Saturday, May 2, 2020

What's the Goal?

As we try to figure out what to do next on COVID, we need a better public discussion of the goal we are trying to achieve. Is the goal to:
(a) flatten the curve to prevent overwhelming the healthcare system
(b) minimize deaths from COVID (before a vaccine or silver bullet treatment?)
(c) minimize total excess mortality, including non-COVID causes... recognizing that massive amounts of healthcare are being deferred, with implications of mortality
(d) balance excess death with benefits of opening. Not just economic benefits, but personal human flourishing that comes from interacting with others: graduation ceremonies, youth athletics, small dinner parties, limited travel, and the million other benefits that "social animals" get from interacting with others.
(e) something else? 

The original intent of lockdowns was (a). If (a) is the goal, Sweden looks good so far, and it seems there has been enough time to judge. Taiwan and South Korea look even better. Opening beaches seems obvious. Radically different policies by geography make sense - rural vs. urban, different baseline rates, sub-geographic actions by age group. "One size fits all" shutdowns don't.

In both online and personal conversations, I hear people slip between these goals. You can't say (a) is the goal and then react negatively when cases rise but stay below hospital capacity. You can't say (b) is the goal without recognizing the cost is increased poverty and negative non-COVID healthcare impacts. Goal (c) seems strictly better than (b), except that it is harder to measure. Goal (d) is not well-enough specified... what is that balance?

Personally, I think (a) is the right goal. This disease is going to take its course. We can focus on vulnerable populations, using testing capacity wisely with that group in mind. Perhaps (d) is also arguable.

But my point here is different: we need to push people - politicians, epidemiologists, commentators, media, and each other - into clarity on the goal.

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