Ten days ago, USA TODAY ran a piece
on how not only did Louisiana suffer a high peak of infections in the spring,
but, more than any other state, has seen one again this summer. Yesterday, the New
Orleans Times-Picayune/Advocate published musings
from Jeff Asher, known more for his analysis of crime but who recently has made
a pivot to looking at pandemic data, about recent patterns in these data.
Louisiana continues to serve as an outlier to
national pandemic trends, because of this bimodal distribution in cases. Because
of that, as of yesterday
it ranked second in infection rate, fifth in current hospitalization percentage
per capita, and sixth in mortality per capita. Only Georgia, at
first, first, and eighth, respectively, arguably is as bad off. But this is its
first rodeo, only within the past month hitting these lamentable marks for the
first time while Louisiana is repeating, and worse daily on cases but with far
fewer deaths, from four months ago.
USA TODAY notes this, but also that the recurrence
occurred in a different way. Previous hotspots such as Orleans Parish, those surrounding
it, and those hugging the Mississippi River north to the outskirts of Baton Rouge,
haven’t seen much of a resurgence. Instead, it observes that the new spikes
have occurred in many places that saw little in the way of incidence back
during the first surge.
Of course. The authors apparently eschewed a close
look at the data from four and five months ago (or didn’t read or understand this
space), or else they would have learned the selective nature of the first
wave largely came as a consequence of Carnival: early on, the Orleans area and
Caddo Parish saw the initial breakouts, or the two areas with the most Carnival
and visitor-related activity just as the virus began its stealthy spread across
the country.
Democrat Gov. John Bel Edwards and the chief
executives of the affected local governments in these areas, as well as the
several other parishes with lesser and lesser-visited Carnival festivities,
would have had to possess seer-like powers to have called off such celebrations.
But by Mardi Gras on Feb. 25, indicators from around the world should have revealed
how Carnival activities elsewhere had served as incubators for virus
transmission. Restrictive orders should have gone out then.
At that time, such orders as distancing by
capacity limits, strategic economic closures, and limited access to vulnerable
populations made sense in incipient hotspots. The point was to squelch the
virus before it got a foothold, while at the same time buying time to ramp up
testing capacity (by jawboning partner hospitals that receive billions of state
dollars to serve as charity institutions) and tracing ability (such as by
mobilizing the National Guard). All together, these would have tamped down on transmission
and make it easier to contain.
Instead, Edwards dithered, waiting until days
after the first reported cases to start proclaiming any restrictions, letting the
cat out of the bag, and doing nothing to accelerate testing or tracing
abilities. In effect, his inaction allowed something that could have been kept at
a low burn and affecting almost exclusively the relatively nonvulnerable population
that could have allowed lifting of economic restrictions within a relatively
short period without need of reimposition to break out of isolation and hit the
larger public.
Because of that, the strategy needed to change. In
essence, he had allowed the area under the curve to inflate, and what he or few
policy-makers (or journalists or analysts) realize is if you “flatten” a curve,
its volume doesn’t change but gets displaced into the future. By allowing it to
inflate so much so early, it guaranteed a long, drawn out process.
In that instance, two strategies presented
themselves. One would continue the course of an economic lockdown that
shuttered some sectors, hampered others, and piling greater expenses onto all,
with a parallel social lockdown that would interfere with activities such as
schooling, provision of government services, and gatherings. However, this
would bring tremendous economic, social, and human costs, over a period of many
months, if not a year or more.
That simply cannot be afforded. Curtailed economic
opportunities ruin lives and hamstring government revenue-raising capacity that
harms service provision in a crisis period, which feeds back onto curtailing opportunity
even further if government chooses debt financing to prop itself up (whether directly
or by the federal government taking on more debt while kicking proceeds to
subgovernments). The result: reduced life prospects and more “excess
deaths” above and beyond lives lost to the virus.
But that’s what Edwards chose, seemingly as a
bizarre reflection of the peculiar notion that government must indemnify the
population against suffering and death from this particular malady; it can’t.
People will get it and people will die from it; it’s a matter of arranging policy
in a way that the ones most capable of fighting it are the ones who do get it while
the ones least able to ward it off receive the most protection.
Instead, Edwards chose a manner almost designed to
be the least effective application imaginable to drag out the suffering and
threat of death as long as possible. Initially, when he started the lockdown it
wasn’t by parish or region, but was statewide. This contained the seeds for the
revival. As a result, the hotspots burned first, but nothing much stirred
elsewhere, delaying the inevitable. For once the virus had broken out – courtesy
of the delayed action and inaction on testing and tracing capacity – it ineluctably
would burn everywhere in the state. It was just a question of when and for how
long.
Under the economic and social strains caused by
his imposed restrictions – and the political pressures these spawned – Edwards
had to let up on his limitations. He couldn’t keep these on for an extended
period needed for the lengthy slow burn. And so when he scaled these back, like
the cessation of rain in forests in summer, eventually the foliage lit up. The
intense burning in some parts of Louisiana, that had made it a regrettable
leader in the early days of the pandemic receded, having been burned through significantly
was replaced by others full of dry tinder, that restored its dubious ranking.
None of this should have surprised the USA TODAY
authors. Because the virus had been allowed to acquire a critical mass, and a
large one at that, it would have to burn out everywhere statewide, because you
can’t cordon off parishes from each other. The measures to control flashes in
some parts of the state also delayed that burn in much of the state, explaining
why previously hot areas now simmer and previously simmering areas have heated
up upon relaxation. Edwards’ actions (delay, crackdown everywhere, loosen up
everywhere) made this outcome inevitable.
There was another way, called, for lack of a
better term, the “Swedish” model. This recognizes that a virus outbreak of
critical mass causes the least health, economic, and societal damage when tackled
by the power of nature, not by government artifice.
When the virus hit there, Sweden restricted the
largest gatherings for a time, closed schools for teenagers on up for the
spring, and restricted access to the vulnerable, and that was it. No economic closures,
no face covering mandates, no capacity restrictions. The theory was the virus
would bounce around the vast majority of the relatively nonvulnerable population
in short order, fairly quickly leaving it few places to go and establishing herd
immunity.
Each day that goes by shows increasingly
this model worked. No deaths from the virus have happened in days, infections
and hospitalizations remain at a low level, and excess
deaths have gone close to zero. Compared to other European states and
Nordic neighbors, the most pessimistic reading is that Sweden suffered less
economically while it paid no more than others in human costs to this point who
have
had overall much tighter restrictions. And as it’s probably farther along
in herd immunity terms, the health statistics will continue to improve relative
to other countries as time goes on.
It’s a point that Asher obliquely picked up upon,
that recent improvements in Louisiana metrics have come not because of
reimposition of certain restrictions, but because of growing herd immunity – as
this space pointed out in July in a review of the science behind epidemics.
Laudably, his piece became the first in the mainstream press to identify this,
behind the curve as it may be. And, he correctly places this as a reason the
burn-through has occurred in different parishes at different times.
However, Asher qualified this as a “temporary” immunity
achievable at lower levels because of transmission disruption through reimposed
restrictions. But this view falls prey to two problems. First, fails to recognize
the latest science that would place Louisiana statewide (although not perhaps parish-by-parish)
at herd immunity already, regardless of restrictions. Second, he fails to
recognize the public policy costs of the restrictions, especially relative to those
places without these.
To illustrate the latter, look at it this way. If we
define Louisiana as being a hot zone for the virus from almost the day of the
initial case identification, for a total of 150 days, Sweden hit those levels
for about a 60
day period from late May through late July. If you are a vulnerable person
for the virus in Louisiana, you have faced 150 days of heightened vulnerability
which will continue for many more to come, while in Sweden you faced it for
only 60 days and perhaps never again. Who is safer in the long run?
The longer an environment is a hot zone for vulnerable
people, the more of them eventually will die. And the longer restrictions stay
in place that keep it a hot zone longer, the more excess deaths will occur and
the more damage to people’s life prospects will occur through the destruction
of their livelihoods.
You only can change the shape of, not the area
under, the curve. And you can change the shape by its temporal shortening to
reduce the risk to human lives and economic fortunes. The virus-fighting policies
of Edwards – by his delay that let the virus achieve critical mass in the
population, his failure to let it burn quicker in the least damaging manner
across the entire state, and his sticking with a lockdown strategy far beyond
its optimal life – have failed Louisiana. Reversing current restrictions –
largely unneeded because of strengthening herd immunity – except for those that
limit access to the vulnerable would better serve the state.
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