Many Insights Here

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March 18, 2020 9:44 p.m.
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Give a read to TPM Reader EM’s report from South Korea …

I write this partly in response to CJ’s letter, but more to express what has been concerning me for the past few days.

I’ve been living in South Korea for over a decade where the response to the virus has been rightly praised, having brought daily infections back into the double digits, at least for now. As I see it, there are broadly three possibilities. The worst case is that we have uncontrolled spread of the virus to much of the population within a short time, greatly exceeding health system capacity and resulting in over a million deaths in the US alone. The best case is something along the lines of what has happened in South Korea or China, which both brought substantial outbreaks more or less under control by using various measures. The middle case, which I’m starting to see as most probable, is where we have radical social distancing and a shutdown of a large part of the economy for four months or more, with localized periodic major outbreaks along the lines Italy is experiencing.

I don’t think we can anticipate the social, political, and economic effects of this, but I could easily see them being truly terrible. For instance, prolonged isolation, anxiety, and massive unemployment could easily reinforce right-wing authoritarianism. We’ve already seen conspiracy theories of the virus being created as a bio-weapon by China (and by the US among some in China and Russia) which could be quickly embraced by the QAnon crowd. Basically, this middle case requires us to run a massive and disruptive social experiment on an already troubled society. CJ’s message highlights how this can exacerbate existing class and generational conflict. In moments of national crisis, there is an instinct to rally to the flag, but Trump makes this unlikely.

My view is that we need to start seriously thinking about how to address these 2nd/3rd order effects. Of course, solving the medical and epidemiological problems comes first as that will make all the subsequent problems less severe.

Also, a brief note on what has been done here in South Korea. Korea has some advantages – recent experience with MERS, an organized national health system, outstanding scientific expertise – but also disadvantages – high population density, a culture of sharing food, political tension in the aftermath of the impeachment and removal of the previous president. The approach here has been technological, scientific, and organized. Korea quickly developed its own test kits and implemented measures like drive-through testing centers. Buildings were rapidly converted to add beds. Contacts have been traced meticulously. Indeed, we receive messages to our phones with the emergency alert system informing us of the precise movements of confirmed patients so we know if we might have been exposed. This relies in part on cell phone location data and credit card spending data. Notably, while large events and schools have been cancelled, restaurants and businesses have not been closed and there have been no limits to movement for the general public.

I am not an epidemiologist, but it seems to me that Korea’s efforts worked in part because they were executed with such competence with strong public cooperation and in part because the outbreak here, while large, was also focused on members of the Shincheonji cult. It was possible to test all 200,000 plus members after the government demanded their membership lists.

While Korea’s efforts have important lessons, I don’t think this will work to bring the outbreak under control in the US. Clusters of cases are already more widespread (as is beginning to happen in Korea as well). Americans would be more willing to accept travel restrictions imposed on everyone than major privacy intrusions affecting individuals. Due to the late start to testing and these cultural reasons, it looks like the US is following something closer to China’s model than Korea’s. One lesson from Korea and China is that both methods can work, and having experienced it, I personally prefer Korea’s. But every option is hard, perhaps harder than we can now imagine. I think we need to think seriously about how to manage the consequences before they overwhelm us.

To me this goes to the point we discussed in this post below. We need to rapidly, rapidly get more data on the nature of this disease, the scope of its spread and strategies to contain it. Otherwise we simply can’t probably balance to impact of the disease against the draconian methods we are using to contain it.

Key Coronavirus Crisis Links

Josh Marshall’s Twitter List of Trusted Experts (Epidemiologists, Researchers, Clinicians, Journalists, Government Agencies) providing reliable real-time information on the COVID-19 Crisis.

COVID-19 Tracking Project (updated data on testing and infections in the U.S.).

IHME Projections Site (COVID-19 epidemic model which has become the canonical model for many states and hospitals.)

Johns Hopkins Global COVID-19 Survey (most up to date numbers globally and for countries around the world).

Worldometers.info (extensive source of information and data visualizations on COVID-19 Crisis — discussion of data here).

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