"Our current actions are only buying time," says the article. (AFP)
This article first appeared in The Stanford Daily. It is co-authored by Peter DeMarzo, Hanno Lustig and Amit Seru, Stanford Graduate School of Business
We are fighting a war. The aggressor is invisible, but the effects are the same: a ravaged economy, physical, social and emotional harm to our loved ones and a threat to our way of life. We must mobilize now to win this war.
The hard truth is that sheltering in place will only slow the onslaught of the coronavirus. It will not stop it. Barring the quick deployment of a vaccine or an effective treatment, or complete success in halting viral transmission, the virus will only relent once a majority of the population has been infected and we have sufficient herd immunity. Our current actions are only buying time. That time must not be wasted. We must use it to prepare and fight back.
According to a Harvard study, at the peak of the pandemic, with a conservative 40% of the population infected over the next 6-12 months, we will need more than double the bed capacity and triple the ICU capacity to care for those infected by the virus. In addition to beds and facilities, we will need caregivers, ventilators, masks, gloves and many other supplies. This is a massive task. We need to turn our attention as a country to building that capacity right now.
The alternative strategy, which has now been instituted in California and New York, is to "shelter in place" in order to slow the pace of the pandemic to fit our current capacity. Unfortunately, this action alone is unlikely to be sufficient. Absent the strict and extreme controls that have been achieved in China (and which may not be feasible in the U.S. and Europe), a recent Imperial College analysis concludes that "flattening the curve" sufficiently would require that we shelter in place for at least 12-18 months until a vaccine or effective treatment is available. The decimation of our economy that would occur in that time frame is enormous – as financial markets and unemployment claims are only beginning to show. More importantly, the social costs of unemployment, gaps in education, social isolation and depression might rival or well exceed those from the virus.
Finally, and worst of all, the shelter-in-place approach may eventually break down (as was the case for instance during social distancing measures at Delaware during H1N1 in 2009). As the economic and social costs mount, many may revolt against being kept in their homes. In that case we would pay a huge economic cost first and then suffer the ravages of the pandemic.
To avoid this grim outcome, we must act now to mobilize our nation's incredible resources to expand our capacity to confront the virus in a realistic time frame. Much like the switching of automobile and other factories to military production during the second world war, we need to develop and administer tests, fast-track potential treatments, create temporary hospitalization facilities, train caregivers and manufacture ventilators at a large scale. We must also do more to make social distancing a practical reality without necessitating a full shutdown of the economy and society. By combining these efforts, we can sustainably slow the progression of the virus while preparing for its inevitable arrival.
In this effort we must respond as a committed and united country as we have to other such wars. Until a treatment arrives, we must all do our part. As a concrete proposal, we suggest the following be considered within our own Stanford community:
1. Build capacity. Convert available buildings, such as our now-empty dorm buildings, to temporary quarantine/hospitalization quarters for the infected. They could be filled by cohorts of less critical but still infected patients in need of observation, or be used by patients with other, non-contagious illnesses to free up existing hospital capacity (as is already being considered at Tufts and elsewhere).
2. Train caregivers. Medical students, staff, faculty and other community volunteers (whose age and health suggest they are unlikely to be harmed by the virus) can be trained to serve as caregivers for the infirm or isolated, as well as providing much needed infrastructure support to those who are on the front line.
3. Design ventilators. Engage our design and engineering schools to develop an easy and quick-to-manufacture ventilator. As Stanford's Design For Extreme Affordability Program has done in the past, we can design simple mechanical ventilators like those first developed to save lives in the 1950s. These do not need to be "hospital quality" by our current standards; basic functionality and a 12-month life span will suffice. No one should die due to lack of a ventilator.
4. Invest in testing and temperature monitoring. Work with our medical school and business supply chain experts to develop fast, cheap and easy-to-deploy tests. We must reach the point that tests are no longer rationed. But even without testing, we must encourage individuals to monitor their temperature multiple times per day, as is being done in Singapore (where it is also required upon entry or exit of buildings and public spaces).
5. Manage the network. Engage our MBA and CS students to develop an app that will track and quickly alert all physical contacts in the event of a positive test or temperature reading. (Such an app has been essential to China's success.) To address privacy concerns, make the app voluntary, easy to delete, with encrypted data, and not controlled by the government. Achieve compliance by promoting a social norm that people socially distance from others who are not being tested and using the app. Develop a real-time reporting system to a central information aggregator that can alert hospitals and health care providers. Provide a financial or other reward system for those who comply with monitoring and follow quarantine recommendations.
These are all things for which planning could be initiated immediately. And with our collective effort, intelligence and willpower, we could accomplish much quickly. Until science provides a cure, we cannot stand idle or remain focused on our private interests. We must prepare to fight this war and motivate others to join the effort.