The mainstream media, both nationally and in Louisiana, still stumble in the dark when comes to understanding the policy blunders that have made Louisiana the worst-hit, longest-hit state by the Wuhan coronavirus pandemic.
Ten days ago, USA TODAY ran a piece on how not only did Louisiana suffer a high peak of infections in the spring, but, more than any other state, has seen one again this summer. Yesterday, the New Orleans Times-Picayune/Advocate published musings from Jeff Asher, known more for his analysis of crime but who recently has made a pivot to looking at pandemic data, about recent patterns in these data.
Louisiana continues to serve as an outlier to national pandemic trends, because of this bimodal distribution in cases. Because of that, as of yesterday it ranked second in infection rate, fifth in current hospitalization percentage per capita, and sixth in mortality per capita. Only Georgia, at first, first, and eighth, respectively, arguably is as bad off. But this is its first rodeo, only within the past month hitting these lamentable marks for the first time while Louisiana is repeating, and worse daily on cases but with far fewer deaths, from four months ago.
USA TODAY notes this, but also that the recurrence occurred in a different way. Previous hotspots such as Orleans Parish, those surrounding it, and those hugging the Mississippi River north to the outskirts of Baton Rouge, haven’t seen much of a resurgence. Instead, it observes that the new spikes have occurred in many places that saw little in the way of incidence back during the first surge.
Of course. The authors apparently eschewed a close look at the data from four and five months ago (or didn’t read or understand this space), or else they would have learned the selective nature of the first wave largely came as a consequence of Carnival: early on, the Orleans area and Caddo Parish saw the initial breakouts, or the two areas with the most Carnival and visitor-related activity just as the virus began its stealthy spread across the country.
Democrat Gov. John Bel Edwards and the chief executives of the affected local governments in these areas, as well as the several other parishes with lesser and lesser-visited Carnival festivities, would have had to possess seer-like powers to have called off such celebrations. But by Mardi Gras on Feb. 25, indicators from around the world should have revealed how Carnival activities elsewhere had served as incubators for virus transmission. Restrictive orders should have gone out then.
At that time, such orders as distancing by capacity limits, strategic economic closures, and limited access to vulnerable populations made sense in incipient hotspots. The point was to squelch the virus before it got a foothold, while at the same time buying time to ramp up testing capacity (by jawboning partner hospitals that receive billions of state dollars to serve as charity institutions) and tracing ability (such as by mobilizing the National Guard). All together, these would have tamped down on transmission and make it easier to contain.
Instead, Edwards dithered, waiting until days after the first reported cases to start proclaiming any restrictions, letting the cat out of the bag, and doing nothing to accelerate testing or tracing abilities. In effect, his inaction allowed something that could have been kept at a low burn and affecting almost exclusively the relatively nonvulnerable population that could have allowed lifting of economic restrictions within a relatively short period without need of reimposition to break out of isolation and hit the larger public.
Because of that, the strategy needed to change. In essence, he had allowed the area under the curve to inflate, and what he or few policy-makers (or journalists or analysts) realize is if you “flatten” a curve, its volume doesn’t change but gets displaced into the future. By allowing it to inflate so much so early, it guaranteed a long, drawn out process.
In that instance, two strategies presented themselves. One would continue the course of an economic lockdown that shuttered some sectors, hampered others, and piling greater expenses onto all, with a parallel social lockdown that would interfere with activities such as schooling, provision of government services, and gatherings. However, this would bring tremendous economic, social, and human costs, over a period of many months, if not a year or more.
That simply cannot be afforded. Curtailed economic opportunities ruin lives and hamstring government revenue-raising capacity that harms service provision in a crisis period, which feeds back onto curtailing opportunity even further if government chooses debt financing to prop itself up (whether directly or by the federal government taking on more debt while kicking proceeds to subgovernments). The result: reduced life prospects and more “excess deaths” above and beyond lives lost to the virus.
But that’s what Edwards chose, seemingly as a bizarre reflection of the peculiar notion that government must indemnify the population against suffering and death from this particular malady; it can’t. People will get it and people will die from it; it’s a matter of arranging policy in a way that the ones most capable of fighting it are the ones who do get it while the ones least able to ward it off receive the most protection.
Instead, Edwards chose a manner almost designed to be the least effective application imaginable to drag out the suffering and threat of death as long as possible. Initially, when he started the lockdown it wasn’t by parish or region, but was statewide. This contained the seeds for the revival. As a result, the hotspots burned first, but nothing much stirred elsewhere, delaying the inevitable. For once the virus had broken out – courtesy of the delayed action and inaction on testing and tracing capacity – it ineluctably would burn everywhere in the state. It was just a question of when and for how long.
Under the economic and social strains caused by his imposed restrictions – and the political pressures these spawned – Edwards had to let up on his limitations. He couldn’t keep these on for an extended period needed for the lengthy slow burn. And so when he scaled these back, like the cessation of rain in forests in summer, eventually the foliage lit up. The intense burning in some parts of Louisiana, that had made it a regrettable leader in the early days of the pandemic receded, having been burned through significantly was replaced by others full of dry tinder, that restored its dubious ranking.
None of this should have surprised the USA TODAY authors. Because the virus had been allowed to acquire a critical mass, and a large one at that, it would have to burn out everywhere statewide, because you can’t cordon off parishes from each other. The measures to control flashes in some parts of the state also delayed that burn in much of the state, explaining why previously hot areas now simmer and previously simmering areas have heated up upon relaxation. Edwards’ actions (delay, crackdown everywhere, loosen up everywhere) made this outcome inevitable.
There was another way, called, for lack of a better term, the “Swedish” model. This recognizes that a virus outbreak of critical mass causes the least health, economic, and societal damage when tackled by the power of nature, not by government artifice.
When the virus hit there, Sweden restricted the largest gatherings for a time, closed schools for teenagers on up for the spring, and restricted access to the vulnerable, and that was it. No economic closures, no face covering mandates, no capacity restrictions. The theory was the virus would bounce around the vast majority of the relatively nonvulnerable population in short order, fairly quickly leaving it few places to go and establishing herd immunity.
Each day that goes by shows increasingly this model worked. No deaths from the virus have happened in days, infections and hospitalizations remain at a low level, and excess deaths have gone close to zero. Compared to other European states and Nordic neighbors, the most pessimistic reading is that Sweden suffered less economically while it paid no more than others in human costs to this point who have had overall much tighter restrictions. And as it’s probably farther along in herd immunity terms, the health statistics will continue to improve relative to other countries as time goes on.
It’s a point that Asher obliquely picked up upon, that recent improvements in Louisiana metrics have come not because of reimposition of certain restrictions, but because of growing herd immunity – as this space pointed out in July in a review of the science behind epidemics. Laudably, his piece became the first in the mainstream press to identify this, behind the curve as it may be. And, he correctly places this as a reason the burn-through has occurred in different parishes at different times.
However, Asher qualified this as a “temporary” immunity achievable at lower levels because of transmission disruption through reimposed restrictions. But this view falls prey to two problems. First, fails to recognize the latest science that would place Louisiana statewide (although not perhaps parish-by-parish) at herd immunity already, regardless of restrictions. Second, he fails to recognize the public policy costs of the restrictions, especially relative to those places without these.
To illustrate the latter, look at it this way. If we define Louisiana as being a hot zone for the virus from almost the day of the initial case identification, for a total of 150 days, Sweden hit those levels for about a 60 day period from late May through late July. If you are a vulnerable person for the virus in Louisiana, you have faced 150 days of heightened vulnerability which will continue for many more to come, while in Sweden you faced it for only 60 days and perhaps never again. Who is safer in the long run?
The longer an environment is a hot zone for vulnerable people, the more of them eventually will die. And the longer restrictions stay in place that keep it a hot zone longer, the more excess deaths will occur and the more damage to people’s life prospects will occur through the destruction of their livelihoods.
You only can change the shape of, not the area under, the curve. And you can change the shape by its temporal shortening to reduce the risk to human lives and economic fortunes. The virus-fighting policies of Edwards – by his delay that let the virus achieve critical mass in the population, his failure to let it burn quicker in the least damaging manner across the entire state, and his sticking with a lockdown strategy far beyond its optimal life – have failed Louisiana. Reversing current restrictions – largely unneeded because of strengthening herd immunity – except for those that limit access to the vulnerable would better serve the state.