 2021. The world reaches immunity some time in 2022.

There will be waves. There will be bankruptcies. There will be suffering.

Because the United States can’t get its shit together. As Rachel Kleinfeld says, The United States is underperforming relative to its wealth.

And because Americans like to be fiercely independent.

The river is waiting for us.