Coronavirus: We’ve only just begun

What started as a viral outbreak in China in November 2019 has grown into a worldwide pandemic. SARS-CoV-2, the virus that causes the COVID-19 disease, has strained the social and economic fabric of the world. As of mid-May, there were more than 1.5 million confirmed cases in the United States and 5 million worldwide. Healthcare systems have faced onslaughts of COVID-19 patients and the ensuing demand on hospital resources such as personal protective equipment, ICU beds and ventilators. Urban areas like New York City, Detroit and Chicago have absorbed the brunt of the cases, with resource demands pushing up against available capacity. The Centers for Disease Control (CDC) has already raised concerns of a second wave of COVID-19 overlapping with the 2020-2021 influenza season. Forecasts of 300,000 deaths in the United States by the end of 2020 are not unrealistic.

The complexity of the pandemic response in the United States is without parallel. Meeting the public health challenges requires a real-time plan for utilizing healthcare personnel, meeting medical supply demand, and widespread cooperation in practicing social distancing protocols. Every person in the nation has an important role to “flatten the curve” or better yet, “emaciate the curve” so that our nation’s healthcare system is not overwhelmed by a tsunami-like wave of patients seeking help in our healthcare system.

The key factor that can arrest COVID-19 is reducing the human-to-human transmission rate. If every person in the world isolated for the requisite time (which appears to be 14 days), the transmission rate would drop to zero, and the virus threat would vanish. COVID-19 is particularly challenging since a person can be infected and contagious for several days prior to displaying symptoms. Moreover, for every symptomatic infected person, there may be as many as 10 asymptomatic infected contagious people, creating a public health nightmare. The social distancing “six-foot separation” rule, copious hand washing and face masks are the primary nonmedical countermeasures implemented to drive down the transmission rate, effectively reducing a community’s basic reproduction number, the average number of infections transmitted by each infected person. In some cases, low-risk infected people with mild or no symptoms are spreading the disease to high-risk populations that have high likelihoods of poor outcomes and consume scarce healthcare resources. Without continual and widespread PCR (antigen) and antibody testing available to everyone, not just those showing symptoms, infected people can unknowingly spreading the virus.

The growth of COVID-19 cases is highly uneven. Most U.S. states implemented stay-at-home orders. In early May, several began to reopen their economies. During the first wave of the pandemic, high population density areas experienced steep surges in cases, often resulting from transmissions prior to the implementation of social distancing protocols. Even with these protocols, transmission reduction is challenging in many urban areas. A large proportion of urban residents live in multifamily buildings, such as apartments and condominiums, with common touchpoint areas (stairwells, hallways, elevators, mailboxes, etc.). These residents often rely on public transportation, further making the area a fertile ground for transmission. These characteristics are ubiquitous in New York City, and as such, it has been the nation’s epicenter for COVID-19 cases and fatalities. 

Harsh Spring

Spring 2020 has been particularly harsh. Several European countries (Belgium, Italy, Spain, France, United Kingdom) have experienced some of the worst fatality rates worldwide, with as many as 30 excess “death days” attributable to COVID-19, respectively, where a death day measures the average number of daily deaths over the prior year. These numbers will rise even higher in the coming months. If the United States experiences similar fatality rates as these countries, then 30 excess death days would represent as many as 240,000 excess deaths due to COVID-19 through 2020. These numbers do not include ancillary death due to factors unrelated to COVID-19, such as cardiovascular events, cancer and accidents, which may end up going undertreated due to the demand on healthcare services consumed by COVID-19 patients. Moreover, the preponderance of these fatalities will occur in urban centers. For example, by the end of August, the New York City area may have as many as 36,000 excess deaths, while Chicago may have as many as 6,000 excess deaths.

How will our nation come out of this pandemic? How will our nation’s economic and social fabric repair? People talk of a “return to normal.” The “old” normal no longer exists. Our world is now fundamentally different, with the current state of affairs transitioning to a new state, yet to be determined. Every crisis presents an opportunity; this pandemic is no exception. Our nation has the opportunity to rethink how we conduct our affairs. After 9/11, there was period of better cooperation across diverse communities. Political leaders on both sides found common ground for agreement. Will we see similar actions in the coming months?

Predicting how our social and economic fabric will evolve over the next two years is futile. At best, we can think about what constraints may exist, and how they can be overcome. The primary public health constraint is limiting the transmission of the virus until effective treatments are developed, or ideally, a safe and efficacious vaccine is formulated. Given that people are inherently social, gravitating to personal and business interactions that draw them in close physical proximity to each other, this creates a natural conflict with social distancing protocols required to inhibit the spread of the disease.

Perhaps technological advances will spur the creation of low-cost personal protective headgear that will resolve this dilemma. Then once a vaccine is created, the mass vaccination of the entire country, let alone the world, will create a supply chain and logistics nightmare. Operations research tools can and will be at the forefront of this effort. As necessity is the seed for innovation, entrepreneurs will spawn new ideas to fill the plethora of opportunities created by COVID-19.

Reawakening a $20 trillion economy will be fraught with false starts, hiccups and unexpected events. There is no “how to” guide available to maneuver through this period; we are writing the book in real time. Adjusting to social distancing protocols, either physically or technologically, will require cooperation and diligence. Global supply chain interconnectivity will come under greater scrutiny, as emphasis on domestic production capacity will make accessibility a critical criterion for supply chains. Optimal system design objectives will include robustness and resiliency. This will inevitably reduce corporate profitably, creating new opportunities to demonstrate the value of operations research. Indeed, operations research can be at the fulcrum of many of these changes, helping redefine our society and the well-being of all citizens. The end of the current COVID-19 national crisis may very well launch a new social and industrial paradigm. Operations research will enjoy a seat at this table. As the 1970s hit song by The Carpenters said, “We’ve only just begun.”