Published on April 13, 2020 / Leer en español
Four things you should know today
1) Some insight and advice from Spain
Analysis by Deepak Lamba Nieves, PhD, Research Director at CNE
For the second entry in our Living with Risk Conversations series, we spoke with Dr. Juan Alonso-Echanove. Alonso Echanove is a doctor and epidemiologist who knows Puerto Rico very well, as he served as Director of Epidemiology in our Department of Health for several years. Right now he is in his native Spain, and from there he spoke about epidemiological curves, the importance of testing, and when the lockdown should end, among other issues. The interview was conducted in Spanish.
2) Manufacturing personal protective equipment in Puerto Rico
Analysis by Nuria Ortiz Vargas, Executive Director at CNE
The shortage of personal protective equipment (PPE) has put thousands of health professionals who care for our patients in hospitals and senior centers at risk. In Puerto Rico, a pediatrician and at least two nurses have died in recent weeks due to coronavirus, and dozens more are infected. A few weeks ago, the Cooperativa Industrial Creación de la Montaña joined a local initiative to produce more than half a million masks with quality material to serve as appropriate PPE for our doctors and nurses who need them so badly. This women’s Cooperative, located in Utuado, mainly makes uniforms, but also makes clothes and Concalma brand bags.
CNE team visits the Cooperativa Industrial Creación de la Montaña in 2017.
The Cooperative was one of the Distribution Centers of the Puerto Rico Recovery Fund (PRRF) that CNE organized in 2017, after hurricane Maria hit Puerto Rico. From their factory, more than 60,000 pounds of water, food, medicine and personal hygiene products were distributed to the most affected families in the area. They also participated in PRRF’s ReActiva program for small businesses. Despite a significant decline in orders after the hurricane, they have continued to work through thick and thin — and now join the few local companies that are operating to meet the high demand for essential protective equipment. We want to congratulate the Cooperative’s team, which has always supported its community at times when people have needed help the most. We hope that when this emergency passes, we continue to support those who, during the worst of times, provided urgent essential equipment and services to our people.
Read more (Spanish): Industria de la aguja se activa contra el coronavirus – El Nuevo Día
3) Reopening the economy (1): It will be complicated
Even as New York City just announced that more than 700 people died from COVID-19 on Saturday, people are already talking about what it will take to lift shelter-in-place restrictions and reactivate the economy in a relatively safe manner. As Ezra Klein writes for Vox, accomplishing this feat will be a lot more complicated than many people think. Klein analyzed four proposals to reopen the economy from: the American Enterprise Institute (AEI), a conservative think tank; the Center for American Progress (CAP), a left-leaning think tank; the Safra Center for Ethics, a research outfit at Harvard; and Nobel Prize-winning economist Paul Romer.
All propose a gradual opening of the economy but differ on the public health infrastructure that needs to be in place to avoid another flare-up of the disease. The CAP and Harvard plans envision the creation of “a digital pandemic surveillance state in which virtually every American downloads an app to their phone that geotracks their movements, so if they come into contact with anyone who later is found to have COVID-19, they can be alerted and a period of social quarantine can begin.” The political, legal, and technological challenges to this approach should be obvious.
Romer, for his part, does not rely on a surveillance apparatus, but on testing “on a scale no one else is contemplating—22 million tests per day—so that the entire country is being tested every 14 days, and anyone who tests positive can be quickly quarantined.” It is not clear at this point, however, whether the United States has the public health infrastructure (staff, equipment, materials) to execute this kind of massive testing. Not to mention the political will to implement it.
Finally, the AEI plan seeks to navigate a kind of middle ground between these two approaches, with no surveillance state and with increased testing but not on Romer’s scale, and “precisely for that reason, what it’s really describing is a yo-yo between extreme lockdown and lighter forms of social distancing, continuing until a vaccine is reached.” All of which, ironically, requires a degree of government planning, coordination, and execution that many of AEI’s own right-of-center scholars probably believe is neither realistic or desirable.
Read the four plans below:
4) Reopening the economy (2): The moral choices will be tough
The hard truth is that until a vaccine is developed, reopening the economy means some people will unfortunately die from infection with the SARS-CoV-2 virus. The New York Times recently convened a video conference panel of the following five experts to discuss the moral dimensions of re-opening the economy: the Rev. Dr. William J. Barber II, president of the nonprofit organization Repairers of the Breach; Anne Case, Emeritus Professor of Economics and Public Affairs at Princeton University; Zeke Emanuel, director of the Healthcare Transformation Institute at the University of Pennsylvania; Vanita Gupta, president and chief executive of the Leadership Conference on Civil and Human Rights; and Peter Singer, a bioethics professor at Princeton.
As Emily Bazelon writes in her summary of the discussion, in the short term there is no trade-off between saving lives and saving the economy: “for the sake of both, it’s imperative to keep businesses shuttered and people in their homes as much as possible.” But over the medium to long term problematic trade-offs will emerge, and “there will be difficult compromises between doing everything possible to save lives from COVID-19 and preventing other life-threatening, or -altering, harms.” How should public policymakers address those issues?
Quote of the Day
“There is always a well-known solution to every human problem—neat, plausible, and wrong.”
—H. L. Mencken
Note from the editor
As we enter the fifth week of “sheltering in place” due to the COVID-19 pandemic, there are some glimmers of hope. It appears, the infection curve in many countries, as well as in several states in the mainland, has started to flatten. All of which is good news and has gotten people thinking about what it will take to return to “normal”, including reopening the economy. But that will not be an easy task.
First, the right public health infrastructure has to be in place. Until there is a safe, effective, and widely-available vaccine, this means having the capability to carry out extensive testing, contact tracing, and monitoring of new cases so as to avoid a new wave of infections; as well as having enough personal protective equipment for healthcare providers and other workers in direct contact with the general public.
Second, once the public health assets are secured, then it will be necessary to follow the right sequence to opening. Some kinds of construction and manufacturing, where it is possible to maintain appropriate distancing, could be among the first. The same with service providers that can modify their office spaces. Retail spaces with the right social distancing measures could be next. Finally, travel, leisure, and entertainment that requires large gatherings (concerts, sports events, conferences) will probably have to wait a bit longer.
Third, there has to be a high degree of coordination and cooperation between government, businesses, and the workforce. Schools, daycare centers, and nursing homes, among other support systems, need to be fully functional for many workers to return full-time to their jobs.
Fourth, we just do not know how many behavioral variables will play out—both at the macro level of political, social, and economic trends and at the personal level. And the recovery of many economic sectors will depend on when a vaccine becomes available. Will the cruise ship industry ever recover? How about air travel? It took two years for air traffic to return to its pre-9/11 level. Will people become used to wearing masks in public for months? How about keeping the appropriate social distancing? Many people are reconsidering their lifestyle: realizing that much business travel was just a waste, while finding that working from home, for those who can do so, could be convenient and efficient (no traffic jams, fewer interruptions, etc.).
Finally, there is a larger moral and philosophical argument we need to have as a society about what it means to return to the “old normal”. Reverend Barber summarized the point nicely in that panel of experts convened by the New York Times: “This pandemic is saying to us that the old normal would be a waste, that it would dishonor all the people who have died and who have sacrificed to save lives. The old normal would mean that the people we deemed essential workers still lack health care, still lack living wages and sick leave. No. We sent you into battle without armor, so to speak, and you fought for us—now we have to change that.”
The time to think about all these things is now.
This is the end of today’s briefing.
Stay safe and well informed!