[D66] We’re not going back to normal
Antid Oto
jugg at ziggo.nl
Thu Mar 19 17:32:09 CET 2020
We’re not going back to normal
By
Gideon Lichfield
technologyreview.com
7 min
View Original
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To stop coronavirus we will need to radically change almost everything
we do: how we work, exercise, socialize, shop, manage our health,
educate our kids, take care of family members.
We all want things to go back to normal quickly. But what most of us
have probably not yet realized—yet will soon—is that things won’t go
back to normal after a few weeks, or even a few months. Some things
never will.
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It’s now widely agreed (even by Britain, finally
<https://www.technologyreview.com/f/615369/uk-dropping-coronavirus-herd-immunity-strategy-250000-dead/>)
that every country needs to “flatten the curve”: impose social
distancing
<https://www.technologyreview.com/s/615355/coronavirus-social-distancing-during-pandemic/>
to slow the spread of the virus so that the number of people sick at
once doesn’t cause the health-care system to collapse, as it is
threatening to do in Italy right now. That means the pandemic needs to
last, at a low level, until either enough people have had Covid-19 to
leave most immune (assuming immunity lasts for years, which we don’t
know
<https://www.theatlantic.com/health/archive/2020/03/coronavirus-pandemic-herd-immunity-uk-boris-johnson/608065/>)
or there’s a vaccine.
How long would that take, and how draconian do social restrictions need
to be? Yesterday President Donald Trump, announcing new guidelines such
as a 10-person limit on gatherings, said that “with several weeks of
focused action, we can turn the corner and turn it quickly.” In China,
six weeks of lockdown are beginning to ease
<https://www.washingtonpost.com/world/asia_pacific/locked-down-in-beijing-i-watched-china-beat-back-the-coronavirus/2020/03/16/f839d686-6727-11ea-b199-3a9799c54512_story.html>
now that new cases have fallen to a trickle.
But it won’t end there. As long as someone in the world has the virus,
breakouts can and will keep recurring without stringent controls to
contain them. In a report yesterday
<https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf>
(pdf), researchers at Imperial College London proposed a way of doing
this: impose more extreme social distancing measures every time
admissions to intensive care units (ICUs) start to spike, and relax them
each time admissions fall. Here’s how that looks in a graph.
Periodic bouts of social distancing keep the pandemic in check.Imperial
College Covid-19 Response Team. Periodic bouts of social distancing keep
the pandemic in check.Imperial College Covid-19 Response Team.
The orange line is ICU admissions. Each time they rise above a
threshold—say, 100 per week—the country would close all schools and most
universities and adopt social distancing. When they drop below 50, those
measures would be lifted, but people with symptoms or whose family
members have symptoms would still be confined at home.
What counts as “social distancing”? The researchers define it as “All
households reduce contact outside household, school or workplace by
75%.” That doesn’t mean you get to go out with your friends once a week
instead of four times. It means everyone does everything they can to
minimize social contact, and overall, the number of contacts falls by 75%.
Under this model, the researchers conclude, social distancing and school
closures would need to be in force some two-thirds of the time—roughly
two months on and one month off—until a vaccine is available, which will
take at least 18 months (if it works at all
<https://www.technologyreview.com/s/615331/a-coronavirus-vaccine-will-take-at-least-18-monthsif-it-works-at-all/>).
They note that the results are “qualitatively similar for the US.”
/Eighteen months!?/ Surely there must be other solutions. Why not just
build more ICUs and treat more people at once, for example?
Well, in the researchers’ model, that didn’t solve the problem. Without
social distancing of the whole population, they found, even the best
mitigation strategy—which means isolation or quarantine of the sick, the
old, and those who have been exposed, plus school closures—would still
lead to a surge of critically ill people /eight times bigger/ than the
US or UK system can cope with. (That’s the lowest, blue curve in the
graph below; the flat red line is the current number of ICU beds.) Even
if you set factories to churn out beds and ventilators and all the other
facilities and supplies, you’d still need far more nurses and doctors to
take care of everyone.
In all scenarios without widespread social distancing, the number of
Covid cases overwhelms the healthcare system.Imperial College Covid-19
Response Team In all scenarios without widespread social distancing, the
number of Covid cases overwhelms the healthcare system.Imperial College
Covid-19 Response Team
How about imposing restrictions for just one batch of five months or so?
No good—once measures are lifted, the pandemic breaks out all over
again, only this time it’s in winter, the worst time for overstretched
health-care systems.
If full social distancing and other measures are imposed for five
months, then lifted, the pandemic comes back.Imperial College Covid-19
Response Team. If full social distancing and other measures are imposed
for five months, then lifted, the pandemic comes back.Imperial College
Covid-19 Response Team.
And what if we decided to be brutal: set the threshold number of ICU
admissions for triggering social distancing much higher, accepting that
many more patients would die? Turns out it makes little difference. Even
in the least restrictive of the Imperial College scenarios, we’re shut
in more than half the time.
This isn’t a temporary disruption. It’s the start of a completely
different way of life.
*Living in a state of pandemic *
In the short term, this will be hugely damaging to businesses that rely
on people coming together in large numbers: restaurants, cafes, bars,
nightclubs, gyms, hotels, theaters, cinemas, art galleries, shopping
malls, craft fairs, museums, musicians and other performers, sporting
venues (and sports teams), conference venues (and conference producers),
cruise lines, airlines, public transportation, private schools, day-care
centers. That’s to say nothing of the stresses on parents thrust into
home-schooling their kids, people trying to care for elderly relatives
without exposing them to the virus, people trapped in abusive
relationships, and anyone without a financial cushion to deal with
swings in income.
There’ll be some adaptation, of course: gyms could start selling home
equipment and online training sessions, for example. We’ll see an
explosion of new services in what’s already been dubbed the “shut-in
economy <https://medium.com/matter/the-shut-in-economy-ec3ec1294816>.”
One can also wax hopeful
<https://slate.com/business/2020/03/coronavirus-goodbye-to-the-before-times.html>
about the way some habits might change—less carbon-burning travel, more
local supply chains, more walking and biking.
But the disruption to many, many businesses and livelihoods will be
impossible to manage. And the shut-in lifestyle just isn’t sustainable
for such long periods.
So how can we live in this new world? Part of the answer—hopefully—will
be better health-care systems, with pandemic response units that can
move quickly to identify and contain outbreaks before they start to
spread, and the ability to quickly ramp up production of medical
equipment, testing kits, and drugs. Those will be too late to stop
Covid-19, but they’ll help with future pandemics.
In the near term, we’ll probably find awkward compromises that allow us
to retain some semblance of a social life. Maybe movie theaters will
take out half their seats, meetings will be held in larger rooms with
spaced-out chairs, and gyms will require you to book workouts ahead of
time so they don’t get crowded.
Ultimately, however, I predict that we’ll restore the ability to
socialize safely by developing more sophisticated ways to identify who
is a disease risk and who isn’t, and discriminating—legally—against
those who are.
We can see harbingers of this in the measures some countries are taking
today. Israel is going to use the cell-phone location data
<https://www.nytimes.com/2020/03/16/world/middleeast/israel-coronavirus-cellphone-tracking.html>
with which its intelligence services track terrorists to trace people
who’ve been in touch with known carriers of the virus. Singapore does
exhaustive contact tracing
<https://www.technologyreview.com/s/615353/singapore-is-the-model-for-how-to-handle-the-coronavirus/>
and publishes detailed data on each known case, all but identifying
people by name.
We don’t know exactly what this new future looks like, of course. But
one can imagine a world in which, to get on a flight, perhaps you’ll
have to be signed up to a service that tracks your movements via your
phone. The airline wouldn’t be able to see where you’d gone, but it
would get an alert if you’d been close to known infected people or
disease hot spots. There’d be similar requirements at the entrance to
large venues, government buildings, or public transport hubs. There
would be temperature scanners everywhere, and your workplace might
demand you wear a monitor that tracks your temperature or other vital
signs. Where nightclubs ask for proof of age, in future they might ask
for proof of immunity—an identity card or some kind of digital
verification via your phone, showing you’ve already recovered from or
been vaccinated against the latest virus strains.
We’ll adapt to and accept such measures, much as we’ve adapted to
increasingly stringent airport security screenings in the wake of
terrorist attacks. The intrusive surveillance will be considered a small
price to pay for the basic freedom to be with other people.
As usual, however, the true cost will be borne by the poorest and
weakest. People with less access to health care, or who live in more
disease-prone areas, will now also be more frequently shut out of places
and opportunities open to everyone else. Gig workers—from drivers to
plumbers to freelance yoga instructors—will see their jobs become even
more precarious. Immigrants, refugees, the undocumented, and ex-convicts
will face yet another obstacle to gaining a foothold in society.
Moreover, unless there are strict rules on how someone’s risk for
disease is assessed, governments or companies could choose any
criteria—you’re high-risk if you earn less than $50,000 a year, are in a
family of more than six people, and live in certain parts of the
country, for example. That creates scope for algorithmic bias and hidden
discrimination, as happened last year with an algorithm used by US
health insurers that turned out to inadvertently favor white people
<https://www.technologyreview.com/f/614626/a-biased-medical-algorithm-favored-white-people-for-healthcare-programs/>.
The world has changed many times, and it is changing again. All of us
will have to adapt to a new way of living, working, and forging
relationships. But as with all change, there will be some who lose more
than most, and they will be the ones who have lost far too much already.
The best we can hope for is that the depth of this crisis will finally
force countries—the US, in particular—to fix the yawning social
inequities that make large swaths of their populations so intensely
vulnerable.
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