Coronavirus Update: We now get to choose between bad, worse and worst.

As kids, many people may have heard adults tell a crying kid “if you don’t shut up, I will give you something to cry about.”

Well, it seems like we are living that experience but the coronavirus is the parent and the child is the American people.

Without going through the missteps and mistakes, there was a time back in March, April, and May where patience would have paid off but, alas, there was not enough cumulative patience. Encouraged by hosts at Fox News and OAN, there was a consistent chorus of voices telling their viewers that the restrictions and recommendations being implemented to reduce the spread were big government trying to squash their (the viewers) freedoms and/or it was the Democrats trying to destroy the Trump by destroying the economy.

Mind you at that point, Democratic governors and many Republican governors were trying to follow the science and do what was recommended as best practices but too many of them got pushed into opening things up before the job was done. On the Republican side of the fence, many governors and politicians did not even try or merely gave lip service to “best practices” while not taking these best practices seriously.

And around mid-May with the rates falling as a result of the aggressive actions taken in March, April and early May, many of these Republican governors who did not take it seriously were quick to claim victory. (Florida, Texas and Arizona I am looking at you.) OAN and Fox (Wheeler, Ledger, Tucker, Hannity, and Ingraham) told viewers that their low infection rates demonstrated that the left and Democratic governors were using this virus as a means to cause Trump to lose in November. At that point, the Republican-run states had opened up and the Democratically run states were opening up but more slowly (hence the claim that they were really trying to hurt the economy).

The pressure was building with these claims. Michigan’s governor had to deal with arm protesters at the capital. California’s governor has similar issues and even had to deal with Elon Musk, founder to Tesla, threatening to open his factory regardless of what the governor said — Musk even threatened to move his factory. Every state to various degrees had people protesting because they wanted the economy opened up — virus be damned. Alas, the nails, and hair could not wait.

The children cried out and would not shut up so the coronavirus is now going to give them and everyone else something to cry about — even if they don’t realize the hole they dug (yet).

As we sit here July 13, 2020, with new infections spiking in Florida, Texas, and Arizona and with Calfornia on the brink, new records of infections are recorded nearly daily. Some states are closing up bars and other higher-risk businesses. Mask recommendations are becoming more strong — even in GOP led states. That said there is still a wishy-washy-ness to it all. There is little enforcement in many places. The stay-in-place orders are largely gone although some governors are asking people only to travel for essentials.

People still seem to deny the seriousness of it to the point where there have been covid parties among younger people where they are around someone with covid to see who gets sick.

The lack of seriousness is disturbing and seems to be a result of the lack of seriousness at the federal level, a lack of consistent messaging, and a lack of messaging to bring us together for the common good.

If seems that the deniers, won’t respond in a constructive way until they are personally affected. To be clear, this is understandable. The Trump administration, in the middle of the latest outbreak, is telling schools that they have to reopen (for many this means next month) — but then follows it up with doublespeak like “it is a local issue as to how they do it” but when a school proposes a combination of on-line and in-person classes, they immediately reject it as not opening up. With this sort of insanity, it is no wonder that others are confused. Communication is one of the most important critical skills needed for effective leadership. We don’t have it where we need it.

All that said, in the middle of chaos, I hear people say that maybe we need stay in place orders again. What I think we need to understand though is that we are at a very different point than we were back in March/April when the numbers were very little.

Here is and example of why:

The difference between having 10 cases and 1,000 is a matter of months when it comes to recovery.

R0 is a measure of how quickly the virus is spreading or, on average, how many people get the virus from one other person.

An R0 < 1 means that one person is, on average, giving the virus to less than one other person. This means that eventually, the virus will die out.

R0 = 1 means that roughly every person who gets it will give it to one other person. The virus is neither really spreading or dying.

R0 > 1 means that the virus is spreading because one person on average is giving to more than one person.

And, while we hear daily updates about the number of new cases, we are not processing what this means to our eventual recovery time.

If, for example, you have 10 active cases and R0 = .5 meaning that one person on average gives it to .5 people or that 2 people give it to one, then the sequences of spread would be like this where T refers to transmission cycle (rounded to the nearest 1):

T1: 10
T2: 5
T3: 2
T4: 1
T5: 0

So basically there would be 5 transmission cycles to get to zero or close to.

But notice what happens to the number of transmissions cycles when 10 becomes 1000 with an R0 of .5.

T1: 1000
T2: 500
T3: 250
T4: 125
T5: 62
T6: 31
T7: 15
T8: 7
T9: 3
T10: 1
T11: 0

The more widespread it is the more transmission cycles need to be cleared to get to the same spot.

I won’t do the math but we currently have 1,759,129 active cases. Needless to say that this will require us to go through a large number of transmission cycles over a much longer period of time unless we bring the R0 down very low and very quickly. (And to be clear, no state even got it down to .5 at its lowest with the previous efforts.)

So what does that mean?

Shelter in place for 2 weeks or 4 weeks as we previously did it is unlikely to work unless it comes with a super strict shelter in place mandate in which no one can really go anywhere except in cases of extreme emergencies. Food, medicine, etc. might need to be provided by delivery only to keep people in place. (This is necessary to get the R0 as close to zero as possible during this time to have the maximum impact of the shutdown.) This would be followed by a slow loosening up with strict restrictions to make sure that any new outbreaks can be caught quickly and to make sure the measures were as effective as they needed to be. If handled skillfully, we could likely return to a more normal situation in 2 to 4 months depending on the area and the level of infection when the shut down happened. (When I say skillfully, I have not seen anywhere the level of skill required. NY might be the closest.) Additionally, to be effective, this would need to be applied to everyone.

Another option might be to create extremely strict social distance and mask mandates with huge penalties for noncompliance. This option would also come with the acceptance that these mandates will likely be around for months even up to a year and with the acceptance of many more illnesses and deaths.

To be clear, none of these options would be easy but the simple fact of the matter is that our current path is not going to be easy either. As painful as these short term requirements might be, they may pale in comparison to what we face if we don’t take some comprehensive, national, mitigation actions.

The cost in terms of human life will be staggering. And the economic costs will be even more devastating. You can not have millions sick and hundreds of thousands of citizens die in a relatively short period of time without a huge toll on all elements of society.

We now are stuck, because we lacked the patience earlier, to choose between several very bad choices. When people complain, it may be important to remind them that there are no easy choices. We get to choose between horrible and worse and, if we stay on our current track, we are choosing devastating with the worst outcomes as far as lives and the economy.

We need to stop acting like a bunch of spoiled children. Sometimes these things happen. Think of the person who is diagnosed with cancer. They can’t yell and scream and deny it away — at least not successfully. Instead, they have to face the reality of their choices, many of them not something they would desire but something they will do to achieve the desired outcome. That is where we are. Everyone wants to get back to normal or close to it. To get there we need to choose our treatment. None of the choices are particularly good but, like the cancer patient, it is the only way to treat this situation so we can return to a healthy state again.

To give you an idea of where the R0’s are and the amount of work that needs to be done, here are the most recent values by state.

For reference, here are the R0 values July 12, 2020