The Price of Victory

Thomas Frieden, former director of the U.S. Centers for Disease Control and Prevention penned a column for The Atlantic titled: "We Know How to Beat COVID-19. We Just Don't Do It." In it, he basically makes what I think is a debatable point; that through carefully targeted and calibrated non-pharmaceutical interventions, that the United States could completely control the current SARS-2 CoV outbreak, limit the economic fallout and avoid restriction fatigue. Personally, this sounds like a tall order, given that no-one seems to understand what these things would actually look like in practice, but I presume that Mr. Frieden is more knowledgeable about the subject than I am. But a couple of things he said stood out for me:

We’ve learned what people care about, and getting haircuts and holiday shopping are high on the list, so let’s try to keep salons and retail stores open but make them safer by requiring masks, eliminating crowds, increasing ventilation, and encouraging workers and customers to stay home if they have symptoms.

People should reduce the size of gatherings, spend less time indoors together, wear masks when not eating, increase ventilation, and make sure that no one who is feeling sick participates.

Mainly because he goes on to make this point:

Many clusters of cases come from people who go to work, school, or social get-togethers while ill. No testing, government, or health-care program can control COVID-19 if people continue this behavior.

So... if dealing with sick people is the key, why is that the last point in his recommendations for what businesses and people should be doing to control the outbreak? Why not lead with that? Because if society as a whole can do a halfway decent job of encouraging workers and customers to stay home if they have symptoms and making sure that no one who is feeling sick participates in gatherings, there doesn't have to be as much of a focus on the other measures.

For all that there is a tendency to treat SARS-2 CoV infections as sui generis, it spreads like any other disease; it starts out in a sick person and is transmitted to a healthy one. It doesn't spontaneously manifest in any situation in which two people come with six feet of one another without wearing some sort of personal protective equipment.

Perhaps the problem becomes that sooner or later, there will need to be an admission that perhaps the problem isn't in our present, but in our past. For all of the decades that the United States has cultivated social norms that fear malingering and missing out, encouraging people to stay home and miss work and/or rare or unique events is likely to great a shift to be pulled off in under a year. Maybe the fatiguing measures that governments seek to impose are preferred specifically because there is an understanding, on some level that forcing a reckoning with the choice of efficiency over resiliency simply won't end well, because as much as people may want things to have effective backups and fault-tolerance in place, consumer behavior shows that they balk at actually paying for it.