When a soccer team is losing heavily at half time, it is traditional for the coach to use the half time team talk to motivate his team to win the second half. It gives a target and can avoid heads dropping, at least until the opponents score yet again when battle resumes.
Humanity has certainly conceded many goals in the first half to the Coronavirus. Perhaps now we are close to half time and ready to regroup and accept some sage advice from our coaches. One part of that surely has to be to look forwards and not backwards. There will be plenty of time for recriminations after the outbreak is over, and plenty of opportunity to win the second half, because we know our opponent better by now and can adopt smarter tactics.
A key prerequisite for the coach is to define what winning is. A defensive minded coach might argue to minimize deaths. But this can be fine-tuned. Excess deaths compared to normal is a better target, not least because it avoids the effortful need to accurately assign each death to Coronavirus or something else. We can be smarter too if we measure something like excess healthy years lost, because surely the death of a centenarian, tragic though it may be, is more harmful than the death of an otherwise healthy child.
This might satisfy our defensive minded coach. But what about the offence? It may be that we can take steps to reduce excess healthy years to nearly zero, but at what cost to our economy and future well-being? There is a valid argument to risk a little on defence if that enables our children to resume learning or more of our poor to resume earning, for surely those things will help us in future matches. It might even help immediately if we can avoid mental health or drug issues. The question becomes a balance: what is the appropriate policy enable humanity to thrive somewhat, while keeping excess healthy years lost low?
By now we have a lot of data. And based on the data I find myself playing more offence than defence. This virus requires a defence, but science and experience and improved behaviour have helped. Last week The Economisttabulated what had been a theory of mine for a while. The 2020 ‘flu’ season in the southern hemisphere has barely existed. It stands to reason. The vulnerabilities to ‘flu’ are similar to those for Coronavirus, and by training ourselves to minimise the new virus we reduce the incidence of ‘flu’ as well.
Before 2020, I certainly never bothered with washing my hands so often or was careful about what I touched or from where I ate. I happily shook hands and hugged and would never have dreamt of wearing a mask. I sang loudly and often, spreading droplets generously, and would have to be very sick before choosing to stay home. Well, that is most of us, and it stands to reason, at least to me, that fewer folk will suffer ‘flu’ as a result.
Then there is the risk from the virus itself. In March and April it is no wonder so many New Yorkers who picked up the virus went on to die. The hospitals had few effective drugs. And contagion was so rife that we were told not to go to hospital at all unless we had been very sick for several days, so by the time many people arrived they were beyond cure.
Now medicine has worked out that steroids are effective, especially early on. So long as an outbreak is relatively contained, there is enough capacity in hospitals. For most of us, our odds are pretty good. And many of those for whom the odds are not good reside in nursing homes or can be a focus for isolation.
We are all waiting for a vaccine, and of course an effective widely-available vaccine would be wonderful, but I think we are talking up the vaccine too much. It will probably end up like the ‘flu’ vaccines. It will take a long time for most of us, many people seem likely not to take it, and it won’t work for everyone anyway, especially as the virus mutates.
Luckily. There is much that we can do with a vaccine. So long as outbreaks are contained relatively quickly, we don’t need to abandon our offence completely. Given the ‘flu’ benefits and the medical advances, excess years lost seem likely to remain quite low, so long as the most vulnerable are isolated. I suspect we are already close to a situation where the risk from driving our car on the highway becomes lower than the risk from Coronavirus.
This assumes that outbreaks are contained, and by now we have a good idea how to do that too, though practice in many countries remains woeful. Why is it such a hardship to wear a mask, and wear it properly? The politicians who have equivocated on this truly have blood on their hands. If everybody avoids crowds and wears their masks and maintains good hygiene, we can otherwise live normally, except where there is community spread.
Avoiding community spread is all about testing and tracing. Again, there is good practice available and woeful project management in many places. We took a test in August, and received our result thirteen days later. That is almost worthless. It has taken far to long here and elsewhere for reliable tests to be readily available and return results quickly. If that is in place, then contact tracing can be effective too.
Can we do this even better than current good practice? I think the real game changer is less about a vaccine and more about an instant test, one we can self-administer like a pregnancy test. This is how professional sports have been able to resume, and it would be wonderful if that sort of test became available to all of us. Then we could do almost anything, even sing or party or go to the theatre. For if even a thousand people enter a clean space, they can do whatever they like if nobody has the virus already: they will all exit virus-free as well.
Perhaps singing and parties and theatres are not top priority, though it would certainly help the mental health of many if they were. But school certainly is a top priority, and so is work. Many people will work from home in future, so it should be possible now to handle the resumed demand on public transit and in offices and retail establishments. This would be a good moment to increase the taxes on car use, to influence more people to return to public transport rather than use their car or even buy a new car.
With cases rising around Europe this prognosis may appear over-optimistic. For sure there will be outbreaks, and local governments must quickly snap back quarantine measures when these become too dangerous. But for most of us, most of the time, we can confidently move towards normality, thus improving our mental and economic health.
Critical to all this is public health messaging that is clear and consistent. We can acknowledge that, while the virus remains deadly to some, the overall impact on lives lost no longer justifies extreme measures. Most importantly, everybody must play by the hygiene rules, notably wearing a mask, and strictly following periodic orders to stay at home. A focus should remain on provision of frequent tests with rapid results, and the possible game changer of the self-administered test.
In some places the first half performance was so bad that winning the second half would be a daunting challenge. How can a public trust leaders who have equivocated on hygiene? In these places, sadly including the one where I live, restoring that trust has to be the only priority, and that precludes more nuanced messages about opening up.
But elsewhere, even when two or three down at half time, ways are opening up to win the second half. Whisper it softly, but that might even include some fun. After the drubbing of the first half, we surely need that.
Even if the second half is won, the end result of the match will be defeat. Most obviously, that is reflected in the mourning that has touched most of us over lives taken to early. But the pandemic had exposed other fundamental weaknesses in our team, from urban design to care for the elderly to underclasses and precarious jobs and health care systems. The time to address these failings will be with us soon enough. But for now let us win the second half.
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