The Plague Year

What You Need to Know About the COVID-19 Pandemic

Should you panic about COVID-19? That's a trick question, because it's too late. All the hand sanitizer and toilet paper (which is somehow necessary for dealing with a pandemic) has already disappeared from the store shelves. Judging from the state of my local Walmart, canned soup cannot be found for love or money.

Here's the better question: Is all this panic necessary? I'll admit I've been slowly stocking up as best I can for a couple of weeks now, on the theory that even if the panic isn't necessary, other people are going to do it, so I'd better be ready for everything to close down for a while.

That's exactly what's happening. Last Wednesday night, President Trump gave a speech intended to reassure the American people, and the result was so un-reassuring that it kicked the panic into high gear.

Is all of this necessary? Panic, by definition, is never necessary—but I think this outbreak merits a high level of precaution. This edition of The Tracinski Letter is an attempt to provide my readers with a rational assessment of the problem.

First, a note about the name. There are the usual knuckleheads online arguing about whether or not to call this "Wuhan Flu." The wokesters say this is racist—because what isn't racist?—while conservatives see it as an opportunity stick a finger in the eye of China. The general public long ago moved on to just calling it "coronavirus," the name for the general class of viruses to which this pathogen belongs. The official name, which I will be using, is COVID-19, which is short for Coronavirus Disease 2019.

Whatever the name, what to make of it?

This Is Not Just the Flu

I will refer you first to the views of an actual expert on infectious disease, Dr. Amesh Adalja, who spoke to me for my podcast late last week. We covered a lot of great information in a relatively short period of time, so this is the place to start. You can listen to the podcast, but I've also put up a transcript.

So let me give an overview based on this and on my own research—and a lot of excellent links provided by Sherri, who was feeding me information on this early on, while I was still preoccupied with the spread of Bernievirus.

The main thing is that COVID-19 is not just like the regular seasonal flu, contrary to the claims of certain people of the type you really shouldn't be turning to for medical advice in the first place.

The two numbers that sum up the risk—see this good rundown of the relevant data—are that COVID-19 seems to be twice as contagious as the flu and ten times as deadly.

A person infected with the flu infects 1.3 other people on average. For COVID-19, that number is believed to be 2.8. Mortality rates for COVID-19 have been between two and three percent, but it's likely that number is too high because it doesn't count cases that remain mild or never show symptoms at all and thus go uncounted. Experts estimate that the mortality rate will end up being closer to one percent. But the mortality rate for the flu, a very well-studied disease, is 0.1 percent.

What does this mean?

The 61,099 flu-related deaths in the US during the severe flu season of 2017-2018 amounted to 0.14% of the estimated 44.8 million cases of influenza-like illness. There were also an estimated flu-related 808,129 hospitalizations, for a rate of 1.8%. Assume a COVID-19 outbreak of similar size in the US, multiply the death and hospitalization estimates by five or 10, and you get some really scary numbers: 300,000 to 600,000 deaths, and 4 million to 8 million hospitalizations in a country that has 924,107 staffed hospital beds. Multiply by 40 and, well, forget about it. Also, death rates would go higher if the hospital system is overwhelmed, as happened in the Chinese province of Hubei where COVID-19's spread began and seems to be happening in Iran now.

A Novel Virus

These are all estimates and educated guesses, and that's the other part of the problem. As we discuss in the podcast, this is a "novel" virus, so part of the problem is that we don't know exactly how it behaves.

Moreover, the danger of a novel virus is that nobody has any resistance or immunity to it from prior exposure to the same or similar viruses. Dr. Adalja estimated that, starting from a base of zero, "30 to 50 percent of people are going to be infected over a period of about a year or so." In America, that means roughly 90 to 150 million people. That's where the scary projections come from.

Between 80% and 90% of the people who are infected with COVID-19 get a version that is no worse than an ordinary cold or flu. But the remaining 10% to 20% suffer an extremely harsh version that rapidly results in sever pneumonia. About 5% who get the disease need to be put in intensive care with ventilators to help them breath. The problem seems to be something called a cytokine storm, in which our own immune system's overreaction to the virus perforates the patient's lung tissue, which is as bad as it sound.

The elderly are especially susceptible to this. If you're over 70, and especially if you have any other serious health condition, this is a killer.

"Flatten the Curve"

You may already have worked out in your head some of the numbers that will result from 90 to 150 million people getting this virus. If five percent of them require hospitalization, that would mean a massive surge of 4.5 to 7.5 million hospitalizations. As indicated above, there are just under a million hospital beds in the US, many of which are already in use for existing illnesses and accidents.

But wait, it gets worse. Because the severe version of COVID-19 results in pneumonia, many patients require intensive care and a ventilator to help them breathe. How many intensive care units are there in the US? How many ventilators are there? According to the authors of one study, "there are about 46,500 medical ICU beds in the United States and perhaps an equal number of other ICU beds that could be used in a crisis." So we have at most 100,000 ICU spots for what could be millions of patients. And those figures are for the US as a whole. In areas with larger elderly populations and fewer ICU beds, local shortages could be much worse.

That's why the mantra for dealing with this outbreak is to "flatten the curve." It's a reference to this image, which shows how a quick increase in cases would overwhelm the capacity of the health care system, while a slower spread of the virus, a flatter curve, would keep the number of cases relatively manageable. There's an even better version out there, which takes into account the initial decline in the capacity of the health-care system as doctors and nurses get sick, then the later increase in capacity as hospitals ramp up and we learn better methods for treating the disease. Note that without a big delay in the spread of the disease, we get a huge number of "poorly treated cases" that result in much higher mortality rates. As the designer of the original "flatten the curve" graph puts it, "It's the difference between finding an ICU bed and ventilator or being treated in the parking lot tent."

That's not an exaggeration. Remember the early news about COVID-19, when there was a story circulating about how the Chinese built an entire hospital in ten days? It seems like a remarkable achievement, except that "hospital" turned out to be a generous term. It was a prefabricated warehouse filled with beds, but with very little equipment and staff. The same thing has been happening in northern Italy, where warehouses and tents are being used to house a wave of new patients.

Let's be clear about the grim reality of this. When a surge of patients overwhelms the health care system, here is what happens:

Giorgo Gori, the mayor of Bergamo, said that in some cases in Lombardy the gap between resources and the enormous influx of patients "forced the doctors to decide not to intubate some very old patients," essentially leaving them to die.

"Were there more intensive care units," he added, "it would have been possible to save more lives."

Dr. Di Marco disputed the claim of his mayor, saying that everyone received care, though he added, "it is evident that in this moment, in some cases, it could happen that we have a comparative evaluation between patients."

On Thursday, Flavia Petrini, the president of the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care, said her group had issued guidelines on what to do in a period that bordered on wartime "catastrophe medicine."

"In a context of grave shortage of health resources," the guidelines say, intensive care should be given to "patients with the best chance of success" and those with the "best hope of life" should be prioritized.

I saw someone on social media trying to make this out as an indictment of socialized medicine, but they're missing the point. Any system can experience short-term shortages under extraordinary circumstances; just try buying toilet paper at your local Costco. When it's a shortage of health care, it is rational in that context to make "comparative evaluations"—and leave the very old and infirm to die. The point is to not let ourselves end up in that context.

Yet that's exactly where we're headed.

Don't Be Italy

The thing about Italy is that I'm not sure they did anything particularly wrong. In fact, they've done pretty much exactly what we have done: first imposing a ban on flights from China, then locking down a few local areas, then finally and reluctantly locking down the whole country. The only difference is that COVID-19 arrived there earlier, so Italy is just a few weeks ahead of us, giving us a preview of our own future.

No, seriously, look at this graph. The US and many other European countries are on exactly the same upward, geometric curve as Italy, just on a delay of about ten days.

You will encounter a lot of arguments saying that this is all overblown, that we're getting carried away, that the national lockdown we're in right now is causing much worse damage than the virus ever could. Following President Trump's early dismissals of the pandemic as an attempt by the media to exaggerate the problem and tank the stock market (a self-fulfilling prophecy), many right-leaning commenters are still portraying the outbreak as some kind of media hoax.

The arguments all begin something like this one, from Heather Mac Donald, who really ought to know better.

So far, the United States has seen forty-one deaths from the infection. Twenty-two of those deaths occurred in one poorly run nursing home outside of Seattle, the Life Care Center. Another nine deaths occurred in the rest of Washington state, leaving ten deaths (four in California, two in Florida, and one in each of Georgia, Kansas, New Jersey, and South Dakota) spread throughout the rest of the approximately 329 million residents of the United States. This represents roughly .000012 percent of the US population....

By comparison, there were 38,800 traffic fatalities in the United States in 2019, the National Safety Council estimates. That represents an average of over one hundred traffic deaths every day; if the press catalogued these in as much painstaking detail as they have deaths from coronavirus, highways nationwide would be as empty as New York subways are now. Even assuming that coronavirus deaths in the United States increase by a factor of one thousand over the year, the resulting deaths would only outnumber annual traffic deaths by 2,200. Shutting down highways would have a much more positive effect on the US mortality rate than shutting down the US economy to try to prevent the spread of the virus.

This sort of argument starts by citing the small number of fatalities from COVID-19 now as proof of over-reaction, without any serious attempt to project what the exponential spread of the disease will look like a week or a month from now. But like I said, we know what it will look like, because we're just ten days behind Italy.

Here, I will oppose Heather Mac Donald with Megan McArdle, who highlights the deceptive nature of a geometric increase.

There's an old brain teaser that goes like this: You have a pond of a certain size, and upon that pond, a single lilypad. This particular species of lily pad reproduces once a day, so that on day two, you have two lily pads. On day three, you have four, and so on.

Now the teaser. "If it takes the lily pads 48 days to cover the pond completely, how long will it take for the pond to be covered halfway?"

The answer is 47 days. Moreover, at day 40, you'll barely know the lily pads are there.

That grim math explains why so many people—including me—are worried about the novel coronavirus, which causes a disease known as COVID-19. And why so many other people think we are panicking over nothing....

When something dangerous is growing exponentially, everything looks fine until it doesn't.

You are going to hear people scoffing about why we're turning the whole country upside down over a few dozen cases, then a few hundred cases—and then very rapidly it becomes a few thousand and then a few million.

So what is to be done?

Live Long and Prosper

The current national lockdown—kids out of school, gyms and theaters closing, restaurants reduced to takeout only, and people encouraged to work from home—is an emergency measure (and largely a voluntary one) intended to slow down the spread of the disease. When you keep in mind that we are a week and a half away from Italy, I think it is a rational response to the circumstances.

Personally, I am locked down for two to three weeks and pretty well prepared to do this indefinitely. But that's easy for me, because it's how I normally work. My reaction is pretty well summed up in this post from the Babylon Bee; this is the self-employed writer's utopia, in which nobody goes to the office and everybody works online.

For the rest of the country, this cannot last indefinitely, and therefore it won't last indefinitely. Rather, it's a measure to buy time. Time for what?

Well, remember that part about "flattening the curve"? It's a measure to slow the initial spread of the disease while we build up health care services. One of the big things I learned from my interview with Dr. Adalja is that we're doing this national lockdown because we failed at the timely application of a better response: aggressive testing accompanied by quarantines only for the infected.

The only country to quickly get COVID-19 under control (for now) is South Korea, which implemented a massive testing program that allowed it to track and quarantine those who are carrying the disease. (One of the reasons this disease spreads so far is that people who are infected can spread the virus for a long time before they show symptoms.) The country has not, so far, imposed large-scale closures of its cities but has instead emphasized an obsessive approach to personal hygiene and the practice of "social distancing," avoiding behaviors that bring us too close to other people and help spread the disease.

We are currently implementing a semi-voluntary version of the Chinese model—shut everything down—because we failed to implement the South Korean model. But I think we will trend back to that model in the near future. We will no longer hunker down in our houses but instead we will all go get tested for the virus at drive-thru kiosks, and we will be trained on how to go to the grocery store or restaurants without infecting all the people around you.

Get used to the "no-contact greeting," replacing the handshake with some other gesture. You all know the one I have in mind, and it is even accompanied by an appropriate salutation: "Live long and prosper"—which is what we're all trying to do.

My main title, "The Plague Year," aside from being a high-quality literary reference, it is meant to prepare you for the actual duration of this crisis.

Before I explain that, though, let me restate why this pandemic is so serious, because I'm still encountering a certain amount of resistance to the hard, cold facts.

Authoritarian Blindness

A recent survey indicates that 76% of Republicans think the media is exaggerating the risks of COVID-19, and while "59% of Democrats and Democratic-leaning independents say the outbreak is a major threat to the health of the US population as a whole; only 33% of Republicans and Republican leaners say the same." I suppose there's some ambiguity in what people interpret as a "major threat to the health of the US population as a whole," but the size of the partisan divide indicates that Trump's early dismissals of the crisis are still echoing in a lot of people's heads.

I wrote a piece last week in The Bulwark explaining how the twin concepts of "fake news" and the "deep state" induce a form of "authoritarian blindness" in the Trump administration and its supporters.

The point of the "fake news" concept is to describe information from any media not obsequiously friendly to the president as some kind of conspiracy intended to hurt him. Veteran reporter Lesley Stahl says Trump told her he uses the term "to discredit you all and demean you all so that when you write negative stories about me no one will believe you."

The point of the "deep state" concept is to describe information coming to the president from within the federal bureaucracy as a partisan conspiracy to overthrow him by means of a "coup." (That's the president's word, not mine.) Thus, some of Trump's prominent supporters dismissed a warning from a CDC official by spinning a conspiracy theory connecting her to the investigation of Russian interference in the 2016 election.

The practical effect of these two concepts is that they create a voluntarily accepted, self-induced authoritarian blindness, in which the administration and its circle of sycophants will accept no information from outside their bubble....

Note particularly the closed information loop created by the president's symbiosis with friendly news sources such as Fox News Channel, from which Trump regularly draws information on crucial issues. The president won't believe COVID-19 is a crisis until he sees it described that way on Fox & Friends or by Sean Hannity—and they won't describe it that way if they think it will contradict the line coming from the White House.

I was only off by a little: It was Tucker Carlson. According to his own account—which you should probably take with a very large grain of salt—the only person able to break through President Trump's bubble and get him to take COVID-19 seriously was Fox host Tucker Carlson, who had to drive to Mar-a-Lago on March 7 and request a personal audience with Trump to do it.

Even so, Carlson is still very much in denial on his own role in this.

So a lot of Trump voters believe that all news about Trump is designed to hurt Trump. And they're absolutely right about that. It's been monomaniacal, the coverage of Trump. So when the moment came, when there was something that ultimately really didn't have anything to do with Trump, which is the emergence of a weird new virus from Eastern China, they were trained to believe that all coverage was designed to hurt Trump. Because that's been true.

I wonder who might have helped "train" them to believe that.

It gets worse. It turns out the incoming Trump administration was briefed by their predecessors specifically on how to deal with a pandemic, but the knowledge didn't stick, in part because of Trump's tendency to burn through staffers.

But roughly two-thirds of the Trump representatives in that room are no longer serving in the administration. That extraordinary turnover in the months and years that followed is likely one reason his administration has struggled to handle the very real pandemic it faces now, former Obama administration officials said.

It doesn't help that the turnover in his staff has been going in a definite direction—downhill—as he fires the most serious thinkers and replaces them with hacks and sycophants. I can't help thinking that a White House where John Kelly was chief of staff, H.R. McMaster was National Security Advisor, and James Mattis was Secretary of Defense—the lineup we had about two years ago—would have dealt with this far more effectively.

For others, the partisan motivation is less strong. For older people, my impression is that the mathematics of the exponential spread of a virus seems abstract and speculative, while the decline in their stock portfolio is very concrete and real. For younger people, there is the usual tendency of youth to regard itself as invincible, combined with the fact that for this disease, that is largely true. COVID-19 targets the elderly, while young people tend to be asymptomatic carriers—a generation of Typhoid Marys who keep going to bars and beaches, acquiring the virus and spreading it to everybody else.

A lot of people still need to grasp exactly how serious this is.

The Plague Year

That part about asymptomatic carriers is very important. Some diseases are not contagious until after the patient shows symptoms, and in those cases, the kind of advice politicians are still giving us—"if you feel sick, don't go to work"—is very effective. But it doesn't work with COVID-19, because someone who is infected can be contagious for five days or a week before showing symptoms. By the time you feel sick, it's too late. That's the reason this disease is spreading so quickly.

A highly influential report from Imperial College London described the likely scale at which the disease will spread under different scenarios.

See one academic's relatively concise Twitter summary of the report, which is what I will be quoting because it's non-technical and easy to follow.

The projected number of deaths and the extent to which intensive care units would be overwhelmed is even more grim in the Imperial College study than in my cautious, back-of-the-envelope version, but the important thing is that those numbers don't fall to acceptable levels without radical measures. The only scenario under which the number of cases falls within the capacity of the health-care system is a national shutdown.

Finally, the Imperial College team ran the numbers again, assuming a 'suppression' strategy: isolate symptomatic cases, quarantine their family members, social distancing for the whole population, all public gatherings/most workplaces shut down, schools and universities close.

Suppression works! The death rate in the US peaks 3 weeks from now at a few thousand deaths, then goes down. We hit but don't exceed the number of available ventilators. The nightmarish death tolls from the rest of the study disappear. But here's the catch: if we EVER relax suppression before a vaccine is administered to the entire population, COVID-19 comes right back and kills millions of Americans in a few months, the same as before.

After the 1st suppression period ends in July, we could probably lift restrictions for a month, followed by 2 more months of suppression, in a repeating pattern without triggering an outbreak or overwhelming the ventilator supply. Staggering breaks by city could do a bit better.

But we simply cannot EVER allow the virus to spread throughout the entire population in the way other viruses do, because it is just too deadly. If lots of people we know end up getting COVID-19, it means millions of Americans are dying. It simply can't be allowed to happen.

So the national lockdown we're in right now is not just for the next three weeks. It will have to be maintained in some form for at least a year.

The paradox of this approach is that if it works, it will seem like it was all unnecessary. People will ask why we overturned the entire US economy because of a disease that only killed a few thousand people. But they will be able to ask that because the lockdown prevented it from killing millions of people.

It's easy to get people to come together in common sacrifice [sic] in the middle of a war. It's very hard to get them to do so in a pandemic that looks invisible precisely because suppression methods are working. But that's exactly what we're going to have to do.

This is not all just abstract and theoretical. Consider the case load in two Italian provinces, Bergamo vs. Lodi, a result that demonstrates the effectiveness of an early lockdown.

That is why we're doing this.

"Trace, Test, and Treat"

It probably won't be necessary to have total shutdowns for this whole time. At some point, we will be able to downshift to a system of "social distancing" that one expert describes as "widespread, uncomfortable, and comprehensive." See a detailed rundown of what that means. It is going to be a lifestyle change that we adopt "for the duration"—a year, a year and a half, maybe two years, unless some other development cuts it short.

And that's the real question: What will end this?

Warmer weather in summer may help, as it does with the ordinary seasonal flu. But there are a number of different reasons why summer tends to be bad for viral transmission, and it's not clear yet how or whether those factors will apply to this new virus.

What will be more helpful is massive, large-scale testing for the virus, which would allow us to move to something more like the successful South Korean model of "trace, test, and treat." It would move us from a system where everyone is quarantining themselves to one in which we only quarantine known carriers of the virus.

Large-scale testing is where the US has fallen down completely. But new tests are being developed, and we can hope that the regulatory barriers on their use are being cleared away.

Here's an overview of how testing might be used.

The better we get at interventions to identify and isolate specific people with the virus, the less we should need to rely on interventions that isolate the entire population. That's a reason the ramp-up of widely available testing remains such an important goal for the US: More testing should, in time, allow for more normal living....

[A]t some point, the massive shutdowns we are undertaking in much of the US (and ought to be undertaking in more of it) should make it possible to sharply reduce the rate of new infections to a point where widespread testing and monitoring can become a cornerstone of a strategy to prevent uncontrolled outbreaks—if we actually have the capability to do such testing and monitoring. This would not mean a complete end to the need for social distancing measures, but it could allow for a reduction in their intensity.

That's what I suspect the beginning of the end of the crisis will look like. There will be a bunch of drive-thru kiosks popping up in Walmart parking lots and at the drug store, and everyone will be told to go get tested. They'll get results within hours, or perhaps within the hour, and those who test positive will be ordered to self-quarantine, while everyone else can go back to semi-normal, just with more masks and better hygiene.

Until we get to that point, everyone has to self-quarantine.

Why don't we have testing already? I promised I would get back to that. Here's the story:

[A] review of the government's regulation of testing up to this point reveals an even more troubling conclusion: Washington missed an early opportunity to leverage the resources of the private sector, states and top-flight academic institutions to do what other countries have done to contain the virus—test as many people as possible. Instead, health authorities were left with a diagnostic tool developed by the US Centers for Disease Control and Prevention that ran into weeks of problems, hobbling efforts to track and control the virus at a time when it might have been contained.

The technical problems with the CDC test have been well-chronicled, by everyone from local labs struggling to use it to frustrated patients who have shown up at the hospital with symptoms only to be told that they couldn't be checked. Less well-known is the behind-the-scenes effort by companies like Swiss medical giant Roche Holding AG, which as early as January was working on a process to run thousands of coronavirus tests at a time.

Roche began work on its high-speed, high-volume test in January, as a team of disease-watchers at the company saw a worrying outbreak in China developing. The test was given emergency authorization by the FDA on March 13. Roche's highest-speed automated machines can process more than 4,000 patient tests a day....

The University of Washington Medical Center's laboratory in Seattle was ready to test local patients for Covid-19, but couldn't. State and local health labs had versions of the CDC kit, but the university medical center didn't qualify for those. Though its team had developed several tests, they couldn't use them on patients without regulatory clearance.

Alex Greninger, an assistant director of the university's clinical virology laboratories, grew so frustrated that he and about 100 colleagues from across the country wrote an appeal to members of Congress.

"This regulatory process is significantly more stringent than that required for every other virus we test for," they wrote on Feb. 28, noting that no test manufacturer or clinical laboratory had successfully been cleared at that point. Many of their labs had already created tests "that we could begin testing with tomorrow, but cannot" because of the FDA's stringent clearance process.

In effect, the CDC asserted, and the FDA enforced, a restrictive monopoly on diagnostic testing for COVID-19—and then failed to produce its own test.

Libertarians in a Pandemic

In a moment of crisis, people like to assert a sense of control, no matter how illusory, by reverting to well-worn habits. In the case of COVID-19, that means using it as a vessel for whatever political hobbyhorses they had before the pandemic. So it's no surprise to see the headline, "There Are No Libertarians in an Epidemic." By "libertarians," the authors mean advocates of small government and individual liberty.

This talking point has since been taken up by others. The idea is that when a crisis hits, everyone suddenly realizes how much they really need Big Government.

This is a bizarre argument to make about a virus that took off because of the corrupt and tyrannical policies of a communist government in China, which is currently at its worst in Italy, a country with socialized medicine, and which was allowed to get out of control in America because the federal government imposed its incompetent monopoly on diagnostic testing.

Not only was Big Government a significant cause of this crisis, but the solutions are largely being implemented through voluntary action. If much of the country is shut down this week, it is not through some kind of national martial law. Most of it happened late last week through the spontaneous and decentralized decisions of thousands of private organizations and businesses. Nobody told my kids' private school to shut down. Nobody ordered our restaurants to change over to curbside service. Our local theater canceled or postponed every upcoming show on its own accord. My gym initially resisted the shutdown—nobody is more convinced he's an invincible specimen of perfect health than a gym rat—but after a few days management bowed to the vox populi.

To the extent government has been involved in this shutdown, it has been mostly on the local level, with school boards leading the way—because the most effective way to get Americans to realize an issue is serious is to send their kids home from school.

Nobody could enforce the level of shutdown we're seeing. It can only be done by the spontaneous agreement of a majority of 300 million people.

The more conspicuous role for the government in this crisis hasn't been shutting things down, but opening things up. There has been a surge of spontaneous deregulation to lift artificial barriers that prevent people from solving problems.

I have already mentioned the loosening of federal controls on the private development of diagnostic testing. We're also seeing the suspension of restrictive licensing requirements on doctors and nurses to allow them to work across state lines, going where the shortages are worst. There has also been a whole series of waivers on restrictions on the transportation and serving of food and beverages in order to help restaurants stay in business and feed their customers by offering curb-side service.

Meanwhile, we're seeing the destructive consequences of government controls. For example, a crackdown on "price gouging" in New York City has exacerbated shortages of hand sanitizers and cleaning supplies because retailers can't pass on the higher prices charged by wholesalers. Price controls lead to shortages? That's Free Market Economics 101.

If you want to get into Libertarian Debate Club with me, I will acknowledge that the government does have a proper role in a pandemic. Just as your right to swing your arms ends where your fist hits my nose, your right to liberty does not include the right to knowingly or negligently transmit a deadly disease to others. Above, I mentioned Typhoid Mary, who was involuntarily confined for 26 years because she refused to stop seeking work as a cook after being identified as an asymptomatic carrier of salmonella typhi. So government has its role in ensuring the humane quarantine of the infected.

But that alone is not what's going to get us through this, especially not at this point. What will get us through is innovation, which will be led by a dynamic private economy.

So far, we have seen distilleries using their alcohol to produce bootleg hand sanitizer. When a hospital in Italy needed replacement valves for intensive care machinery, a local entrepreneur brought over his 3-D printer and made new ones. There is already a group banding together online to make 3-D printing designs available for manufacturing ventilators.

That's on the medical end. As for how we will all survive this shutdown, in both our work and our personal lives--where would we be without a whole host of private businesses, from Internet mail-order giants to videoconferencing services?

While I'm hearing from friends about their public school kids re-enacting Lord of the Flies at home, my private school has turned on a dime to offer practically a whole day's worth of instruction over the Internet, relying on file-sharing and videoconferencing services. For many other parents, the hero of this national school shutdown is going to be Khan Academy, a private non-profit creator of online educational videos.

The government did not create and could not have created all of these services. They were created by private initiative in a free market. They are how liberty is going to help us get through the pandemic.

Failure Is Not an Option

The innovation we're looking for most of all, however, is a medical one.

We expect a vaccine, and several private companies and research labs have them in development. But that will take at least 14 months, and there is really no way to speed that up. The barrier isn't the creation of the vaccine but the need to test it. Think of it this way. COVID-19 has a morality rate of about one percent, possibly smaller as treatment improves. If a vaccine has unexpected side-effects that cause anywhere near that level of mortality, and we administer it universally to everyone, then the cure will prove worse than the disease. So we can't skimp on the testing.

That means that the only way to end this crisis on a shorter time scale is through innovation in treatment. This is a "novel" virus, so we're still figuring out how it spreads and how deadly it is and what to do when people get sick. This also means that there is a lot of opportunity to improve how we treat it.

Given the long approval process (and high risk) of totally new drugs, the first progress we should expect is from established drugs that are "repurposed." There are already tests being conducted with anti-viral drugs, but possibly the most promising avenue is treatments to mitigate the "cytokine storm." Cytokines are natural chemicals in the body that stimulate the immune system to attack a biological intruder. In excessive quantities, though, they can trigger an immune system attack on healthy cells. Early indications are that this self-destruction of lung tissue might be the real killer in severe cases of COVID-19. A treatment that mitigates the cytokine storm could dramatically decrease the mortality of the disease—and if scientists can figure out how to do that, they will not only save many millions of lives, but they will restore the possibility of normal life to the rest of us.

Human being are ingenious and resilient. I remember after the Gulf War in 1991 when Saddam Hussein had his retreating troops set fire to Kuwait's oil wells. The resulting blazes were lamented as an economic and environmental disaster that would take years to extinguish. Instead, teams of engineers poured in from around the world, invented new methods on the fly, and put out the fires within months.

Humans are ingenious and resilient, and nobody more so than Americans. We've faced many difficulties before, and we've learned how turn a crisis into our finest hour.

We can do it again. Failure is not an option.