Georgia: Proceed with Caution

John Safranek, MD

It is difficult to discern whether the reporting on COVID-19 is a function of political bias or ineptitude. What is not difficult to discern is that it is has been mistaken. Based on erroneous analysis, many commentators paint a foreboding future for states loosening COVID-19 restrictions. Governor Brian Kemp of Georgia came under particular fire from the mainstream media, and even, to some extent, from President Donald Trump. But neither Georgia nor most other states have much to worry about, notwithstanding the media criticisms.

One of the biggest errors of media is to treat increasing infection rates as a sign that the disease is still out of control. A telling example of this mistake is in a New York Times article critical of Governor Kemp. The reporters point out that the White House recommends that, before opening businesses, officials wait for two weeks of a downward trend in either the number of new cases or the share of all COVID-19 tests that come back positive is decreasing.

While acknowledging that the share of test coming back positive had decreased for the previous week, the reporters offer their “gotcha” moment: the state of Georgia fails the second test because the number of positive tests are actually increasing. Sounds like a disastrous policy. What they fail to acknowledge is that the number of positive tests is increasing because Georgia is testing so many more people on a daily basis. If I test a group of 10 for left-handedness, I would probably find one. If tomorrow I test 100, I would find 10. That does not mean the rate has increased 10-fold. It just means that we have expanded the pool of people we are testing.

Lest the reader think that this problem is confined to the New York Times, a recent AP article displays a graph showing that “China appears to have flattened its curve of coronavirus cases” while “The US arc continues its ascent”. The number of cases will certainly increase for awhile as long as we are testing millions more people and the disease is still active.  Whether this is an honest error is debatable: regardless, it is erroneous.

Even more egregious is the media coverage of Sweden.  Long a darling of the mainstream media, Sweden fell out of favor because it did not enact severe restrictions like the rest of the first-world countries. We are told that Sweden is awash in deaths due to the lax policies, and, by extension, US states that loosen restrictions will suffer the same fate. As the media never tires of noting, Sweden does have a higher mortality rate and more deaths than its neighbors, Norway and Denmark. But the media does not acknowledge that this is a function of Sweden’s higher mortality rate prior to any restrictions. Once it had enacted its relatively lax restrictions, Sweden bent its mortality rate as much as Norway and Denmark. In other words, laxer restrictions seem to work as well in some cases as more restrictive measures.

There are 3 reasons to trust the liberalizing instincts of Governor Kemp (and by extension, many other Republican and Democratic governors). First, the mortality rate of Georgia started decreasing only two-and-a-half weeks after he imposed moderate restrictions and less than two weeks after he issued the more conservative shelter-in-place order. Since it usually takes at three weeks for the mortality rate to respond to restrictive measures, Georgians apparently were already voluntarily social distancing, washing hands, or enacting other measures before the government acted. These will most likely continue to some extent even after the restrictions are lifted because the coronavirus has changed behaviors.

Second, calamitous super-spreader events, such as a large funeral in Georgia and Mardi Gras celebrations in Louisiana, will not be permitted during the first phases. These events substantially exacerbated the mortality rates in any states they occurred. In fact, Georgia’s mortality rate was low until the super-spreader event later altered the mortality curve. That rate has essentially been flat for the last month. The White/CDC plan, followed by most governors who are relaxing restrictions, keeps these in check even through Phase 3.

Third, experts have not given proper due to the “sunshine” effect. Warmer states, such as Tennessee, California, and Texas have lower mortality rates; Hawaii has the lowest mortality rate per million citizens of any state in the country. All countries south of the equator, currently in their warmer months, have extremely low mortality rates.  Australia, a first world country, has a mortality rate about 20% of the United States. Warmer spring and summer temperatures will likely mean fewer deaths throughout the United States.

Fourth, Sweden has bent its mortality rate curve while using measures that are halfway between Phase 1 and 2 of the White House/CDC plan. Deaths are decreasing even though young children have remained in school, and restaurants, bars, casinos and even ski resorts have remained open. Sweden restricts gatherings to 50 people, practices spacing in bars and restaurants, and encourages sick employees to stay home, among other moderate measures. These modest measures have been effective in Sweden; they should work here as well.

The summer and early fall are not going to be problematic for Georgia if a phased recovery approach is used. Late fall and winter might present some difficult trade-offs, such as opening potential super-spreader venues for sports or entertainment. But if these prove to be problematic, states can always return to the more restrictive practices of an earlier phase.

The important point is that a federalist approach will provide more answers than a monolithic national policy. The world owes Sweden a debt of gratitude for demonstrating that laxer measures can work. States should experiment enough so that we can garner significant data to guide us through uncharted waters. A uniform national policy, which many on the Left seem to favor, would not prove as useful.

We need disparate approaches to formulate sound policy and protect human life. Let’s use reliable data to establish sound epidemiologic policies. It’s time for Georgia and all of America to get back to work.

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