Six Months Is More Than Enough

Here's a good (anti-)joke for you: What do Julius Caesar and America as we knew it have in common?  Both died on the Ides of March (aka March 15).

What is the cruelest April Fools joke in all of recorded history? "Fifteen days to flatten the curve", which began on March 16, 2020 (and by it's very own definition, should have ended April 1, 2020.)  

And six months later, in most of the country we are still not anywhere close to being back to normal, despite having "flattened the curve" months ago.  Not the New Abnormal, but rather the true normal.  America is almost a completely different country now than we were just a little over six months ago.

Keep in mind that the original strategy of "flatten the curve" was a very modest and short-term one:  to slow the spread of the virus just enough so that the same number of patients will arrive at the hospital but staggered out over a longer period of time rather than all at once, so hospitals would not be overwhelmed.  DONE.  Then, by early April, in a swift moving of the proverbial goalposts and mission creep, the strategy morphed into a suppression and elimination ("zero COVID") strategy.  Which is unrealistic once the proverbial horse is out of the barn, of course. Ditto with trying to suppress it until the vaccine, which may take years or never come at all, and will most likely not be the silver bullet that people hope it is.

All at a truly massive social and economic cost, the likes of which have not been seen since the 18...nevers.  For a disease which, for the most part, is in the ballpark of a strong seasonal flu in terms of deadliness and overall severity.  We may very well see that lockdowns and related measures will have actually caused more deaths than COVID itself ever could, making the "cure" far worse than the disease.

In any case, there were really only two choices:  transmission now, or transmission later.  Or more likely, a bit of both.  And many countries got the worst of all worlds by choosing lockdown. When it comes to viruses, you can run, but you can't hide.  At least not for very long, as nature always finds a way, even if such ways may not always be fully understood.  The ox may be slow, but the Earth is very patient indeed.

Thus, as the ever-insightful Dr. John Lee notes, the only viable strategy at this point is learning to live with the virus, kinda like we do with the flu and stuff like that.  That way the pandemic will simply end the same way others before it have ended, with herd immunity and attenuation (weakening) of the virus itself, after circulating so much. Meanwhile, as we noted in a previous post, we have also learned how best to treat the disease and prevent the very worst outcomes for the most part.  And the virus is currently fizzling out on it's own all over the world as we speak, including the USA, as we are already in the endgame now.  ("Casedemics" from increased testing, false positives, and lagged legacy deaths notwithstanding.)

Apparently a lot of people don't like the term "herd immunity" because it contains the word "herd".  No problem, we can simply call it "population immunity", "community immunity", "collective resistance", "community resistance", "heterogeneous group resistance", "saturation", or perhaps our favorite, "The Final Countdown", named after that famous Swedish song from the 1980s.  Either way, it is not a "strategy" so much as an inevitable fact, kinda like gravity.  And delaying it for too long ultimately hurts the vulnerable in the long run, by increasing their chances of exposure, to say nothing of the very harmful effects of extended isolation and loneliness. 

And such wrongheaded measures to delay it also end up disproportionately hurting the poor and working classes, a fortiori for people of color, who are bearing a disproportionate share of not only the massive social and economic costs of lockdowns, but also the inevitable burden of building collective immunity as well, while the elites easily "shelter in place" and work from home in their ivory towers.

Thus, it's long past time to lift or phase out the many authoritarian restrictions (which were largely ineffective) put in place that would've been unthinkable as recently as February 2020.  That is not to say that people should not continue taking precautions to one degree or another, but the time for such top-down coercion has come and gone long ago.

Let America Be America Again!

P.S.  This is NOT a left-wing vs. right-wing thing, so let's not fall into that trap.  In fact, our position is really the only genuinely progressive position there is overall, especially when combined with other progressive priorities like UBI and Medicare For All.

The TSAP's Updated Position On Face Mask Mandates

DISCLAIMER:  The TSAP still encourages everyone to continue observing official mask mandates in public places at the national, state, and/or local level, for as long as those mandates are still in effect, and does NOT promote or condone any civil disobedience in that regard.  Choose your battles very wisely, and don't be a Karen or Kevin either way (with apologies to people who actually have those given names.)

NOTE:  The following shall fully supersede any positions taken or advice given prior to August 1, 2020, and shall remain in effect until further notice.

As we now finally enter the endgame of the COVID-19 pandemic in the USA, and face mask mandates are now entering in their third, fourth, or even fifth month in many places, we at the TSAP feel it is time to start talking about how long these mandates shall last, and to what extent, before they are ultimately phased out.   Yes, you read that right.  There, we finally said the heresy out loud now, and we don't regret it.

While the TSAP has enthusiastically supported fairly broad mask mandates from late April onwards, that support was predicated on these policies being temporary, logical, and nuanced.  We have never supported permanent mask mandates (or ones that last until that ever-elusive vaccine), nor have we supported ones that apply to any places that are both not open to the public and and not workplaces (such as private residences and exclusive members-only clubs).  Nor have we supported any outdoor mask mandates that last for more than two weeks, unless an exception is made for situations where six feet of distance is possible to maintain between people.  And we have opposed all mask mandates that apply to children under two years of age, and have not (yet) taken a position on whether children between the ages of two and ten years of age should be required to wear masks in public either.  And penalties for individuals, if any, should not exceed a small civil fine similar to a parking or traffic ticket, with no criminal record.  After all, for most people, not wearing a mask is no more dangerous to others than speeding is.

We have generally considered New York State's mask mandate, and later California's, to be a good model for the nation.  In contrast, the local ones in Miami and Broward County, Florida, are too broad and harsh by our standards.  But even the very best of such mandates should still ultimately have a sunset clause.

Our current position is the same as before, with the following changes:

1. All broad mask mandates should sunset no later than January 1, 2021 at the latest, or six months after they began, whichever occurs first.  Even in areas currently designated as "red" zones (i.e. characterized by seriously widespread community transmission of the virus).
2. In areas that are currently designated as "yellow" or "green" zones, all broad mask mandates should sunset no later than November 4, 2020 (i.e. the day after Election Day).
3. Narrow mask mandates, covering only very selected situations such as inside retail shops and/or public transit, can last beyond the end of broad mask mandates, but after November 4, 2020 shall sunset no more than an additional 90 days later in any case.
4. Until the November 2020 election is over, masks should remain mandatory at all election locations and on all public transit, even if masks are no longer required elsewhere.
5. Going forward, all new broad mask mandates imposed after August 15, 2020 should only be imposed on areas with seriously widespread community transmission of the virus.  Otherwise, no new mask mandates.

Of course, in the event of a severe second wave in the winter, these mandates may very well need to be reimposed, and nothing written here shall preclude that, but the TSAP doubts very much that will happen, since "herd immunity" is likely to be reached nationwide by then if it hasn't already.  Yes, really.

As for children under the age of ten, the TSAP now believes that after August 15, 2020 they should be completely exempt from any mask mandates, with the possible exception of public transit and within 100 feet of a polling place, in which case only children under the age of two should be exempt.

Furthermore, deaf people and those communicating with them, and anyone for whom wearing a mask is medically contraindicated, should also be automatically exempt from such mandates.

Face masks do work to an extent in slowing (not stopping) the spread of the virus when used properly, though their effectiveness has likely been overstated and they should not be regarded as a talisman or a substitute for social distancing and hygiene, but as an additional modest layer of protection when they are widely used by the vast majority of people.  They protect those around the wearer more so than they do the wearer.  The "effect size" of universal mask wearing is relatively high when there is a high level of widespread community spread of the virus (i.e "red" zones), while it becomes practically negligible when the level of community transmission is at a very low baseline level (i.e. "green" zones).  And outdoor transmission is relatively rare with or without masks, while at least 99% of transmission occurs indoors.  Thus, the TSAP's nuanced position makes sense now.

Interestingly, none of the Nordic countries (including Sweden) ever saw the need to mandate the use of face masks, nor did the Netherlands, and yet they did not do any worse overall in terms of the the pandemic compared with other European countries that did (often belatedly) require them.  On the other hand, all of the East Asian success stories did involve widespread mask wearing, though not every country required it and often it was voluntary.  So unlike lockdowns, which turned out to be unequivocally counterproductive and thus worse than useless, the jury is basically still out on the effectiveness of mask mandates when looking at the international evidence.

(The debate on masks, after all, is well over a century old.  Really nothing new under the sun here.)

Make no mistake, mask mandates are NOT lockdowns, and are nowhere near as bad.  After all, the TSAP supported them as a way OUT of lockdown.  But they do come with their own downsides too, and as the weeks turn into months and the months turn into years, they don't exactly age very well either.

UPDATE:  It looks like there is yet another nuance to the centuries-old debate about the effectiveness of masks.  That is, the latest theory is that even though masks (especially cloth masks) are only partially effective as PPE and source control, they do likely reduce the viral load, which while it can still be somewhat infectious it would would make the wearer and those around them less sick and less likely to die than receiving a higher dose of the virus.  A lower dose of the virus is easier for the immune system to knock out quickly before it gets bad, while still enabling the infected to build some immunity going forward.  After all, "the dose makes the poison", and indeed the etymology of the word virus comes from and old word for "poison".  Another way to potentially reduce viral load is to gargle with an alcohol-based mouthwash regularly.   That said, these nuances do not materially change the TSAP's position, and in fact reinforces our middle-of-the-road approach.

Of course, to avoid further concentrating one's own potential viral load, be sure to change or clean your mask very regularly, and don't wear it 24/7 with no breaks.  Fresh air is also a good thing too, after all.  That is, use common sense!

And this begs the question once more to the lockdown enthusiasts who at first opposed masks but later embraced them:  if masks are so effective, why did we even lockdown at all?  Seriously, why did we?

OCTOBER UPDATE:  A cursory review of the empirical evidence so far reveals that while masks may very well be marginally effective at the micro level, they apparently are practically insignificant at the macro level, at least in the long run.  To wit, as the charts here so clearly show, broad mask mandates do not appear to have had any noticeable impact on the course of a country, state, or locality's epidemic curve.  To name a few, Hawaii, Illinois, LA, Miami, Kansas, Wisconsin, Israel, Japan, Spain, Argentina, and most notoriously Peru all have seen no beneficial long-run impact on cases (which actually increased at some point after implementation, even in conjunction with strict lockdowns in some cases), and the same was ultimately true for deaths and hospitalizations as well, except for Hawaii, Israel, and Japan whose death rates remain unusually low for reasons not yet fully understood.  As for Czechia, the crown jewel of early mask mandates, it appears to have only worked the first time in conjunction with their early suppression strategy in the spring, but not the second time around when the virus came roaring back in the fall.  Meanwhile, mandate-free Sweden, Denmark, Norway, North and South Dakota, Georgia, and the parts of Florida without local mandates don't seem to have had worse trends overall.  Thus, the TSAP no longer officially supports broad mask mandates as of October, except perhaps for a limited time (two to three weeks) in locally-defined "red zones". 

And we certainly do NOT support any federal mask mandates in the USA at all, period.  They are not only constitutionally dubious at best, but as noted above there is simply not nearly enough evidence in their favor to justify such unprecedented federal government overreach even temporarily.  Fortunately, even Joe Biden himself has largely walked back his initially strong support for such federal mandates.

NOVEMBER UPDATE:  On November 18, 2020, the much awaited Danish mask RCT study was finally released and published three months late in the Annals of Internal Medicine.  And the results were, shall we say, rather underwhelming, and not statistically significant (i.e. not statistically different from null).  Not necessarily the final word, but hardly a ringing endorsement for the effectiveness of general mask use in the community at the macro level.

A recent Cochrane review of the literature is not exactly reassuring either, to put it mildly.

But what about source control, you say?  That is, protection of people around the wearer, which most studies were not designed to look at?  Again, a cursory look at the data in the weeks and months following the implementation of mask mandates don't really support that either, at least not at a general population level.  Thus any such community benefit is likely either very small, very transient, or both.

Thus, we can conclude that even if there is some overarching benefit to wearing masks in some situations, universal community masking (or lack thereof) is nowhere near the game-changer it was originally sold as.  If it were, the pandemic would have been effectively over in a given locality, state, or country (even as it raged elsewhere) within two or three weeks following the implementation of a broad mask mandate.  And that has not happened anywhere in the world, even in places with very high (90%+) compliance, and even when combined with a ban on indoor restaurant dining (a behavior which might vitiate the results).  And as of November, the TSAP believes going forward that mask wearing (outside of a healthcare setting) should be largely (if not entirely) voluntary, and that businesses of any kind should be free to decide whether or not to require employees and/or customers to wear them.

Our best advice?  "Use masks judiciously, NOT superstitiously", pretty much sums it up.

The Only Way Out Of The Pandemic In One Piece

As time goes on and the endgame of the COVID-19 pandemic is now coming into focus, it is becoming increasingly apparent that not only do lockdowns not work very well and in fact do more harm than good, but that there is really only one realistic way out of this nightmare at this juncture.  And that way out will ultimately come about sooner or later, via a combination of three things:

1. "Herd immunity", which simply means that a large enough percentage of the population has become at least relatively immune to the disease (either via natural infection and/or mass vaccination) so as to quash the epidemic and keep it from taking off again in the near future.  The former route is far more likely in the near term than the latter, and the herd immunity threshold (HIT) is most likely far lower than was originally believed, and many states and countries are likely already there by now.
2. "Attenuation", which really is just a fancy way of saying that the virus becomes weaker over time, losing its "mojo".  There is some evidence that this process has already begun at least several weeks ago.  Especially if combined with herd immunity, the virus may eventually become the new common cold, if not phase out entirely.
3. Better early treatment of patients with the disease.  This cannot be overstated, as we have learned a lot about how to treat such patients, and most importantly what NOT to do, through trial and error (sadly, mostly error).  Now if only the feds were use the Defense Production Act to force production of PPE for hospitals rather than focus on often counterproductive ventilators.

These three things are, of course, all a result of the widespread circulation of the virus, which of course came at a very heavy price in terms of human lives.  But once the proverbial horse is out of the barn, as it has already bolted long ago, such a thing is inevitable sooner or later.  Especially with the prospect of a safe and effective vaccine likely years away.

Sweden, as we know, understood this very well from the start.  It is really a shame how most other countries did not, and some still seem not to for whatever bizarre reason.  Instead, they mocked Sweden's moderate mitigation strategy and attempted to suppress the virus all the way to zero via lockdowns and mass quarantines, often belatedly.  Those that acted too late basically trashed their economies for nothing while inadvertently creating a Sweden-like herd immunity scenario anyway (albeit often with far more excess deaths), while those that acted early seemed to dodge a bullet, only to see a resurgence (or extra legs) of the virus later.  Basically, as the now-famous Swedish epidemiologist Anders Tegnell predicted, a year from now (if not earlier) we will see that practically all countries and states will end up the same way (within error bounds) regardless of what strategies they pursued, a few lucky (or unlucky) outliers notwithstanding.

In other words, the virus is in the wild and has been for a while now, so shutting down again will only delay the inevitable, and drag it out that much longer and more painfully.  So don't do it again!

That said, we should also note that the TSAP unequivocally does NOT support the practice of "corona parties" or any other deliberate or grossly negligent mass infection-inducing behavior.  This virus is, at best, extremely difficult to control.  Just because most people will inevitably be exposed to the virus at some point does NOT mean that anyone should willingly and unnecessarily tempt fate in any way.  And even though the virus is relatively harmless to most people, that clearly does NOT mean that it is for everyone, and there are of course documented cases of people dying or suffering irreversible damage from it at surprisingly young ages.  This is still a potentially dangerous and deadly virus, after all.  So seriously, live your life, "keep calm and carry on" as the old saying goes, but please do take precautions, avoid large crowds, and don't be stupid and reckless about it!  Young people, this means you too.

UPDATE:  Some pundits apparently still believe in a "Zero Covid" strategy in which no level of the virus is tolerated, assuming that it can actually be truly eliminated via suppression measures.  The problem with that quixotic, ivory-tower idea is twofold--first, even if possible, we missed our chance to do it many months ago, and secondly, any attempt to do so now will only drag it out and prolong the pain by further delaying herd immunity.  With plenty of collateral damage too.  And we would basically have to live like the unfortunate folks in Susan Cooper's Orwellian-style dystopian novel Mandrake for the foreseeable future, a truly disproportionate response to a disease whose deadliness is most likely in the range of seasonal flu to medium pandemic flu.  And with most likely zero lives saved as a result.  Fortunately, we will likely reach herd immunity and/or attenuation of the virus sooner than expected, if not already there, so it won't be long before this debate becomes academic.

And sorry, but moving the goalposts does NOT really furbish the "Zero Covid" strategy one bit, which is still just as ridiculous as a "Zero Flu" strategy.  After all, there was a reason we were able to (relatively) tame the flu over time without eradicating it, and that reason was via the three aforementioned factors:  herd immunity, attenuation, and improvements in treating patients.  We'd be wise to learn from history.

Case Closed: Lockdowns Don't Work

A new study published in The Lancet examined the effects of various countermeasures and other country-level variables on COVID-19 cases, deaths, and related statistics in various countries.  And the results were rather underwhelming and disappointing for any lockdown enthusiast.  Behold the key takeaway, in the authors' own words:

Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people.

And that was after controlling for a whole host of variables in a multivariate analysis.  As the late, great William Farr (of Farr's Law fame) has famously noted, "the death rate is a fact; anything beyond this is an inference".  That is, if you know the death rate for a given disease, you can fairly accurately estimate the (lagged) infection rate from that.  And that is especially true of COVID-19, where cases are often counted differently in different times and places.

(The Occam's Razor is as sharp as ever here.)

And that is not even the most scathing study done on the matter to date.  Followers of our blog may recall others as well that were far less charitable than this one.  Worse, in some countries, lockdowns actually appear to have been deadlier than doing nothing or taking less extreme measures.  In many countries, deaths with COVID and from COVID are conflated, and even non-COVID deaths saw increases during at least the first few weeks of lockdown.  Excess all-cause mortality in so many countries shows a rather suspicious pattern that is strongly suggestive that the government response of lockdowns (along with closely related policies such as artificial restrictions of healthcare and monumentally screwing up with nursing homes) likely caused far more deaths than the virus itself.  In fact, despite the fact that the virus was already circulating much earlier, excess all-cause mortality did not exceed statistical norms in any country until after such lockdowns were imposed.

If that is the case, then that is nothing short of mass murder!  And those are just the short-term effects, with longer-term effects coming down the pike.

At best, then, such lockdowns were unnecessary infringements on civil rights and liberties, and at worst they were far worse (and deadlier) than useless.  All the more reason NOT to repeat such mistakes going forward.  Seriously, don't do it!

So what about those few supposed success stories of countries and states that locked down very early in their epidemic curves and seemed to have dodged a bullet?  Well, take a look at them now, or if not now, a few weeks or months from now.  Those are the ones who are or will be having the much dreaded "second wave" of the virus, since they still have quite a ways to go before reaching even partial herd immunity thanks to their early lockdowns.  Meanwhile, those hard-hit countries and states with belated lockdowns (or none at all, like Sweden) will most likely avoid a second wave, having built up enough immunity to keep the virus from taking off once again.  A very lucky few countries in the former group might still remain lucky, of course, but as Dr. Sunetra Gupta notes, that is really thanks to the rest of the world building up such immunity, a classic "free-rider" problem that really is nothing to be so smug about.

The thing about viruses is, you can run, but you can't hide.  At least not for very long.  Sooner or later, it has to run its course.  It really doesn't take a rocket scientist to see that playing hide-and-seek with an invisible enemy would be a lose-lose proposition.

QED

JULY-NOVEMBER UPDATES:  Looks like yet another rug has been pulled out from under the strongest pro-lockdown argument recently, confirming the WHO's famous June 8th "gaffe" that truly asymptomatic transmission of the virus, while it exists, is indeed relatively rare and is thus not a particularly significant driver of the COVID-19 epidemic.  A new study in Annals of Internal Medicine in August simply confirmed what previous research has already found in that regard in countries that did very thorough and detailed contact tracing.  And of course, we now know that the decision to implement lockdowns was really due to countries simply copying each other and flying blind, not based on empirical evidence.  And the whole general concept has quite a checkered pedigree as well, while its original justification of "flattening the curve" was quickly and thoroughly supplanted by moving the proverbial goalposts practically 180 degrees.

(While presymptomatic transmission and subtly symptomatic transmission is apparently quite common, that is also true for the flu as well, a virus for which large-scale mass quarantines have been roundly discredited as useless and counterproductive for nearly a century.  The lockdown zealots can't have it both ways: either COVID-19 is as stealthy and practically unstoppable as the flu and common cold, and lockdowns are thus utterly useless, OR it is possible to contain it without lockdowns, and lockdowns are thus utterly unnecessary.)

And yet another study has recently found that the curve was in fact largely self-flattening from the start with or without lockdowns or other non-pharmaceutical interventions (NPIs) such as curfews, closures, quarantines, travel restrictions, event bans, or even the much-vaunted mask mandates.  That is, while the growth rate of the epidemic inherently started out very high, it had already begun decelerating after roughly the 25th cumulative death was recorded in practically every country studied regardless, with the daily curve peaking or plateauing within 20-30 days from then.  Even long before herd immunity was or will be reached, transmission rates were already slowing down dramatically due to the virus reaching "natural dead-ends and roundabouts" in human social networks.  Which is really not surprising for a virus that is primarily transmitted by a small "superspreading" sliver of the population, and that still in a highly heterogeneous population in terms of susceptibility as well.  And even if lockdowns and/or other NPIs were perhaps somewhat effective at first, any such effectiveness apparently rapidly decays over time to essentially nil by now.

And Lyman Stone, an early opponent of lockdowns, noted all the way back in April that Americans, much like Europeans, generally began voluntarily social distancing before, and often well before, lockdowns went into effect.  This was particularly true in Washington State, but true to an extent practically everywhere eventually.  Information and recommendations would thus appear far more effective than coercion, especially when done early.

Still not convinced yet?  Well, even more new evidence just keeps piling up, and none of it is particularly flattering to lockdowns.  Also, for the USA, it appears that the significant regional variations in the death curves are far more due to to climate and seasonality than to lockdowns and NPIs.  The Northeast was "early peak" much like Europe, the South and Southwest was "late peak" much like Latin America, and the Midwest and Northwest were essentially "no peak", just a long and low undulating plateau.  And a few borderline states were "mixed", not clearly fitting into any category.  All essentially independent of the timing and relative stringency of lockdown and reopening.  Thus, looking at the USA as a monolithic country, especially when comparing it to Europe, is highly misleading and disingenuous.

See also this video by the ever-insightful Ivor Cummins as well.  A real eye-opener indeed!

Thus, yet again we see that anti-lockdown Sweden (and Belarus, etc.) was not a special case at all, but rather the proper control group while the rest of the world essentially embarked on a crazy experiment whose theory behind it didn't really pan out.

Oh, and about that supposed "success" story of Peru?  There's a good reason why lockdown enthusiasts don't seem to want to talk much about them anymore.  Let's see:  world's longest lockdown (over six months), world's toughest lockdown (makes Melbourne look like a walk in the park), world's earliest lockdown (for their region), and--wait for it--world's worst death rate.  If that's "success", we'd really hate to see what failure looks like!  Now their fully-open neighbor Brazil doesn't really look so bad after all, do they?

(Pardon the pun, but don't cry for me, Argentina, either.  Another longest-lockdown country now getting the worst of both worlds, with the added insult of borderline hyperinflation (again!) as well.)

Later, Belgium of course became a bit worse than Peru once again despite going back to lockdown, as their second wave appears to rival their first one.  Neither their first nor their second lockdown seem to have done them a lick of good.  Supposedly they have quite a problem with Vitamin D deficiency, kinda like New York and the UK, so they might wanna start fortifying their food like the Nordic countries do.

Thus, in conclusion, the most fundamental flaw of lockdowns of all flavors is that it is applying a micro-level solution (quarantine of sick individuals and/or their contacts) to the macro level (mass quarantine of the healthy as well, over a wide area), which ultimately creates far worse macro-level problems.  The same can perhaps even be said about overbroad mask mandates as well, at least in the long run.  History will not judge such measures kindly at all.

And in case you think that the shiny new October study in The Lancet somehow overturns the aforementioned ever-growing mountain of evidence against lockdowns, well, we've got a shiny new bridge we'd like to sell you.  The ever-insightful Toby Young of the British site Lockdown Sceptics has an excellent takedown of this highly questionable study.  If only the UK Government (and indeed the rest of the world) would actually listen to him for once.

Meanwhile, yet another study finds that lockdowns still don't work in terms of reducing death rates, and another finds that the recent autumn outbreaks are (surprise!) strongly correlated with seasonality regardless of policy.  Case closed, full stop.

See also here, here, here, here, here, here, and here.  

Looks Like Sweden Won The Debate After All

Short version:  Sweden clearly won the lockdown debate, opting instead for a far more sustainable strategy that balanced the short-term goal of "flattening the curve" with the longer-term goal of "herd immunity", and the virus is now on the run and all but disappeared from their country as of July.

Longer and more nuanced version:  Sweden is one of those countries that, in our polarized world, you either love them or hate them.  Being the most famous of the non-lockdown countries, the anti-lockdown side loves them while the pro-lockdown side just loves to hate them.  Which makes sense, given how Sweden is one of the few and most well-known countries who chose not to do a lockdown at all.

In truth, however, they are neither a shining city on a hill, nor are they an unmitigated disaster in terms of how they handled the COVID-19 pandemic.  They are in fact...about average by European standards, at least in terms of per capita death rates for now.  Worse than their Nordic neighbors and Germany and Austria, but better than the UK, Belgium, Spain and Italy.  Worse than the USA as a whole, but better than the seven worst US states, especially New York.  Which is nothing to brag about, of course, but hardly a ringing endorsement for lockdowns either.  Especially since they avoided completely annihilating their economy (albeit still suffering) and inflicting other collateral damage that the lockdowns in other countries (especially the UK) did, while still being able to "flatten the curve" and thus keep hospitals from being overwhelmed and collapsing Lombardy-style.

The architect of the Swedish mitigation strategy of moderate social distancing, Anders Tegnell, admits that Sweden could and should have done more.  And yes, they did screw up in several major ways, at least in the beginning.  But he still does not endorse a full lockdown.  So what could they have done differently, short of a lockdown?

Here are the things that come to mind that they should have done but didn't, or should have done earlier but did too late:

• They kept their borders wide open with no hard restrictions on international travel or even any health screenings at ports of entry.  Even Japan and Belarus didn't make that mistake.  In hindsight, that was really quite foolish.
• They did not declare a state of emergency.  Even the Donald did that, albeit belatedly.
• Their gatherings limit of 500 people, first imposed on March 11, should have been cut down to 50 people or some other double-digit threshold much sooner, ideally on that same day or the very next day, rather than waiting until early April to finally do so.
• They should have made virus testing available much sooner.  Instead, until very recently, you literally had to be sick enough to go to the hospital in order to get a test as per their test rationing policy that began in March.
• They made a reasonable stab at contact tracing at first, but gave up when the numbers grew too overwhelming.  (Though even with very little testing, they could still have done it the Japanese way had they started earlier than they did.)
• Like most countries, they should have done a better job protecting nursing homes. In Sweden's case, they should have banned or severely restricted visits to nursing homes much, much sooner, instead of being loosey-goosey about it until finally doing so on March 31.  And they should have made sure early on that the staff had (and used) adequate masks and PPE, which they failed to do.  Even Florida did better than they did, though New York and New Jersey were far worse, as was the UK.
• Their triage protocols for nursing home patients being (not) sent to the hospital turned out to be wholly unnecessary and counterproductive.  Ditto for any other artificial restrictions on health care.  (Other countries did this too, so this was not unique to Sweden.)
• And like most countries also failed at, they should have kept colleges open even if they canceled classes temporarily.  Sending students home to infect their parents and grandparents was probably not the wisest idea in the world.
• And last but not least, they advised against face masks (and apparently still do) on the mistaken belief that they create a false sense of security and lead to less social distancing.  And that stance does not appear to be accurate.  (Though admittedly, the book has still not been 100% written on the question of net effects just yet.)

Aside from those flaws, there is still much to admire about Sweden and their strategy.  But ultimately they are paying a rather heavy price for their earlier errors, even after belatedly correcting such mistakes.  They likely will reach the holy grail of "herd immunity" sooner or later, if they are not already there, but unfortunately due their missteps, the journey turned out to be much more dangerous than the destination.  Thus, we give Sweden a gentleman's C for effort.  Still far better than several lockdown countries did.

As for population density, in case someone uses that argument, it is misleading to compare average densities across nations, given the large variations in density and distribution within each country.  And even so, higher densities do NOT necessarily imply higher per capita death rates, in fact the opposite may very well be true as a result of at least somewhat better healthcare provision in denser areas.

It looks like not only is Sweden's COVID epidemic all but oven now as per Worldometer death rates, and their death curve did turn out to be much more bell-shaped after all, but that Sweden is now quite vindicated indeed compared to even some of their neighbors in terms of cumulative all-cause mortality through the first 24 weeks (roughly the first half) of 2020.  Though worse than Norway, Sweden nevertheless fell very close to and just between Denmark and Finland, and fared far better than Scotland.  So it looks like the lockdown zealot vultures will need to find a new punching bag now--take a guess which country? 

(Hint: it's the one that is still not only debating on whether to reopen schools in the fall, but actually has the GALL to crassly turn the issue into a silly political football because it is an election year.  Really. Meanwhile, most other countries have successfully reopened K-12 schools with essentially no problems, and Sweden never closed them at all.)

Additionally, it looks like the Swedish city of Malmo is in fact doing a particularly good job overall.  After watching and learning what not to do from the early hotspot of Stockholm, they followed essentially the same Swedish strategy minus the nursing home screwups, basically, and as we can see now, it's really paying off.  Their per capita death rate is lower than even Copenhagen, Denmark across the Oresund strait.  That is, they are achieving herd immunity AND protecting the most vulnerable members of society at the same time, while maintaining individual freedom and avoiding an economic depression.  Now THAT is really a shining city on a hill!

(Lest anyone claim that somehow America is too diverse and multicultural for the Swedish model to work here, keep in mind that Malmo is also a very diverse and multicultural city as well.)

In other words, we can certainly learn a lot from Sweden--both what to do as well as what not to do.  But all things considered, Sweden clearly wins the debate hands-down.

Lockdowns Don't Work. But Masks Do.

NOTE:  As of August 14, 2020, the TSAP's positions taken in this article are hereby superseded by those in a newer post.  Also, since the article was posted, the study that formed the primary basis for this article has apparently been recommended by over 40 scientists to be withdrawn due to its apparent flaws.

That is essentially the conclusion of a new study that looks at the (former) COVID-19 hotspots of Wuhan, NYC, and northern Italy.  Based on the relative timing of when social distancing measures, stay-home orders (i.e. lockdowns), and mandatory mask rules were first imposed, the researchers found a strong inverse correlation with COVID-19 cases and mask requirements, while barely any correlation with social distancing and stay-home orders.

(And not the only study either.  Though other studies do find some degree of effectiveness for social distancing as well.)

Unfortunately, the study authors kinda shoot themselves in the foot by effectively conflating as "airborne" both larger ballistic droplet as well as small aerosol droplet transmission.  The strong inverse correlation with mask wearing would if anything make even more sense for catching larger droplets than smaller ones.

Either way, while correlation does not prove causation, this is nonetheless a pretty strong correlation.  Thus, there is no good reason not to reopen the economy at this point, and quite frankly, yesterday is not soon enough.  During the reopening process, state governors (Ducey of Arizona, I'm looking at you!) really ought to require masks to be worn in public, particularly indoors (which is far riskier than outdoors) and during the most critical and riskier phases of the reopening process.

And of course, We the People really need to wear them, yesterday.  At least in indoor public spaces and public transit, or any other crowded area where sufficient physical distance is difficult or impossible.  Even if it is just for the next few weeks or so, it will still make a big difference, especially in reducing the overshoot beyond the herd immunity threshold in places that are at or approaching that threshold.  In fact, as source control, when a large enough percentage of the population wears masks, it can effectively simulate herd immunity, and the virus will thus quickly run out of momentum and die out.  And all without wrecking the economy and society at large, and with minimal effect on individual rights.

That said, the TSAP should clarify that we support mask mandates that are nuanced and temporary, not absolute or permanent.  Absolute (i.e. without nuance) ones should not last more than two weeks in any case, and the much lower risk of outdoor transmission should be taken into account by mandates lasting longer than that.

It is worth noting that the states with mandatory mask requirements have seen decreases in COVID-19 cases, while the states without (including California, who only very recently implemented such a requirement, thus the effects haven't kicked in yet), have seen significant increases.  And that is true even though all 50 states and DC have reopened to one degree or another at some point.  It is hard to find a correlation stronger than that.

So even if there is a surge in cases, resist the impulse to lock down again.  Simply require masks to be worn in public, particularly indoors, and tighten limits on building occupancy and large gatherings.  That's it.  Add some temperature checks and you're golden.  Maintain such policies until case numbers drop to a statistically and practicallly negligible level, then repeat as necessary.  As for a vaccine or cure, don't hold your breath, since a vaccine is likely years away, while anything resembling a (belated) cure would most likely not be much of a game-changer compared to existing treatments (remdesivir, steroids, etc.).

As for contact tracing, they really need to step it up.  And any supposed shortage of testing capacity (even after having many months to prepare!) is no excuse not to do it, as Japan was able to do retrospective contact tracing successfully with very little testing (2000 tests per day, equivalent to about 5000 per day in the USA), focusing on the larger clusters and thus the "superspreaders" that account for the vast, vast majority of virus transmission in the community.

And perhaps COVID-sniffing dogs will soon become a thing as well.  Apparently they exist.  Regardless, all of these aforementioned alternatives are far better than a return to lockdown.  So what are we waiting for?

Latest Pro-Lockdown Studies Are Far Less Than Meets The Eye

The latest two studies that claim that lockdowns somehow prevented millions of COVID-19 cases from occurring are getting a lot of attention right now.  But upon closer examination, we see that there is less here than meets the eye:

• Only six countries are included in the first study:  China, South Korea, Iran, Italy, France, and the USA.  Conspicuously absent are the UK, Belgium, Spain, Germany, Sweden, Iceland, Taiwan, Japan, and Belarus, which clearly skewed the results.
• The other study, done by the same Professor Neil Ferguson known for his buggy and discredited model back in March among others included 11 European countries (including many left out of the other study) and did a "simplistic counterfactual" compared to no intervention.
• Teasing out the precise effects of each specific type of intervention is not easy.
• The researchers in the second study assume an R value of 3.8 and a doubling time of two days at the beginning of the epidemic, before any intervention, and that it would have remained that high in the absence of such interventions.  In contrast, most other researchers put the basic R value at between 2 and 3, with a doubling time of 3 days--and that makes a very big difference.
• Epidemics do not keep growing exponentially forever, rather, they famously follow a sigmoidal Gompertz curve even without intervention.
• There is evidence that the R values in many countries plummeted well before any lockdowns went into effect (Germany's dropped below 1 just days before their lockdown, and Sweden's also did without ever doing a lockdown).  This was due to voluntary behavior changes as well as more modest policy measures.
• Failing that, the R value will plummet and drop below 1 when the herd immunity threshold is reached regardless.
• There is evidence that the herd immunity threshold is lower than the naive assumption would put it, and that it would be reached sooner than believed even in an unmitigated scenario.  Also, a LOT more people were infected than the number of confirmed cases, by at least a factor of 10 if not a factor of 80 or 100.
• The first study only looked at confirmed cases, not hospitalization or death rates.  And confirmed cases are probably the most biased measure of true infection rates that there is.
• And now the real kicker:  flattening the curve does not actually change the number of cases or deaths, only delays and staggers them.  Except to the extent that it prevents hospitals from being overwhelmed and collapsing, but that generally did not materialize anywhere outside of Lombardy, Italy and some localities of Spain, not even in Sweden.  Moderate social distancing appears to be sufficient to prevent such a collapse, while belated lockdowns utterly failed to prevent it in the very few rare and exceptional cases where it happened.  Thus, the case for lockdowns, well, collapses.

And the best empirical evidence does not pan out in favor of lockdowns:  non-lockdown countries are generally outperforming lockdown countries on average, and within the USA, non-lockdown states have also been outperforming lockdown states in terms of coronavirus case and death rates per capita.

The supposed effectiveness of lockdowns (compared to far less extreme restrictions) in terms of slowing or stopping the spread of coronavirus has been called into serious question lately by other recent studies.
Such studies have found there is at best no correlation, and perhaps a perverse effect between the two defining features of hard lockdowns (stay-home orders and closures of all non-essential businesses) and COVID-19 cases and deaths per capita after other factors such as less-extreme policies are accounted for.  The benefits are thus nothing more than a statistical mirage that does not stand up to scrutiny--much like the supposed benefits of the 21 drinking age vis-a-vis DUI deaths in the long run.

Meanwhile, the collateral damage (economic depression, inequality, poverty, alcohol and other drug abuse, domestic violence, child abuse, loneliness, poor mental health, delayed medical treatment, etc.), which also kills people too by the way, continues to mount with each passing week of lockdown, making an utter mockery of practically all progressive and even basic humanitarian priorities.  And that's to say nothing of the civil rights and liberties, as well as community cohesion, that progressives generally support.  It seems that the "cure" is quickly becoming far worse than the disease as time goes on.

(And that's just for the affluent countries.  For poorer countries, the collateral damage will most likely be at least an order of magnitude worse and deadlier.)

Furthermore, all may not be what it seems in terms of death rates.  In many countries, deaths with COVID and from COVID are conflated, and even non-COVID deaths saw increases during at least the first few weeks of lockdown.  Excess all-cause mortality in so many countries shows a rather suspicious pattern that is strongly suggestive that the government response of lockdowns (along with closely related policies such as artificial restrictions of healthcare and monumentally screwing up with nursing homes) likely caused far more deaths than the virus itself.  In fact, despite the fact that the virus was already circulating much earlier, excess all-cause mortality did not exceed statistical norms in any country until after such lockdowns were imposed.

If that is the case, then that is nothing short of mass murder!  And those are just the short-term effects, with longer-term effects coming down the pike.

Thus, the latest Nature studies should be taken with at least a grain of salt, if not a whole pound.

How Japan Beat COVID-19

One country that the lockdown enthusiasts seem to conspicuously avoid talking about is Japan.  Sweden is their favorite punching bag, as is Florida, but Japan?  It's as if they don't even exist.  And yet, they managed to beat the COVID-19 virus by doing everything "wrong".  And by "wrong", we actually mean RIGHT for the most part.

Despite being in the original geographical danger zone for the pandemic, and being one of the earliest countries to be infected that was not named China, their per capita death rate (the most important indicator) remains so low that it barely even gets on the chart relative to the rest of the world.  So how did they do it?

They did not impose a compulsory lockdown, opting instead for what they called a "soft lockdown" that did not even have the force of law (as their constitution, that they actually take seriously, strictly forbids doing such a thing), and even that was fairly brief and quite belated.  Nor did they close their borders either, opting instead for health checks at ports of entry and fairly modest visa restrictions early on.

What they did do, rather famously, is habitually wear face masks in public, as they did even before the pandemic began during flu season as well as allergy season.  Not everyone, but apparently enough to make a difference. And they are generally very good about hygiene overall there as well.  But less famously, and yet likely contributed even more to their success, was their virtually unique strategy of contact tracing despite doing relatively few tests for the virus.  Instead of going high-volume, labor-intensive, and prospectively, they quietly went after the larger clusters and traced contacts retrospectively, working backwards.  And that strategy really seemed to out-ninja this rather stealthy virus, since the spread pattern is highly skewed and heterogeneous, overwhelmingly driven by a fairly small number of "superspreaders" (10-20% of infected people), while about 70% of infected people statistically don't pass the virus on at all to anyone.  So this pattern lends itself more to that kind of contact tracing paradigm.  And best of all, they did it with excellent timing, unlike so many other countries that squandered and missed their chances to do so before it was too late.

Some cynics may think that Japan deliberately did as few tests as possible so as to make their numbers look good to the outside world, in the hopes of hosting the 2020 Olympics in Tokyo (which nevertheless got postponed to July 2021), thus sweeping it under the rug.  While that may or may not have been part of the motivation for running a low number of tests, their death numbers don't lie, and they seemed to have outsmarted the virus in any case.

And last but not least, despite having the oldest population in the world, they apparently protected the elderly quite well, and apparently did NOT screw up with their nursing homes like so many other countries (especially the UK and New York) unfortunately did royally.  That alone is worth its weight in gold, and the proof is in the numbers.

Now THAT is a shining city on a hill!

(The Wall Street Journal has another great article about Japan's success story here.)

OCTOBER UPDATE: While Japan still seems to have quite a lot of "cases" (positive tests), their per capita death rates are still very low and barely even get on the chart. Another good article can be found here.

2021 UPDATE:  We now basically take back anything we said about Japan "beating" the virus, especially anything about masks which turned out to be largely a red herring all along.  Japan had lots and lots of cases, even with low testing, but very few deaths and essentially no excess deaths, most likely due to low obesity and prior immunity from related coronaviruses common in East Asia.  That is a far better explanation than masks or ingenuity.  Their two worst waves so far both occurred in 2021, and they also had quite the surge in RSV in 2021 as well, despite a whopping 98% mask compliance.  Otherwise though, we still praise Japan for avoiding a hard lockdown, or even any serious mandates prior to 2021.  The virus was always destined to become endemic, and on some level they seem to be accepting that despite their initial elimination strategy.

The Nuanced Truth About Sweden

Sweden is one of those countries that, in our polarized world, you either love them or hate them.  Being the most famous of the non-lockdown countries, the anti-lockdown side loves them while the pro-lockdown side just loves to hate them.

In truth, however, they are neither a shining city on a hill, nor are they an unmitigated disaster in terms of how they handled the COVID-19 pandemic.  They are in fact...about average by European standards, at least in terms of per capita death rates for now.  Worse than their Nordic neighbors and Germany and Austria, but better than the UK, Belgium, Spain and Italy.  Worse than the USA as a whole, but better than the seven worst US states, especially New York.  Which is nothing to brag about, of course, but hardly a ringing endorsement for lockdowns either.  Especially since they avoided completely annihilating their economy (albeit still suffering) and inflicting other collateral damage that the lockdowns in other countries (especially the UK) did, while still being able to "flatten the curve" and thus keep hospitals from being overwhelmed and collapsing Lombardy-style.

The architect of the Swedish mitigation strategy of moderate social distancing, Anders Tegnell, admits that Sweden could and should have done more.  And yes, they did screw up in several major ways, at least in the beginning.  But he still does not endorse a full lockdown.  So what could they have done differently, short of a lockdown?  Here are the things that come to mind that they should have done but didn't, or should have done earlier but did too late:

• They kept their borders wide open with no hard restrictions on international travel or even any health screenings at ports of entry.  Even Japan and Belarus didn't make that mistake.  In hindsight, that was really quite foolish.
• They did not declare a state of emergency.  Even the Donald did that, albeit belatedly.
• Their gatherings limit of 500 people, first imposed on March 11, should have been cut down to 50 people or some other double-digit threshold much sooner, ideally on that same day or the very next day, rather than waiting until early April to finally do so.
• They should have made virus testing available much sooner.  Instead, until very recently, you literally had to be sick enough to go to the hospital in order to get a test as per their test rationing policy that began in March.  Their testing is basically a national joke.
• Contact tracing?  What's that?  (Though even with very little testing, they could still have done it the Japanese way.)
• Like most countries, they should have done a better job protecting nursing homes. In Sweden's case, they should have banned or severely restricted visits to nursing homes much, much sooner, instead of being loosey-goosey about it until finally doing so on March 31.  And they should have made sure early on that the staff had (and used) adequate masks and PPE, which they failed to do.  Even Florida did better than they did, though New York was far worse.
• Their triage protocols for nursing home patients being (not) sent to the hospital turned out to be wholly unnecessary and counterproductive.
• And like most countries also failed at, they should have kept colleges open even if they canceled classes temporarily.  Sending students home to infect their parents and grandparents was probably not the wisest idea in the world.
• And last but not least, they generally eschewed masks on the mistaken belief that they create a false sense of security.  Spoiler alert:  Um, NOPE!

Aside from those flaws, there is still much to admire about Sweden.  But ultimately they are paying a rather heavy price for their errors, even after belatedly correcting such mistakes.  They likely will reach the holy grail of "herd immunity" sooner or later, if they are not already there, but unfortunately due their missteps, the journey turned out to be much more dangerous than the destination.  Thus, we hereby give them a gentleman's C for effort.

In other words, we can certainly learn a lot from Sweden--both what to do as well as what not to do.

JULY UPDATE:   It looks like not only is Sweden's COVID epidemic all but oven now as per Worldometer death rates, and their death curve did turn out to be much more bell-shaped after all, but that Sweden is now quite vindicated indeed compared to even some of their neighbors in terms of cumulative all-cause mortality through the first 24 weeks (roughly the first half) of 2020.  Though worse than Norway, Sweden nevertheless fell very close to and just between Denmark and Finland, and fared far better than Scotland.  So it looks like the lockdown zealot vultures will need to find a new punching bag now.

Additionally, it looks like the Swedish city of Malmo is in fact doing a particularly good job overall.  They followed the Swedish strategy minus the screwups, basically, and as we can see now, it's really paying off. 

A Report Card For The Pandemic

It is June now, and we at the TSAP think it is time to issue tentative grades for each country on how they handled the pandemic.  These will be updated over time.  Grades are based on a mixture of per-capita death rates, economic damage, and policy measures.  All grades are on a curve, normalized with the European average set at C.  Here is the current list:

Taiwan:  A+
Hong Kong:  A
Iceland:  A
Belarus:  A
Norway:  A
Finland: A
Denmark: A
Japan:  A-
New Zealand:  A-
Germany:  A-
Austria: A-
Russian Federation:  B+
Portugal:  B+
Australia:  B+
Canada:  B
Singapore:  B-
Switzerland:  C+
Netherlands:  C
Sweden: C
USA: C (overall, varies by state)
Brazil:  D
France:  D
Italy:  F
Spain: F
UK:  F
Belgium:  F
China:  F (though they really deserve a Z, for infecting the whole world!)

Countries that avoided a full lockdown and still got good results automatically get higher grades than those who achieved the same results with a full lockdown.

For US states, a partial list of states' grades:

Washington State:  A
Iowa:  A
Wyoming:  A
Hawaii:  A-
South Dakota:  A-
Arkansas:  A-
North Dakota:  A-
Oregon:  A-
California:  B+
Florida:  B+
Georgia:  B+
South Carolina:  B
North Carolina:  B
Texas:  B-
Arizona:  C+
DC:  C
Maryland:  C
Virginia:  C
Wisconsin:  C
Connecticut:  C-
Massachusetts:  C-
Louisiana:  D
Illinois: D
Michigan:  D-
Pennsylvania:  D-
New Jersey:  F
New York:  F

If you remove the seven worst states, the USA has one of the mildest outbreaks in the world.  Only a very few states are worse than the European average as far as per capita death rates.  And non-lockdown states outperform most non-lockdown states.

All of these grades are of course subject to change in the coming weeks and months.

The Progressive Case For Reopening America (And Never Shutting Down Again)

Recently there was an article titled "The Left-Wing Case Against Lockdowns" that explains in detail why genuine leftists and progressives should oppose extending these coronavirus lockdown policies.  It basically echoes what we at the TSAP has been saying for weeks now, namely that these policies have not aged very well and are doing more harm than good in the long run. And the empirical evidence actually bears this out:  non-lockdown countries are generally outperforming lockdown countries on average, and within the USA, non-lockdown states have also been outperforming lockdown states in terms of coronavirus case and death rates per capita.

The supposed effectiveness of lockdowns (compared to far less extreme restrictions) in terms of slowing or stopping the spread of coronavirus has been called into serious question lately by more recent studies.
Such studies have found there is at best no correlation, and perhaps a perverse effect between the two defining features of hard lockdowns (stay-home orders and closures of all non-essential businesses) and COVID-19 cases and deaths per capita after other factors such as less-extreme policies are accounted for.  The benefits are thus nothing more than a statistical mirage that does not stand up to scrutiny--much like the supposed benefits of the 21 drinking age vis-a-vis DUI deaths in the long run.

Meanwhile, the collateral damage (economic depression, inequality, poverty, alcohol and other drug abuse, domestic violence, child abuse, loneliness, poor mental health, delayed medical treatment, etc.), which also kills people too by the way, continues to mount with each passing week of lockdown, making an utter mockery of practically all progressive and even basic humanitarian priorities.  And that's to say nothing of the civil rights and liberties, as well as community cohesion, that progressives generally support.  It seems that the "cure" is quickly becoming far worse than the disease as time goes on.

(And that's just for the affluent countries.  For poorer countries, the collateral damage will most likely be at least an order of magnitude worse and deadlier.)

As for the disease itself, here is what we already know:  The horse has already bolted long ago, the train has left the station, the genie is out of the bottle, and herd immunity is ultimately inevitable at some point (if we're not already there in some places).   That is the only way the pandemic will finally end for good, since any effective vaccine or miracle cure will most likely come far too late.  Fortunately though, the true infection fatality rate is revealed to be far lower than was originally believed, and most likely somewhere between seasonal flu and pandemic flu (though still nothing to, um, sneeze at of course).

Thus, whatever the original merits of these sweeping, medieval-style quarantines (unprecedented on such a large scale and for such an extended period of time), there is really nothing "woke" or progressive about extending them any further than yesterday.  It is no longer "merely" about lives versus livelihoods anymore, but increasingly about lives versus lives.

So what would a progressive reopening plan look like?  At the TSAP, we believe that the following schedule should be the case:

Phase 1:  End of stay-home orders and "bubbles", and gatherings of up to 10 people permitted.  Construction, manufacturing, and select retail reopened with restrictions, with priority given to small businesses. Masks required in all public places where six feet of distance cannot be maintained.  Parks and beaches reopened with restrictions.

Phase 2:  Gatherings of up to 20 people permitted.  All retail stores reopened with social distancing and 50% occupancy restrictions.  Restaurants, but not bars, reopened with 25% occupancy restrictions.  Masks required for all employees and customers of reopened businesses whenever practical.  Select places of amusement reopened with restrictions.

(Somewhere around this point, reduce the six-foot rule to three feet, in line with the World Health Organization's recommendation of one meter distance.)

Phase 3:  Gatherings of up to 50 people permitted.  All retail stores reopened with social distancing and some occupancy restrictions.  Salons, barber shops, and other "hands-on" businesses along with gyms and fitness centers reopened with strict hygiene standards and occupancy restrictions.  Restaurants reopened with 50% occupancy restrictions, select bars reopened with 50% occupancy restrictions and table service only.  Nightclubs and casinos remain closed.  Places of amusement reopened with restrictions.  All schools and educational facilities reopened, and all daycares and camps reopened as well regardless.  Some professional sports leagues at least partially resume, without the fans of course.

Phase Out:  Gatherings of up to 100, then 500 people permitted.  Everything including nightclubs and casinos reopened, albeit with some occupancy restrictions.  Bar service now permitted.  Mask wearing is now voluntary, except on public transit and for employees of higher-risk businesses, where it will remain mandatory at least at first.   Six-foot rule is now just a common-sense and non-absolute guideline rather than a hard and fast rule.   Hand and respiratory hygiene still taken as seriously as ever.  All schools and educational facilities reopened, period.  Professional sports leagues fully resume, without fans until at least Labor Day, then fans very gradually reintroduced to stadiums/arenas.

Each of the first three phases will last two weeks (or one week each for both Phases 1 and 2, if the onset of Phase 1 happens to be delayed until June 15 or later), while Phase Out is indeterminate but will likely last for 90 days or more.  Ideally, Phase 1 would not have begun until a state is at least two weeks post-peak, but after June 1st states may not have the luxury of waiting any longer to begin reopening (if they wish to avoid irreversible economic damage and a long-term depression).  If during any phase there is any resurgence in disease there should be a further pause between moving to the next phase, but otherwise full steam ahead with no backtracking after June 1st.

(Any reimposition of tighter restrictions after June 1st should be limited to the local level only, not statewide or nationally.)

Indoor gatherings, which are riskier than outdoor gatherings, should probably have a tighter limit.  For example, thet could have a cap of 10 people indoors vs. 50 people outdoors for Phase 3, or 50 people indoors vs. 500 people outdoors in Phase Out.

At all phases, mask and sanitizer kiosks should be available everywhere, and/or there should be a Taiwan-style free mask rationing app available for everyone.  And Taiwan-style temperature checks to enter most places should prevail through the first three phases and much of Phase Out as well.  (Hey, they must be doing something right over there, and with no lockdown or shutdown either.)

And while we clearly need to scale up testing and contact tracing, quite frankly the time to do that was weeks if not months ago, and we can no longer afford the luxury of time at this point.  We will simply need to make do with what capacity we have right now and in the immediate future, even if we have to do it the Japanese way of focusing mainly on the larger clusters instead of every single case out there, which is far less resource- and labor-intensive.

As for vulnerable populations (elderly, immunocompromised, and/or those with underlying health conditions), the lockdowns have utterly failed to protect them, so extending the lockdowns will not benefit them at all.  Rather, they should be encouraged (but not forced) to stay home as much as possible and avoid crowds during Phase 1 and 2 (and possibly 3), and nursing homes should continue to ban visitors or allow only one designated visitor per family during at least the first three phases of reopening.  And for the love of all that is good, immediately stop discharging still-contagious hospital patients into nursing homes!  Shame on any policymakers (New York, I'm looking mainly at you) who thought that was somehow a good idea!

The TSAP also supports a far more robust stimulus that includes Universal Basic Income and Medicare For All, and the rest of Rodger Malcolm Mitchell's Ten Steps to Prosperity.  We also support expanded unemployment benefits, expanded Social Security, and a Green New Deal.  And of course the HEROES Act.  It is not too late to prevent the greatest depression the world has ever seen--but only if we both reopen reasonably soon and implement such programs sooner.  It is NOT an either-or.

Also, it should really go without saying of course, but we at the TSAP do NOT support any sort of reckless behavior, rioting, violence, or death threats against Governor Gretchen Whitmer of Michigan or any other governor or government official regardless of how much we dislike their policies.  We hereby denounce and condemn such behavior, period.  Peaceful protests which follow proper health and safety precautions, fine, but anything else has no place in our movement or any other movement worth its salt.

UPDATE:  The TSAP does NOT support Trump's Fourth of July military parade or any other parade, campaign rally, or mass gathering of similar size at this time, as it is really far too soon and thus very, very ill-advised.  We believe that even the best-performing states and localities who appear to be almost out of the proverbial woods in terms of the pandemic should still do their darnedest to avoid gatherings of more than 50 people before July 4, and more than 500 people after that until at least Labor Day at the earliest.  The deadly lessons of the 1918 flu pandemic loom large.  But if we must have a second wave, which Dr. Fauci himself claims is somehow (but hopefully not) inevitable, frankly better it should happen in the summer when the virus is less virulent than in the fall or winter, and as a bonus, those Trump supporters who will be earning Darwin Awards will thus "thin the herd before" they can vote in November.  Unfortunately, these fools also put others at risk as well--they should at least be wearing masks to protect others even if they don't care one iota about themselves.  (At least it won't fall on the conscience of progressives this time.)

JUNE UPDATE:  It looks like several states are seeing spikes in COVID-19 in recent weeks following reopening.  While some of it is due to increased testing, the very large spikes in Texas, Arizona, Florida, California, and some other states also show increases in hospitalization rates*, so at least some states are seeing real increases.  And those are generally the ones who reopened before even reaching their peaks, while California's early flattening of their curve seems to have merely delayed the bulk of their infection burden.  And interestingly, Georgia had not seen any real spikes until very recently, despite being the first state to reopen.  Meanwhile many states, most notably New York and New Jersey, have not seen any spikes at all despite increased testing and massive protest rallies in recent weeks.  Both were among the first states to have mandatory mask requirements, and were also the earliest and hardest-hit states.

(*Even the increase in hospitalization numbers may be less than meets the eye.)

Thus, it may not even be due to the timing and pace of reopening at all, but rather due to how many people are wearing masks, and simply that states that were hit harder earlier, the epidemic has largely run its course, while the states that started with milder outbreaks simply still have a ways to go yet.  And overcrowded bars and nightclubs seems to be the biggest culprits in the new hotspots lately.

It is notable that death rates are still dropping nationwide despite the apparent surge in daily cases to new record highs.  Even in the new hotspot states, deaths are generally low and flat or declining, and even Arizona's death rates are still following the same old slow-burn pattern they had before reopening despite being the fastest-growing state in terms of positive test results lately.  Most new cases are coming from younger people (under age 35), a possible reason for the apparent decoupling of infection rates from death rates, and suggesting herd immunity likely occurring sooner rather than later.  Or perhaps we have learned (often the hard way) better ways to treat the disease, thus saving more lives.  Or the virus itself could simply be getting tired and losing its "mojo" after circulating so much for so long.

Also, here is another good article for any anti-lockdown leftist or progressive.  And another.

Reborn On The Fourth Of July? (Updated Part Deux)

A little gallows humor:  What do Julius Caesar and America as we knew it have in common?  Both died on the Ides of March (March 15).  That date was, indeed, roughly when America began to shut down to one degree or another.  But will America be reborn on (or before) the Fourth of July?

There is much debate lately about how and when to ease lockdown/shutdown restrictions and re-open the country for business.  Unfortunately, neither side seems to do nuance very well if at all.  Opening up everything or nearly everything all at once overnight would of course be reckless and cavalier, risking a resurgence of the virus (and associated deaths) and eroding much of the progress that has been made thus far.  But continuing the status quo indefinitely (or even simply taking too long to ease restrictions) is also not very wise either since that will do irreversible economic damage and likely will still not conquer the virus entirely.  Thus, if we wait too long, there may not be anything left to re-open by then, at least for small businesses.  And that's to say nothing of the adverse consequences to civil rights and liberties, mental health, and community cohesion as well.

(And you know, slopes are much, much slipperier than they appear, as Orwell spins in his grave.)

The supposed effectiveness of lockdowns (compared to far less extreme restrictions) in terms of slowing or stopping the spread of coronavirus has been called into serious question lately by more recent studies comparing those locations that had lockdowns and those that did not, or differed in the timing.  The results strongly imply that the observed declines in COVID-19 deaths (and thus the number of infections three weeks prior) was actually driven by the more moderate social distancing measures that were in place earlier, not the lockdowns, based on the timing.  And if there somehow was any extra effectiveness of the most extreme measures such as lockdowns, it is most likely only a short-term effect that eventually reaches a point of diminishing returns after which the "cure" really DOES become worse than the disease.

In other words, lockdowns early enough (and long enough) in the curve to successfully suppress the disease are unnecessary since more moderate measures apparently work just as well when done that early, while belated lockdowns are apparently worse than useless in terms of total excess deaths.

Perhaps the much-maligned Swedish mitigation strategy of moderate social distancing (not to be confused with the mythical "do nothing" strategy) really isn't so crazy after all?  The train has clearly left the station long ago for a suppression strategy to work at this point, and herd immunity is ultimately inevitable at some point in most countries (including the USA), if we're not already there in some places.

And support for reopening is clearly NOT just for right-wingers and fringe folks, by the way.   An even stronger left-wing and progressive case can also be made for ending the lockdowns sooner than later as well.  Keep in mind that Sweden is largely run by progressives, and even their self-proclaimed "conservatives" are still largely to the left of most American Democratic Party politicians today.

Thus, a careful and gradual but fairly speedy easing and re-opening is what is called for, in order to minimize the damage from both the pandemic itself as well as from the restrictions in place to suppress it.  The timing should vary by state and locality as well as exactly which types of restrictions to be eased and which types of businesses to re-open.  It would probably be best for all states to wait until at least two weeks post-peak (whichever is later) before making any major changes (though baby steps can and should be taken sooner).  Some states have already peaked in early to mid-April, others in latw April to early May, while others will not peak until well into May.  Hospitals would also have to not be overwhelmed as well (fortunately, very few are).  And testing would at least ideally be significantly ramped up along with contact tracing and individual quarantining--which should have been done weeks or even months ago--as well in order to move forward into the later stages of reopening.

(Though at this point, large-scale testing and contact tracing would probably best be put in the "wouldn't that be nice?" category rather than decisive.)

And of course we need a far more massive stimulus, and the Ten Steps to Prosperity that Rodger Malcolm Mitchell recommends.  Because even if we re-opened tomorrow, consumers will still be too cautious to come roaring back right away, and the damage is already done.  Especially a significant and permanent UBI, which would cure even the worst depression a lot sooner than not implementing a UBI.

Mitchell also recently wrote an article noting that reopening can be done a lot sooner, safer, and more cheaply simply by requiring everyone to wear masks in public (at least when practical to do so) and provide such masks for free to everyone via kiosks.  And with a little bit of nuance added to the mix, this seems to make the most sense of all for now.

Trump's latest guidelines for reopening are surprisingly reasonable now, likely because he finally consulted with experts rather than just going with his gut as usual.  But his administration is really lagging on providing coronavirus testing kits, which would clearly hinder any reopening strategy.  So they really need to speed that up.  It was, after all, due to the Trump administration's recklessness and negligence that this pandemic got so far out of control here in the first place, and it is estimated that up to 90% of the deaths could have been averted had they acted sooner and not screwed up so monumentally.

Thus the TSAP recommends that all states gradually lift lockdowns and partially reopen by Memorial Day (with many states doing so in early May) and fully lift all significant restrictions (except perhaps for restrictions on very large gatherings of, say, 500+ people) by the Fourth of July at the latest.  While some outlier states like Georgia rushed the reopening process (though interestingly, it still did not turn out to be the disaster that was predicted), most states are being cautious to a fault right now in terms of reopening, and you really can't blame them in the current climate of fear.

At the local (county and municipal) level, some hotspots may choose to still maintain tight restrictions or reimpose them in the event of a resurgence of the virus, but these restrictions should be exactly that--local.  In a similar vein, states may also impose modest, New Rochelle-style "containment zones" or "red zones" where local outbreaks or large clusters are observed.  As we move past the initial crude "sledgehammer" phase of suppression and into the more refined management phase, we need to be careful in how we calibrate such measures to avoid doing more harm than good in the long run.

As for school closures, that should really be decided locally for the most part.  While school closures are known to work very well in the short term in slowing the spread of infectious diseases in general, the longer-term effects are unknown, and children and teens seem to be at relatively low risk from this virus as well as not a particularly significant vector for spreading it to adults.  While some evidence strongly suggests that temporary school closures early in the epidemic curve have helped to flatten that curve (even if only indirectly to reduce the number of adults infecting each other), it remains unclear how long such benefits can last (likely not very long).  Some countries like Iceland, Denmark, and Taiwan have already reopened schools with no evidence of resurgence of the disease, and Sweden never closed them at all for children under 16.  Certainly they should at least plan on reopening in September at the very latest absent evidence of a large second wave of the disease.  And the usual summer school programs and even summer camps should be seriously considered as well.  At the very least, daycares (if not schools as well) should be opened yesterday, as it is really the only way to get the economy going since so many of American's workforce are parents of young children.

Regardless of the effectiveness (or lack thereof) of lockdowns, simply going straight from red to green overnight would be utterly foolish, since it's really still too soon to safely encourage a massive influx of tourists when the "all-clear" signal is given.  So we should thus go from red to orange, then yellow, then green, and we really only need a few weeks (not months) of orange and/or yellow in between.   And even green does not preclude very mild restrictions and common-sense precautions as well.

We have already flattened the curve.  Now let's keep it flat, without also flattening the economy as well.

UPDATE:  It should really go without saying, but we at the TSAP do NOT support any sort of reckless behavior, rioting, violence, or death threats against Governor Gretchen Whitmer of Michigan or any other governor or government official regardless of how much we dislike their policies.  We hereby denounce and condemn such behavior, period.  Peaceful protests which follow proper health and safety precautions, fine, but anything else has no place in our movement or any other movement worth its salt.