Dr. Sarah Cody. That’s the name of a local government employee probably unknown to almost everyone reading this. Yet I think there’s a good chance that a million or more Americans will owe her their lives. And therein lies a tale…
Last Tuesday President Donald Trump announced that he expected to lift most health restrictions recently imposed due to the Coronavirus epidemic and send the country back to work by Easter, a possibility that shocked and horrified nearly all mainstream health professionals.
No need to worry, I said. I predicted that the exponentially-growing Coronavirus death toll in his home city of New York would have reached such horrifying levels by Easter that his Wall Street friends would persuade him to “pivot” away from such a foolhardy proposal.
At the time I made that prediction, Coronavirus deaths in New York were running at around 50 per day, and they soon jumped to 140 per day, then reached 209 in a 24-hour period by Saturday. Wall Street Wizards are quite familiar with exponential growth, the fundamental basis of compound-interest, and presumably they began to notice what was happening outside their own windows. So on Saturday, Trump announced that rather than any relaxation, he was instead considering an unprecedented federal quarantine of the entire State of New York as well as adjoining parts of of New Jersey and Connecticut, though he later backed down under fierce pressure. Just five days had made all the difference in the world.
The unimaginable human disaster now facing our country has several obvious roots. Our oceans had protected our home front from any attack during the two world wars while modern medicine had rendered disease epidemics a fading memory for three generations. Our arrogant and incompetent national leadership simply could not comprehend the possibility that their missteps might actually kill hundreds of thousands or millions of Americans. Moreover, our mainstream media was equally oblivious, and even if they had sounded the alarm, they had hysterically cried wolf so many times about so many ridiculous things that nobody would have taken them seriously.
But an important contributing factor is surely the inability of most individuals to grasp the unusual dynamics of an exponentially-growing process. In such a situation, seemingly insignificant delays can have enormous consequences.
Let us consider a very simple example in which two similar cities each happen to have 1,000 Coronavirus infections, with a doubling-period of 3 days.
Suppose that the first city immediately implements a complete lock-down, thereby drastically reducing the spread of the disease, and then uses that window of opportunity to track down and temporarily quarantine all the infected. Assuming a 1% death rate, 10 total fatalities will result.
Now suppose the second city takes exactly the same approach, but merely delays implementing the policy for a single week. During that lost week, the number of infected will grow to 5,000, and the resulting five-fold increase in cases requiring hospitalization may overwhelm the local health care system, thereby increasing the death rate to 5%. The result is 250 fatalities. So the delay of a single week has increased the death toll by a factor of 25.
I live in Palo Alto, and every now and then I see a squirrel wander into the middle of a street, then remain frozen in fear as an approaching car bears down upon him. Almost invariably, the squirrel leaps away to the nearby pavement at the last moment, saving its life. But occasionally I have noticed the remains of a youthful squirrel who did not react in time.
For a month or two, our national government and its top health officials seemed similarly paralyzed with horror as they began to recognize the oncoming locomotive of a deadly disease rapidly approaching them. But during this crucial period, they did little or nothing and vast numbers of Americans may die as a consequence.
The Coronavirus is extremely contagious and once it has significantly established itself within a community, the only effective means of halting the rapid spread is through a full social lock-down. This approach had been especially necessary in America, given our woeful lack of adequate testing capabilities.
China completely locked down and quarantined the city of Wuhan at a point when only 300 detected infections and 17 deaths had occurred, thereby strictly confining all 11 million residents to their homes. Not long afterward, similar measures were applied to the 60 million residents of the surrounding province of Hubei, and later extended to include some 700 million Chinese across the country, a medical quarantine perhaps a thousand times larger than any such previous effort in human history.
These remarkable Chinese actions shocked and astonished many observers around the world, certainly including myself. But they succeeded brilliantly, and China seems to have almost entirely stamped out the deadly disease at the final cost of just a few thousand deaths. Millions perhaps even tens of millions of Chinese owe their lives to the decisiveness of their bold and courageous national leadership.
China and America have different political systems, each with its own strengths and weaknesses. The ruling Chinese Communist Party can impose by immediate fiat national policies that are almost unimaginable under America’s Constitutional system, and order these implemented at speeds that seem impossible to us.
I was aware of no precedent in modern American history for locking down a major city for health reasons, an action that appeared completely contrary to our widespread notions of civil liberties and constitutional rights. Moreover, during January and February various anti-China pundits had had a field day attacking and vilifying “totalitarian China” for shutting down its entire economy and confining so many hundreds of millions of its citizens to their own homes, thus rendering it seemingly impossible for any American political leader to propose similar measures.
With so little testing and a three week lag-time between infection and death, only the tiniest sliver of the gigantic Coronavirus iceberg bearing down on the U.S.S. America was visible to the public, and our insouciant mainstream media paid almost no attention to this terrible oncoming danger. Therefore, I regarded it as almost inconceivable that America’s dysfunctional government would take such difficult steps quickly enough to halt the spread of the disease before it became fully endemic and uncontrollable.
My own Santa Clara County was then the national epicenter of the Coronavirus outbreak, and the local morning newspapers carried more and more indications of its rapid, almost invisible spread, with a couple of firefighters testing positive one day and a few TSA workers found infected the next. I assumed this pattern of reports would continue and grow exponentially until California was entirely submerged by the rapidly approaching tsunami wave of disease.
But then on Monday, March 16th a miracle occurred. With no prior warning or public discussion, Santa Clara County Public Health Officer Dr. Sarah Cody and her counterparts from five other SF Bay Area counties announced that they had issued a “Shelter in Place” order, their somewhat euphemistic term for a full regional lock-down. Effective at midnight and lasting three weeks all non-essential businesses would be closed, all large public gatherings prohibited, and all residents required to spend their time at home, with certain reasonable exceptions. This directive covered seven million California residents. If anything similar had ever happened in American history, I’m certainly unaware of it.
My own sense of relief was enormous and I suspect very widely shared since I did not hear a single word of criticism from any source. Instead, a day or two later huge Los Angeles County adopted a similar policy, and a couple of days afterward, Gov. Gavin Newsom extended the order to the entire state. Health officials had warned him that without such prompt action, more than 25 million Californians could become infected over the following couple of months, probably producing a million deaths. So 40 million Californians joined the lock-down.
New York, Illinois, and numerous other states soon implemented similar policies, so that well over 200 million Americans are now following the trail blazed by Dr. Cody and her colleagues, “sheltering-in-place” to block the spread of the Coronavirus.
But in any exponential process of disease propagation, timing makes all the difference in the world. Last month, my own Santa Clara County was the American center of the epidemic, while the first New York death did not even occur until March 14th. But our lock-down came several days before that of New York, and as demonstrated above, a week’s delay can easily raise the relative death toll by a factor of 25, or perhaps far more if a local outbreak becomes uncontrollable. Based upon the data I’ve seen, I hope that Santa Clara County can escape with just a few hundred fatalities, while I fear that the death toll in New York may be in the many tens of thousands or even higher.
At this stage, no one can easily predict how many Americans may die from the Coronavirus by early summer, and perhaps some miracle drug will come along quickly enough to change the situation. But otherwise I think the epidemic may eventually produce the greatest death toll of any event in our entire national history. Yet whatever the final figure, that total would have been vastly greater without the wave of rolling lock-downs launched by the SF Bay Area counties two weeks ago.
Politicians are a timorous lot, rarely willing to take the lead on highly controversial decisions. Once Santa Clara County and its neighbors had locked down their populations with absolutely no political backlash, the rest of California and America felt confident enough to quickly follow. But if Dr. Cody had not taken that decision, any national lock-downs might have been delayed for week or two, while every week’s delay might have raised the death-toll by a considerable factor. I think there’s a good likelihood that Santa Clara County Public Health Officer Dr. Sarah Cody may have saved a million or more American lives, probably more than anyone else in our entire national history.
My own impression of this historic event is probably not unique. Even as I was finalizing this piece on Sunday, I discovered that half the front page of my local San Jose Mercury News was devoted to the story of Dr. Cody and her crucial decision, with the story appropriately entitled “The Doctor Who Shut It All Down.”
Under a decaying and decadent political system, there is often a dangerous tendency to select public officials based upon ideological factionalism or the blandishments of self-interested lobbies. During normal times, this may lead to the sort of inefficiency and corruption that saps the strength of a society, but during a severe crisis, survival itself may be at risk. Until a couple of weeks ago, I had never even heard of Dr. Sarah Cody, but I am greatly relieved that my local officials are still appointed based upon the highest standards of meritocratic competence. The contrast with America’s national government could not be greater.