95% of the nation is under stay-at-home orders - and we’d like to know when this will end.
To understand what’s ahead of us, it’s useful to understand how much has changed in the past few months.
The Past 90 Days
- Jan 20 - The first case of COVID-19 was reported in Washington
- Jan 27 - First meeting of President’s Coronavirus Task Force
- Jan 30 - 9976 cases are reported worldwide in at least 21 countries.
- Jan 31 - White House announces ban on entry for foreign nationals traveling from China
- Feb 24 - DJIA closes down over 1000 points
- Mar 6 - Congress passes $8.3 billion emergency spending package
- Mar 11 - WHO declares global pandemic as cases confirmed in 110 countries and territories
- Mar 12 - MLB, NHL, NCAA suspend season
- Mar 13 - President declares State of Emergency for COVID-19.
- Mar 13 - Minnesota declares a peacetime emergency
- Mar 16 - Minnesota closes bars, restaurants, gyms, coffee shops, breweries, and other venues to close to dine-in guests
- Mar 18 - Congress passes second spending package, Families First Coronavirus Response Act
- Mar 19 - Australia and New Zealand close borders to all foreigners
- Mar 26 - Congress passes third spending package, CARES Act, with more than $2 trillion in aid
- Mar 26 - US is the new epicenter of the coronavirus pandemic
- Mar 27 - Minnesota stay-at-home order is in effect through April 10th (Easter weekend)
- Apr 8 - Minnesota extends stay-at-home order through May 4th
- Apr 13 - Minnesota extends peacetime emergency to May 13th
In the timeline above, official declarations from Federal, State, and WHO consistently lagged behind the early warnings of key events. This isn’t a criticism. Instead, it’s notable and points to the idea that organizations should not wait for an official order to make decisions.
And they didn’t; many events, sports organizations, and businesses suspended or changed operations in advance of government declarations.
On a clear positive, the timeline highlights an unprecedented scope and speed to aid. And for each of these federal actions noted, many states and local municipalities followed with their own aid and relief programs.
Key Point: Businesses should take preventative action based on facts and information in advance of government intervention or edict. Better safe than sorry.
So here we are today.
The US population is 330 million; with around 165 million people in the labor force. Most states have declared a stay-at-home order, affecting 95% of all Americans.
In recent years, it was estimated that 5% of workers in the US worked from home full-time - around 8 million people. This month, it’s likely greater than 50% of all workers, which is close to 80 million people.
At the same time, it’s estimated that the unemployment rate is now around 13% - or 16 million people, as of April 3rd. For context, the unemployment rate was 3.6% in October of last year, and has not been this high since the Great Depression, which saw an unemployment rate greater than 20%.
This leaves an estimated 69 million people who are employed and that cannot work from home.
Today’s normal, is that close to 75% of the population (an estimated 245 million people) are either working from home or at home, sheltering in place - assuming compliance with stay-at-home orders.
The Next 60 Days
Over the next four weeks, the majority of states have their current stay-at-home orders ending the last week of April (week of April 27th), with the other states forming a bell curve around this high point.
In thinking about what the next 60 days looks like, there are two great resources I’ve been using. First, is John Hopkins COVID-19 Dashboard which provides up-to-date information on cases, testing, and deaths. Second, is Covid Act Now providing trend data used to predict when a peak might happen for states and counties.
For Minnesota specifically, the state has provided a dashboard to track cases and response: https://mn.gov/covid19/. Linked from this site, is a PDF made by the Department of Health in collaboration with the UMN School of Public Health, that shares additional data on the models the state is currently using for decision-making - last updated on April 10th. This is a very useful resource and I recommend you read the presentation or watch the video briefing.
When looking at reported cases, I had been using a heuristic of multiplying any number of cases by 10 to account for the lack of testing worldwide and the delay in reporting information to authoritative sources. As experts have gathered more data on COVID-19 in Minnesota, they believe the number of cases is much wider spread than originally thought. Originally, the assumption was that 12% of cases in Minnesota were detected by tests. This is now believed to be closer to 1%, which would lead us to multiply the number of reported cases by 100.
The report (and relevant related data sources) reinforces several key points:
- The incubation or latent period (the time between infection and exhibiting symptoms) is on average five days, with more than 95% of people infected exhibiting symptoms within two weeks.
- The infectious period lasts eight days.
- R0 is averaging 3.87, which is noted to be higher than previously thought, “faster spread and quicker time to peak”.
- Compared to the original v.1 model, the virus is believed to be more contagious and less deadly.
The report then details four scenarios that the governor used to inform the decision of the current extension of the stay-at-home order to May 4th.
In Scenario 1, the order would have ended on April 10th, with no planned additional mitigations. This scenario estimated 50,000 deaths compared to 22,000 for Scenario 4.
Based on this report, it appears that Minnesota chose a path similar to Scenario 4 - which modeled extending the stay-at-home order until May 8th (as compared to our current May 4th order).
Scenario 4 then recommends an additional 3 weeks of physical distancing following May 8th, which brings us through the end of May.
Key Point: For those who can, they are staying and working from home through all of May, at least.
June and July
Scenario 4 projects a peak of infections occurring around mid-July. The information we’ve been provided makes this clear that this is an educated model with an estimate variance of several weeks - earlier or later of peak.
There are other much more optimistic models, including the much-cited University of Washington projections. In the UW model, peak happened yesterday for the United States and infections are projected to peak in late April for Minnesota.
The Minnesota governor has stated that he and his team are using multiple data points to make decisions. What we do know, is that the state response appears to be erring on the side of caution. And the more cautious model shows a peak in mid-July for the state.
We also know the actions that were taken leading up to the current order, such as gyms, bars, and restaurants closed to dining while other businesses were able to remain open. A reasonable expectation is that a similar ban would be in place through the peak of July and into August.
Key Point: For those who can, they will likely continue to stay and work from home through July.
Looking forward, we’re beginning to see concrete proposals on how to manage beyond the sledgehammer we’ve been using: shutting down major functions of our society.
The American Enterprise Institute proposes a Phase II, which is a process for states to lift their stay-at-home orders when they meet the following criteria:
- The state reports a sustained reduction in cases for at least 14 days (the incubation period)
- Hospitals in the state can safely treat all patrons requiring hospitalization (i.e. enough ICU beds and ventilators to handle peak infection loads)
- The state can test all people with COVID-19 symptoms and has the ability to monitor and trace infections.
- Note: even if a state lifts their bans on stay-at-home and distancing, older adults will still need to practice these measures until there is a vaccine or similar remedy.
Up until this point, we’ve only discussed a single peak. However, there is an increasing belief that we will see multiple infection peaks until a vaccine is available or a herd immunity develops (which requires around 60-80% of a population to have developed an immunity).
As these peaks arise, policy makers and planners will likely need to react by reintroducing mobility restrictions of their constituents. This is sometimes called an on and off strategy, or an open and closed strategy.
The AEI proposal includes similar measures to revert to Phase 1 (Physical Distancing) if there is a rise in new cases for five days or if infections can no longer be traced to known cases.
During this second phase, every case should be isolated at home, a hospital, or an isolation facility for a period of seven days. And close contacts will need to be monitored for 14 days.
Once there is a vaccine or similar therapy, then the proposal is to move to Phase III, where restrictions are lifted once a sufficient portion of the population has been inoculated.
Key Point: over the next year, we may see restrictions temporarily lifted, and then put back in place as infection rates begin to climb. As evidenced so far, it seems reasonable to expect that this is a state-by-state decision.
In Search of a Vaccine
We hear conflicting reports on whether a vaccine is even possible (we don’t have a 100% effective vaccine for the seasonal flu), to much more encouraging ones that report a vaccine may be developed in the next 12-18 months - or sooner.
As of April 8th, there are over 115 vaccine candidates being reviewed or developed. Most of those are in the very early exploratory stages, with five moving to clinical development - and possibly to human trials this year.
It’s too early to say if a vaccine will be developed, or at least, developed in time to prevent mass infections. But, it’s encouraging that treatments for SARS, MERS, and similar respiratory viruses may speed development of a new vaccine for COVID-19. Additionally, it’s possible an effective antiviral may be developed to reduce the severity of symptoms of contagion.
What we do know, is that the world is united in developing a therapy. And a united world can do anything.