COVID-19

You infect two friends, and they’ll infect two friends, and so on, and so on…

To understand what those numbers mean, think back to the 1980’s Fabergé Shampoo commercial where Heather Locklear “told two friends, and they told two friends, and so on and so on…”  (OK, I just showed my age, but for those of us who were around at the time it is kind of iconic.)

Except in Italy before lockdowns an infected person didn’t infect two friends, they infected four. After lockdowns that number dropped to 1.4. That makes a huge difference in how the thing grows. The goal is to push the reproduction number below one, at which point the number of new infections actually starts to decrease.

There are indications that lockdowns are working in the US as well. You can see this by looking at growth rates from place to place. Last week when I looked at the growth in case numbers, in the Phoenix area (where schools were closed, but there were few other real restrictions)  the number of cases was doubling every 1.7 days. In contrast, communities in the San Francisco region which had been locked down for a while were taking 3 to 4 days for cases to double.

By the way, a word to those in regions that have yet to see large numbers of COVID-19 cases; the earlier restrictions are imposed, the more lives are saved. (See figure below.) It is best not to wait until there are lots of reported cases before you act. That one extra person who get’s the disease at the local bar or restaurant might become responsible for hundreds of additional cases.

The Less Good News: We are in it for the long haul.

So, there is some good news, or at least hopeful news suggesting that we can slow this thing down. But that news has a flip side. There is a lot of misinformation out there giving the impression that after a few weeks of lockdown we can go back to business as usual. That’s not the way it works. If lockdowns are lifted we are right back where we started with a population full of vulnerable people, and another outbreak begins.

Once you put this malicious genie back in the bottle you either have to keep the stopper in or recognize the consequences if you don’t.

There is a lot left to learn about COVID-19. We are not even sure at this point about the fraction of cases that become serious. But there are things we do know. We know that you don’t have to look or feel sick to wind up infecting other people. You and your child might feel great, but while you’ll never know it, that lady you bumped into at the store may have you to thank when she winds up in the morgue.

Sorry for the dark turn, but that is our reality.

There are also indications that the virus is proceeding differently in the U.S. than in some other countries. When the virus emerged from China it appeared as though its most serious effects were limited to those over 60 years old. In contrast, in the U.S. a substantial fraction of the most severely ill patients are under 55.  This may be because we Americans are kind of known for things  – obesity, diabetes, not enough sleep, lack of exercise and chronic stress, etc. – that make people more vulnerable. Smoking and vaping also make the young vulnerable.  Now is not a bad time to quit smoking and start getting serious about the whole 8 hours of sleep and 8,000 steps business.

The bottom line: if we want to prevent rather than simply delay the human toll of COVID-19 we are looking at more than just a few weeks or even a couple of months. Restrictions on schools, work, public gatherings, businesses, social distancing and the like will be needed until we either have a vaccine or much better treatments. We are in it for the long haul.

There will be no return to “normal,” ever.

Looking forward, I don’t own a crystal ball, but I’ve got a pretty good track record at reading tea leaves. Coming out of this the ways we work and live will be different.

At the moment we’re discovering that a lot of those long commutes and interminable meetings really were wasted time and effort; that stuff can be handled in emails and Zoom chats. Now is probably not a good time to invest in the future of business travel, or conventions, or (this one hurts a bit) speaking at meetings. COVID-19 will doubtless accelerate the transition toward AI, automation and hyperproductivity.

In the public sector, education will change in profound ways. (A special word to schools: know that there is a very good chance you will be on-line for much of the coming year.) We will see shifts in political and cultural landscapes as we come to accept that we are in this together. There are a lot of people who imagined they were economically secure (and voted that way) who are suddenly finding themselves in the same boat with the millions of Americans who always wondered where the rent money was coming from this month.  COVID-19 will not be the last such event, and it is showing the inherent failings of a health care system in which preparedness plays second fiddle to short-term profit. Many still spread and buy into rhetoric downplaying COVID-19. They won’t feel that way when it takes their parent or spouse or child. They might see things from a radically different perspective as they lie on a gurney in the crowded hallway of an overwhelmed hospital wondering whether someone else will die before they do and free up the ventilator they so desperately need.

I could go on at length. The world is going to change. We are going to change.

Perhaps the clearest lesson of the present moment is that in any confrontation between ideology and reality, reality ultimately wins. Two weeks ago we were assured that this would all go away by Easter. Yesterday from that same podium we heard that the best case scenario is 100,000 to 240,000 Americans dead. COVID-19 didn’t listen when politicians and pundits declared it to be just like the flu. Real expertise, scientific expertise in particular, is turning out to be important after all.

The future holds opportunities as well.

That is my sense of where we are. COVID-19 is a transformational event. People will look back at the spring of 2020 and say, “that’s when it all changed.” My general advice to clients has been to accept that the coming 18 months or so are going to be volatile and uncertain. Plan in ways that allow you to respond as seamlessly as possible to inevitable ongoing disruptions that will last far longer than that.

We are going to learn a lot about ourselves in the months to come. Humans have a way of emerging from crises stronger, largely because crises force us to face reality on its own terms. They also show us that people who we used to think of as “them” turn out to be “us” after all. The shock of what is happening and will continue to happen is undeniable, but we will get through this. Longer term there are as many opportunities in the present moment as there are pitfalls. New ways of living will emerge. New businesses and industries will rise as old businesses and industries fail. Many who thought themselves invincible are now dinosaurs whether they know it or not. Evolve or die.

The winners will be those who are able to reassess their assumptions, remember their humanity, look in new ways at the world, and demonstrate the agility and courage to act. In a future defined by uncertainty there is huge risk and no guarantees. The world beyond COVID-19 will favor the nimble and the bold.

COVID-19 ^ Cutting through the confusion  © Dr. Jeff Hester
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