Meet the New Wave. Same as the Old Wave

This morning the Wall Street Journal is looking closely at a second wave of COVID-19 cases both in editorial and opinion pieces. Peggy Noonan warns of a second wave of COVID-19, either following the reopenings and mass demonstrations of the last two weeks or in the fall:

It had been assumed the summer would offer a respite, and that seems likely in many places, maybe most. New York, hard hit early on, is experiencing a decline in cases. Coronavirus doesn’t like sunlight, fresh air or warm temperatures. It prefers coolness and poor ventilation in enclosed places, meatpacking plants being the most famous example.

Flus and colds tend to recede in the summer and return in the fall and winter. The 1918 influenza epidemic hit America hard in the spring, but its second, deadlier wave came in October.

Harvard epidemiologist Marc Lipsitchtold the Journal of the American Medical Association that he thinks warmer weather is likely to reduce transmission rates by about 20%: “That’s only enough to slow it down, but not enough to stop it.”

Anthony Fauci can be distressingly deft when speaking on issues that touch on the political, but one never doubts he’s being forthcoming when he speaks of disease. This week he told a biotech conference that Covid-19 has been his “worst nightmare”—a highly infectious new virus that typically attacks the respiratory system, with no clear treatment and no cure. “In a period of four months it has devastated the world,” he said. “And it isn’t over yet.”

She continues:

If you expect the worst on coronavirus you’ll think personal caution and carefulness are absolutely essential this summer, and a hard time is coming late this fall and winter.

Which gets us to the governors, who again will be galvanized.

Merriam-Webster defines “galvanize” as

1. 1. to subject to the action of an electric current especially for the purpose of stimulating physiologically
      // galvanize a muscle
   2. to stimulate or excite as if by an electric shock
      // an issue that would galvanize public opinion
2. to coat (iron or steel) with zinc
   // especially : to immerse in molten zinc to produce a coating of zinc-iron alloy

Now I think that in general we would be much the better off if governors were galvanized in the sense of 1a or, even better, 2 but I suspect that Ms. Noonan means 1b, something that should concern us all. She explains why we should be concerned:

They were right to take strong action early on in the crisis. There is no doubt that the lockdowns saved many, many lives and allowed hospitals to hold their ground.

At least in Illinois that might have been true for about the first three weeks. After that Ms. Noonan’s second explanation sounds a lot more likely:

Then they got carried away. They received too much adulation, enjoyed the role of savior too much, and the lockdowns became longer. Told we were grateful someone was taking responsibility, they became micromanagers of human life. Briefings became self-aggrandizing and Castroesque in length.

Illinois’s governor is on record as saying that he won’t allow the state to reopen completely until there’s a vaccine and the number of new cases per day has been driven to zero which is to say possibly never. Presently, the percentage of positive tests for COVID-19 is at 4% with a larger number of tests being made nearly every day. My question today is the same one I asked over a month ago and to which I have never received a response. I can tell you the cost of Illinois’s lockdown. What is the benefit of 50% excess ICU bed and ventilator capacity over 30% excess ICU bed and ventilator capacity? Illinois hasn’t gone below either figure and, at least in Chicago, the only real threat to ICU bed capacity is due to gunshot wounds.

Ms. Noonan continues:

There will be exactly zero appetite this fall for daily news conferences in which governors announce the phased, Stage 2 openings of certain sectors that meet certain metrics that some midlevel health-department guy seems to have pulled out of his ear. That was the past three months.

What’s the plan if things turn difficult? People won’t want and may not accept a second lockdown, even in the face of a more lethal iteration of the virus. They will likely in a crisis accept increased calls for voluntary social distancing, mask directives, bans on big events, not that we have big events. But—what else?

The governors gained great stature and authority in March and April and began to lose it in May, as did some in the medical and scientific establishments, who became inconsistent in their advice regarding safety and crowds. What early on seemed nonideological came, inevitably, to look like activism.

You can only squander the credit you’ve earned once.

Meanwhile, the editors of the Wall Street Journal have some warnings of their own:

Democrats cite a spike in cases in Florida, Arizona and Texas as evidence of a virus resurgence. But more testing, especially in vulnerable communities, is naturally turning up more cases. Cases in Texas have increased by about a third in the last two weeks, but so have tests. About a quarter of the new cases are in counties with large prisons and meatpacking plants that were never forced to shut down.

Tests have increased by about 37% in Florida in two weeks, but confirmed cases have risen 28%. Cases were rising at a faster clip during the last two weeks of April (47%) when much of the state remained locked down. Now restaurants, malls, barbershops and gyms are open if they follow social-distancing guidelines.

In Arizona, cases have increased by 73% in the last two weeks though tests have increased by just 53%. But a quarter of all cases in the state are on Indian reservations, which have especially high-risk populations. The rate of diabetes is twice as high among Native Americans as whites and the rate of obesity is 50% higher.

Liberals and the media demanded more testing before states could reopen, yet now are criticizing states because more testing has turned up more cases. Keep in mind that New York has reported about the same number of new cases in the last two weeks as Florida, though it ramped up testing earlier so the relative increase appears less significant.

A more important metric is hospitalizations. In Arizona the weekly rolling average for new Covid-19 hospitalizations has been flat for a month. Emergency-room visits for Covid-19 have spiked this week, but the number of ER beds in use hasn’t changed since late April. Hospitals in Arizona (and California) have reported an increase in cases from U.S. citizens and green-card holders returning from Mexico where hospitals are overwhelmed. But with 22% of ICU beds and 62% of ventilators available, Arizona hospitals should have capacity to manage an increase in patients as it reopens.

Texas has also recently reported an uptick in Covid-19 hospitalizations, mostly in the Houston and Austin areas. Current Covid-19 hospitalizations are up about 20% since the state began to reopen, but Gov. Greg Abbott says hospitals aren’t overwhelmed and much of the increase is tied to nursing homes. The number of currently hospitalized patients per capita is still about 80% higher in New York City than in Texas. Mr. Abbott started reopening six weeks ago while Mr. Cuomo began letting manufacturing and construction resume in the Big Apple this week.

concluding:

More infections are inevitable as states reopen, and there will be much trial and error. States need to be vigilant for outbreaks and protect high-risk areas and the vulnerable. But the costs of shutting down the economy are so great, in damage to lives and livelihoods, that there is no alternative to opening for the broader public good.

Good managers must be able to make difficult non-absolutist decisions in the absence of complete information. Good managers are scarce in the private sector. It’s too bad there are even fewer in the public sector.