A serious discussion about re-opening a state's economy (using OH as an example)
Note: This is not meant to be a political (read: partisan) discussion, but a practical discussion about how states are/can/should approach the issues of re-opening. I believe that the board is (mostly) mature enough to limit the discussions to reasonable facts and opinions and not lapse into a political flame-war... maybe.
I just watched today's COVID update press conference from OH governor Mike DeWine (playfully known as "Wine with DeWine Time" around these parts - if only since the man is so bland when talking if nothing else). The conversation was mostly about his plan to re-open businesses (to some extent... TBD) starting on May 1 and has been a bit... underwhelming.
For context, DeWine (a Republican) has been (possibly surprisingly so) one of the more pro-active governors in the nation about getting ahead of the crisis. One good example: on Sunday March 15th he ordered the closure of bars & restaurants statewide (well before most states had taken any significant action at all - I happened to be back in MI visiting family that weekend and they were shocked to see that such a drastic action was taken by anyone, let alone a Republican in OH). DeWine received a great deal of criticism (in OH and elsewhere) for that action at the time (and other similar actions shortly after), but was vindicated by late March when much of the rest of the country had taken the same steps (he was even called out for praise internationally by the BBC, among other outlets).
However, his current actions in pushing for a re-opening of non-essential businesses on May 1st seem in stark contrast to his prior string actions to secure public health. In his press conference today, he (and his Lt. Gov) outlined various economic reasons why the state economy needs to be re-engaged yet failed to address many of the immediate health issues raised in doing so (let alone why the May 1 date was being strictly pushed). Just a few of the issues that I saw (and some of the reporters called out in the Q & A):
1) DeWine earlier this week said that OH would adhere to the guidelines issued by the White House, which include 2 weeks of declining daily COVID cases and deaths before a state economy can re-open. As of yesterday, the 7 day average of both for OH are slightly increasing (https://www.nytimes.com/interactive/2020/us/ohio-coronavirus-cases.html) and thus could not mathematically meet that criteron - and the re-open date is 9 days from now (he said they have "flattened", which is not strictly true, but also his med chief said today that ICU admissions are trending up again).
2) A question was asked if the supply chain (masks, disinfectant, etc.) would be ready to support businesses and individuals returning to work by May 1 - especially considering that people are having high difficulty in finding masks even now. He had no answer to this.
3) Another question was regarding child care and the practicalities of having working parents leave home when child care centers might not be re-opened to sufficient levels (let alone being deemed "safe" health-wise) and with all schools closed until Fall.
4) Much attention was given to the financial/economic risks of maintaining the shutdown yet absolutely no numbers/models/estimates were provided about the expected increases in cases/deaths that were likely to be incurred with a May 1 re-open (let alone modeling how these increases would change as a function of changing the re-open date).
5) Coordination/comparison with other states was not really addressed. He has in the past emphasized coordination with IN and KY (which have lower cases than OH), yet hardly mentions any coordination with MI and PA (which have higher cases) - yet even in today's Q&A a reported remarked that a Jeep plant in Toledo is scheduled to re-open May 4th and a large contingent of its workers commute from Detroit. DeWine commented that the plant would be monitored by the OH Dept of Health to keep safe operation but made no mention/discussion about the movement of possible cases across state lines (and how to address it).
6) A day or so ago, DeWine said he had been approached by small businesses that it was greater concern to them about re-opening soon only to be forced to close quickly again upon any cases resurgence - a later re-opening date would be an easier pain for them to accept than a series of starts/stops. No information/discussion was provided today (or thus far) about how this would be addressed and how a May 1 date is or is not optimal to avoid this.
These are simply the issues my wife & I noticed while watching today (I'm sure there are others), but it is rather concerning that the state officials seem to be pushing blindly (or perhaps half-blindly) toward this re-open date without crafting a more deliberate and coordinated response. I know other states are facing the same issue (some more agressively, such as Georgia and S.C., and others more cautiously, such as most of the northern eastcoast, WI, IL and CA), but it just seems foolish to have such a patchwork level response to this issue nationally.
Also, I know that many on this board live/work in OH, may be from OH or have family there, and am curious what their opinions are of DeWine's response and how they would like to see the state government proceed.
Apologies to all if this seems too ranting, but I had been relatively impressed by Ohio's handling of the crisis to date - yet this seems like a significant risk to take that could cost 1000's of lives unecessarilly.
April 22nd, 2020 at 11:27 PM ^
This is another point that a lot of people miss. They point to scary graphs from 100 years ago and decide that "flattening the curve" will save hundreds of thousands of people, but that's without considering that we have a lot more tools at our disposal in 2020 than we did in 1918. In 1918, we didn't have the ability to turn Cobo Hall into a (mostly empty) hospital or fly doctors from Los Angeles to help in New York City.
At this point, it seems a near certainty that most of the lives saved are due to the lack of other deaths (accidents, etc.), because we didn't come close to overwhelming the system anywhere except NYC and maybe Detroit, and there's no real reason to think that we will. People are going to get sick from this virus for a long time, especially if it turns out to be resistant to vaccine. (I still haven't figured out how it is that people can confidently say "we'll have a vaccine for this by next year" -- we've been working on an AIDS vaccine for 40 years and a vaccine for the common cold for, what, 100?)
Hospitals are laying people off all across the country ... people will definitely die because of the shutdown. To argue otherwise, is to say we should be shut down forever because, after all, we're saving lives!
In looking at the data, it seems 75% or more of death is coming from the elderly and it jumps to 90% if you include aged 60 or higher. Are you suggesting we shouldn't accept their death as a society? Is death something we just aren't going to allow anymore?
Not really pointing out "only the negative possibility" - more the fact that no COVID numbers are being given to justify the specific May 1 re-open date over any other dates. Even some rough projections, using any of the myriad models out there, would be something.
I'm actually not big on the NYT in general (more prefer WSJ), but I really like how they visualize the data (which is direct from ODOH) - better graphs than ODOH's COVID tableau site.
I'm not "dismissing" DeWine - I was actually very impressed with his leadership through this crisis in general (look at my older posts and see for yourself). However, I've been watching his conferences for weeks now and he has not really delivered a solid case (IMO) for choosing May 1 specifically as the re-open date. Unlike his other orders, this one seems like there is too much hand-waving to "balance" economic vs public health considerations (not to mention addressing the other concerns I mentioned in the OP).
The sentiment of "let's try this and see what happens" is a bit cavalier when the cost of a mistake can be 1000s of lives. This is not a science fair project or some financial venture.
April 23rd, 2020 at 12:32 AM ^
By now, we should all be better informed than we were 3 months ago and better able to protect ourselves. We can’t stay locked in forever.
We are better informed than 3 months ago - which is why the lockdowns are in place and the initial surge of hospitalizations was not as dire as it could have been (yet it was still quite severe).
No one is suggesting a "forever" lockdown - just to let the data guide the policy to determine when the lockdowns should end.
April 23rd, 2020 at 11:15 AM ^
People are suggesting a lock down through the summer.....that's "forever" considering currently 22mm+ are unemployed. That number will double by the end of the summer. So, it looks like our leaders are choosing a nationwide depression over the death of 100,000 80 year olds.
Summer is 3 months - far cry from forever (and the discussion is really about May-June timelines anyway). For perspective, consider the Great Depression: where unemployment percentages were much higher, for so much longer (the eye-popping unemployment numbers right now will drop precipitously when re-opening begins in earnest), without any prospect of quick recovery. We are not there, nor likely to approach it.
The deaths are happening to a much larger group than simply 80+ year olds... but you might feel a little less cavalier about those deaths if your loved ones (or you yourself) were part of that group.
April 23rd, 2020 at 12:24 PM ^
Great post, the conversation has been interesting.
To your last point, I would argue IT IS a financial venture, and that he has to be cavalier about opening up. The curve has been (mostly) flattened in Ohio, hospitals are not overwhelmed. Will more people become infected, yes.. absolutely. But how much longer do we put people out of work? How many more small businesses are never going to open up again? How many more corporate lay-off's can we stand?
It is our duty to save lives, within reason. Continuing an indefinite shut down is not within reason. He set May 1st as the date, lets open up a little, monitor the hospitals, and return to productivity. Otherwise, it's just going to a "one more month" thought process until we have no society to return too.
My point was the this is not *simply* some financial venture that - if it goes wrong - the worst that can happen is a loss of money (which is a risk that is known and accepted before engaging in any financial venture - if the risk is too much to stomach, the venture would not proceed).
However, this venture not only involves billions of dollars but also 1000's (possibly 10's or 100's of thousands) of human lives in the balance. The magnitude of the risk is much greater and thus should require a much more thorough and deliberate approach - with clear, data-driven justifications for every action communicated to the public.
My point was that, thus far, no real justification has been given about why May 1 is the best re-open date for all factors (economic and public health) - and why it is chosen versus others (why not May 8? Or May 15? Or June 1?)
Other states are being more clear and deliberate about this, making sure to couch their decisions with health data to back it up. The undesirable alternative is playing out in Georgia, where a premature open is in progress and has been panned by nearly all national public health experts (and even the the president himself, who is generally in favor of reopening sooner).
All fair points, I certainly won't argue it is a very risky thing to do, I'm just not sure how much of a choice we're going to have.
If opening up is going to be totally reliant on data, when will that happen? We're two months into this, and there is virtually zero agreement on how many Covid-19 cases the US has seen, how many actual deaths Covid-19 has caused (not just confirmed cases), how transmittable it is, the actual CFR, the percentage of people with antibodies, etc.. you get my point. If it were up to some in the medical community, we'd be locked down a lot longer, possibly through the summer. Reliable, agreed upon data is a looong way away.
My point is, opening up is going to suck for many people, no doubt about that. But being locked down sucks for most everyone right now, and isn't economically sustainable. Dewine was criticized for locking down when he did, and now everyone agrees it was the right call to make. Perhaps opening up May 1st won't be as bad as you think, only time will tell us.
I completely agree that this is not any easy decision for anyone.
My recommendation would be to create a clear set of criteria for the conditions necessary for a re-open (or for each phase of a structured re-open) - the White House put out their guidelines for such, but states could craft their own if desired.
Whatever criteria are used, it should be something that all stakeholders can monitor using publicly released data (e.g. case rates, hospitalizations, deaths, etc.). All parties can observe when the factors are close to meeting the criteria and prepare for a re-open. Lightly hit states (or perhaps regions within a state) could reopen sooner, but heavier hit regions could reopen later. Either way, it doesn't rely on an individual fixing an arbitrary date - the date is determined by the situation.
For OH, the May 1 date has been fixed since the first week of April (which was just an optimistic estimate then). It would incredibly coincidental if that also happens to be the optimal date for reopen considering the current health conditions.
Double post.
One reason that some governors are pushing for an early opening is that unemployment insurance is state-funded, and they're going to run out:
https://www.ajc.com/news/state--regional-govt--politics/report-budget-s…
If they lift the stay-at-home orders, then they can deny unemployment claims for people who "choose" not to put themselves at risk. The businesses that choose to reopen and require their employees to show up or quit can still get aid from the various packages, while their employees are almost certainly in the socioeconomic/demographic groups with the worst outcomes.
April 23rd, 2020 at 12:28 AM ^
So either they open up and some people go back to work relieving some of the stress on the system, or they stay shutdown, quickly run out of money, and nobody gets anything at all.
You're right. With this information, it is obvious that opening up is the right thing to do.
Take time and look at the data. The past 7 day average for deaths and hospitalizations is declining. So, whatever you read is wrong, unless it's talking about cases which is only up based on 2 days where they tested entire prisons that had outbreaks. The new cases data is useless, for this reason, so only hospitalizations and deaths make sense to look at.
The data is posted to Ohio's COVID site every day. If people don't want to pay attention to the data and choose to be afraid of the spread, then stay home.
The seven day death average rate is increasing, not decreasing (using data directly from ODOH).
The seven day average cases is up when including the prison data (which is real data that one cannot just dismiss on a whim); even excluding that data, the trend is relatively plateaued and not declining as required by the guidelines.
Dr. Acton stated at today's conference that ICU admission rates are increasing.
The hospitalization and ICU admissions rates are the trends that are most concerning to me. I had been pretty impressed with Dewine’s leadership up to this point. The lack of a clear plan so far is a little unnerving, but I’m willing to keep an open mind pending the announcement at the end of the week.
I agree that, until recently, he has been very reasonable. He waited until nearly the last minute to extend his first stay-home order (from Apr 7 until May 1), but was very clear with his data-backed justifications each day leading up to it. I haven't seen those clear, indisputable justifications with the more recent positions since it is no longer only the public health data driving the decisions.
Agree. It’s been a little puzzling following things the last week or so. I get that it is a difficult time to lead, especially the longer this goes on. Any of us that lead a team at work (or are parents), certainly get how trying this has been to put your best foot forward every day. I hope he finds his voice again.
I am waiting for a detailed announcement from any governor. And they are sort of the announcements that have been missing all along. Let's have some clear plan and stick to it with clearly defined rules. The federal government guidelines are decent first stabs at what we should be striving for.
The biggest gray area in the guidelines is what is a "robust" testing system. I think we are still missing that. And if people behave and the businesses that can allow people to continue working at home, we are sort of back in business.
However, I think we need to be clear up front on what data could turn the restrictions back on and if those are local, regional, or statewide. Is any increase bad or is it some 5-consecutive days of increase or something? This might also help people behave if there is a risk of going back if you are stupid.
This isn't true. I pull the data every day. Here is the latest chart. Please, tell me where the increase is?
Image is from New York Times, but data is direct from ODH.
www.nytimes.com/interactive/2020/us/ohio-coronavirus-cases.amp.html
ohio has had 14k confirmed cases versus michigans nearly 34k. 610 deaths in ohio versus 2813 in michigan. its hard for persons in michigan to understand the general feeling here in ohio. with the early shelter in place we have had a very flat increase in cases save for two counties with large prisons. without the prison population ohio would likely be trending down. we also had plans in place for the half dozen or so largest hospital systems to function as one in a scenario such as this.. the expansion hospitals were quickly erected and supplies when necessary early on pooled. additional supplies were quickly obtained and we have since sat and waited for weeks for what has yet to or may never come. public hospital admissions are minimal. a very small percentage of available mechanical ventilatory support equipment being utilized. i have never been a fan of the governor but i have to admit the early actions and the preplanning years in advance for something such as this was impressive. i am going to judge his decisions on the safe assumption that he and his advisors have a far better understanding of things than fox news msnbc or cnn.
I agree with all of your comments but it wasn't just the acting early. Michigan started the official shelter in place 24 hours after Ohio. Schools were closed on the same day. DeWine did a bunch of smaller things before Whitmer, but nothing drastically different. There is something about how it spread in SE Michigan that seems to have caused all the difference.
i agree with you. in fact the toledo metro area has more cases than the cincinnati metro area, with Cincinnati having a substantially larger population. proximity to SE michigan may be the reason for this disparity.
Yeah but in all seriousness what if you found out that Michigan had say 20% of the citizens there who have the disease and Ohio only had 2%? Totally hypothetical but just saying looking at total cases just means you're going to get it little later because once everyone leaves the house they're eventually going to get it over next year I would think.
April 22nd, 2020 at 10:04 PM ^
i agree...michigan would be closer to achieving some degree of herd immunity while ohio would be at a disadvantage. health alone...should we continue on the current path until there is a highly successful treatment regimen and/or an effective vaccine...absolutely. the trade off for doing that is likely having little to return to in two years. COVID-19 will be part of american life for years to come....
April 22nd, 2020 at 10:42 PM ^
If you look at death’s per million, Michigan is at 283 and Ohio is at 52, so it is probably reasonable to assume that cases also vary by a factor of 5 to 6.
April 22nd, 2020 at 10:21 PM ^
The case comparison between states is not appropriate since OH was not testing as many people (and also made the conscious decision to limit testing to mainly the more severe incoming cases) - however the death comparison is a more interesting contrast (which one could argue is more of a "Detroit" issue rather than a "MI" issue.) I live in NWO and testing for the general public is minimal.
The bump in the daily OH cases is mainly (but not entirely) attributed to the recent prison tests, but without it the cases per day is about constant, not declining. This is supported by Dr. Actor's announcement today that ICU admission rates are rising again.
Also keep in mind that the prison data is not some one-off event that can be dismissed - this is data that would be counted anyway if the state-wide testing were at the recommended levels.
The criticism of the decision is not compared to what the networks or pundits are dating - it is compared to what the credentialed national health officials (CDC and NIH) are recommending.
April 22nd, 2020 at 10:36 PM ^
any healthcare provider can order a covid screen in ohio. the ability for a provider to practice has not been stripped. the decision was made early on to not waste limited resources solely to appease the talking heads in the media. now that testing is much more available more should be done. the prisons in ohio as an example have had a 25-30% asymptomatic positive rate which until proven otherwise should be the assumption utilized in the community for decision making. my far less imformed opinion than the governor of ohio.
April 22nd, 2020 at 11:35 PM ^
With the back and forth of how bad this virus really is, my take is that the answer usually lies somewhere in the middle. And in this case, the middle is still really bad. There is not a good solution to this situation because it is a really, really shitty situation. Pointing fingers right now at who could have done more is also really, really shitty. There will be a whole lot of time for that after this thing is past, stop trying to use it for political advantage. If you want a political advantage, do your job and be a leader during a difficult time.
Also, people keep talking about who is dying and who is surviving, etc. Keep in mind that that data is all based on being able to receive medical care in a hospital. Overload the system and that data looks a lot worse - maybe not for every demographic, but for many. People are acting like they have a complete understanding of how Covid-19 works because they have looked at some numbers and studies. The data is very incomplete and over the course of this pandemic has never been up to date with test results commonly taking five days or longer. The models are changing all the time because the data is changing and our responses are changing.
It is okay to have a discussion about how long our economy can handle these restrictions and its okay to be concerned about it. It is okay to worry that opening things up could kill a lot of people. But to act like either side of that equation does not matter, or that the other side does not have an argument because you are only going to look at data that supports your agenda, is unhelpful and foolish. It does not help to draw parallels to situations that are nothing like this. This is not a car accident. It is not the flu. Also, saying that every life matters is not helpful. At some point economic issues also cause death. The problem is that we are playing a game where we do not understand the rules. Hopefully our leaders will take into account what we do know and hopefully individuals will act responsibly. Also, we might need to find more creative solutions that just sending checks to people and businesses. I’m not saying it won’t fill an immediate need, but what’s next?
Also, if you want to protest the government that is your right. But do not advocate for individual responsibility and that you do not need the government to force you to do the right thing while you stand huddled in a group of people. The stay-at-home order is not just designed to protect you, it is designed to protect others from you (and I understand that the statement stands for me, too). The virus does not care if you do not think that it being hyped for fear-mongering, it can still kill you or your loved ones.
I think if everybody considered “maybe my views are wrong” and at least listened to the other side, we could find the best solutions – or at least the least shitty solutions.
Tl;dr – you do not know everything and neither do I. Listen to people that do not believe exactly what you believe and you will learn something, even if you still do not agree with them.
April 23rd, 2020 at 12:03 AM ^
I think if everybody considered “maybe my views are wrong” and at least listened to the other side, we could find the best solutions – or at least the least shitty solutions.
This does not happen at all in 2020. It hasn't happened for quite a while, it seems. It's very frustrating. I feel like I'm 1 in 10 million who constantly has an open mind about, well, mostly everything. In this world of 100mph all the time, I think that gets looked upon at times as weakness or ignorance and that's wrong (like whatever the person talking to me is likely spouting off about!).
April 23rd, 2020 at 12:22 AM ^
80% of patients that have needed ventilation have died anyways. The hospitals don't actually do much to lower the death rate; it's all still up to the individual patient's immune system.
The possibility of overwhelming hospitals is not nearly the apocalyptic scenario it's been portrayed as.
April 23rd, 2020 at 12:19 AM ^
Certain things should be opened up and relaxed May 1. We will be at 4 weeks or so of a down trend from the peak at that point. Certain forms of distancing and precautions will remain in place
I'm not sure where you are getting those numbers.
For OH specifically, the first peak in reported cases per day was ~ Apr 5th (less than 3 weeks ago) - yet a second peak in cases per day occurred 4 days ago (which was more about an increase in testing rates, but are still real cases). Also, since that first peak it has not been continuous decline - the daily rate of new cases simply plateaued at ~ 400/day (if the second peak is neglected). A true decline must see the rate of new cases/day decrease continuously such the the count of total active cases starts to decrease (as people recover). We are not there yet and probably will not be for a week or two (at best).
Not to mention that the daily death rate in OH is still increasing. Yesterday's daily deaths hit a new high and show that they haven't even peaked yet, let alone starting to plateau or decline.
I say all of this not to present a doom & gloom assessment of the situation and suggest that the state can never reopen. Rather, I am saying that there are some early signs of turning the corner on this crisis, but it is still too early to say it has passed - and could easily surge again if policy changes too quickly.
April 23rd, 2020 at 10:54 AM ^
Good topic. I watched as Dewine took action and thought, "man that seems drastic." But in a month span it seemed like whatever he did, Whitmer would do the same 3, 4 or 5 days later.
I think he will be seen as proactive with reopening too. A slow reopening is justified because most have modified their behaviors now, especially in regard to hand hygiene. And the curve is flattening. Masks are fairly useless because it is droplet precaution not airborne but don't get me started.
More people will die regardless. I work at the VA and it is a ghost town. Most hospitals are that way right now. Gotta start opening up slowly. Comparisons to the Spanish Flu with it's incredible mortality rate are irresponsible. It killed like 5% of the the planet's population.
April 23rd, 2020 at 11:15 AM ^
In March, Whitmer did follow Dewine like a puppy dog on issuing these orders. Since then, she has mismanaged the crisis. She is getting more push back lately.
April 23rd, 2020 at 11:11 AM ^
The time has come to have a smarter approach to reopening. The stay at home and shuttering orders the past six weeks were effective and accomplished it's mission. I follow the data but it also reveals a pattern. The virus is more deadly to elderly with pre-existing conditions. Nursing home residents, inner city low income folks are among the highest risk. The point is there needs to be a surgical and not carpet bombing approach all these states have been doing, albeit successful up till now.
Loosening restrictions could be done by zip code, nationwide would work much better going forward in restarting the economy.