Lane Kenworthy, The Good Society
August 2, 2020
Covid-19 has killed nearly 700,000 people worldwide and 155,000 in the United States. It has caused the sharpest economic downturn since the 1930s. It has massively disrupted schooling for many children and young adults. And there is, at the moment, no end in sight.
What do we know about the virus and the disease? How has the United States fared, in terms of cases and deaths, compared to other rich democratic nations? What have governments done to help minimize the economic damage? Can we resume in-person schooling? What will it take to end the pandemic? In what ways will it change us? How can we be better prepared for the next one?
- Infectiousness and deadliness
- The United States and other rich democratic nations
- Mitigating the economic damage
- Can we resume in-person schooling?
- When will it end?
- Will the pandemic permanently change us?
- Preparing for future pandemics
INFECTIOUSNESS AND DEADLINESS
Figure 1 shows the daily number of new confirmed Covid-19 cases per million population. The infection rate worldwide has risen slowly but steadily since the middle of March. In the United States there was a steep rise from mid-March to mid-April, concentrated in New York City and nearby New Jersey. Infections then fell steadily for two months. But since mid-June they have once again risen rapidly, and the case numbers are now much higher than in the previous peak. This more recent rise has extended across much of the country.
Many people who are infected display no symptoms and so never get tested. They therefore don’t show up as a confirmed case. The CDC (Centers for Disease Control and Prevention) conducted extensive tests between March 23 and May 3 and concluded that the actual infection rate is approximately 10 times the rate suggested by confirmed cases.1
Early on, it was thought that transmission occurred mainly by touching surfaces, but scientists increasingly believe that most transmission is via airborne particles.2 Infection is most likely when multiple people are gathered in the same room indoors without ventilation that can rapidly recirculate and filter the air. There seems to be little transmission outdoors.3 A good test case is the mass protests that began in response to the police killing of George Floyd on May 25 and continued throughout June. There is no indication of significant spread of the virus from these protests.4
Adverse health consequences
According to the World Health Organization (WHO), in most nations about 20% of confirmed Covid-19 cases have needed hospitalization in order to get supplemental oxygen or more advanced care.5 If the true number of cases is 10 times the number of confirmed cases, this suggests that about 2% of all cases are “serious” in this sense.
From March 1 to August 1, an estimated 685,000 people worldwide have died from Covid-19. The average daily toll has been 4,450. Prior to the pandemic, it was estimated that about 60 million people would die in 2020, which is about 164,000 per day. Figure 2 shows the toll added by the pandemic. From this perspective, the impact appears relatively small. But keep in mind that the number is small only because a significant part of the world essentially shut down in March, April, and May, an enormous economic sacrifice.
How deadly is the disease? The share of people infected with Covid-19 who die is estimated to be approximately 0.5%, or 1 in 200.6
Thus far, deaths have been most common among people who are old, who have preexisting health problems, or who live in cities. In the United States, as of the end of June, 80% of Covid-19 deaths were among persons aged 65 and over.7 And 42% of deaths have been in nursing homes, though this counts not only elderly residents but also employees.8 We don’t have hard data on deaths among people with preexisting health conditions, but it is widely agreed that this group is among the most vulnerable if they contract the virus. Urban residents are vulnerable not because they are more likely to die if they get infected but because the extensive movement of people in and out of cities, along with cities’ high population concentration, increases the likelihood of infection. It also appears that men and members of minority racial and ethnic groups are more likely to die if infected.9
THE UNITED STATES AND OTHER RICH DEMOCRATIC NATIONS
Figure 3 shows daily death rates in the United States and 20 other rich democratic countries. In March and April a number of nations in western Europe — Belgium, France, Ireland, Italy, the Netherlands, Spain, and the United Kingdom — experienced spikes in infections and deaths. By the end of May nearly all of these countries had brought the infection and death rate way down, via partial or full lockdowns. In June they began to reopen businesses, restaurants, and in some cases sports leagues, yet infections and deaths have still been contained.
The United States has been different. Apart from New York City, the US didn’t experience the kind of dramatic spike in Covid-19 cases seen in parts of western Europe, and beginning in late April lockdowns and physical distancing efforts yielded considerable progress. The number of daily deaths fell to about 2 per million by mid-June. But since then there has been little progress, as much of the country moved aggressively to reopen — often without proper distancing, without requirements to wear masks, without sufficient testing, and with little contact tracing.10 As seen in figure 4, infections began rising rapidly again in mid-June. The lag between infection and death tends to be three to five weeks, and in mid-July the death rate in the US began rising again.
The rise in deaths is unlikely to be as sharp as the rise that occurred in April. For one thing, there is now greater awareness of the vulnerability of elderly persons, particularly in nursing homes, so more aggressive efforts have been taken to guard against outbreaks. And a larger share of new infections appear to be among people under 30, who are far less likely to die if infected. Also, hospitals appear to have gotten more effective at preventing death among Covid-infected patients.11
Sweden’s approach has differed from that of other rich democracies, The Swedish government chose not to require businesses to close during the peak infections period beginning in March. The government believed Swedish citizens would voluntarily exercise appropriate caution, thereby slowing transmission of the virus while avoiding a devastating economic downturn. At the same time, some of Sweden’s top public health officials hoped that allowing moderate, as opposed to minimal, transmission might enable Sweden to more quickly reach herd immunity.12
The strategy doesn’t appear to have worked well. Sweden’s death rate has been far higher than in neighboring Denmark, Finland, and Norway, as we see in figure 5. And there has been no apparent economic benefit; Sweden’s economic contraction has been very similar in magnitude to those of its neighbors. In addition, attempts to gauge the prevalence of Covid-19 antibodies among the Swedish population suggest the country remains a long way from herd immunity.13
What countries have been success stories? South Korea is one. It moved early to limit travelers into the country. And it very quickly instituted heavy testing and contact tracing, with quarantines for anyone testing positive or identified as having been in contact with an infected person.14 Covid-19 deaths per million persons in South Korea have never exceeded 0.2 (see figure 3 for comparison).
Germany’s performance has been perhaps even more impressive, given that it is a large nation connected by land to an array of other countries from which there is, in principle, freedom of movement. Germany has kept the number of cases and deaths among the lowest of the rich democracies. It was early (February 28) to take precautions to prevent travelers into the country from spreading the virus, it was early to impose a contact ban (March 22), it ramped up testing volume rapidly and offered tests for free, and, perhaps most important, it made a special effort to prevent the spread of the virus in elderly facilities.15 Daily deaths per million persons in Germany never exceeded 2.8 and fell to nearly zero by early July.
MITIGATING THE ECONOMIC DAMAGE
The pandemic has laid bare the financial precarity of tens of millions of US households. Prior to the crisis, nearly one in ten Americans had no health insurance, one in four workers got zero days of paid sick leave, and 40% of adults didn’t have enough savings to cover a $400 emergency expense.16 In March and April, more than 20 million jobs disappeared, and even though some came back in May and June, as of July there were still 15 million fewer Americans employed than before the pandemic.17
The federal government has responded with extraordinary relief measures, including loans and bailouts for small and large corporations, expanded sick leave, increased unemployment benefits, direct cash transfers to individuals, and a moratorium on evictions for some renters. The spending amounts to more than 15% of GDP, a historic high.18 Thus far, this money has proven effective in preventing a rise in poverty.19 But these programs are temporary, and it isn’t clear whether Congress will extend them when they run out. And while the government aid has helped sustain incomes for many needy Americans, surveys have found an increase in the number of people going hungry.20
One part of the US strategy has been loans to small businesses that encourage them to not lay off employees, and this appears to have helped.21 Many other affluent democratic nations have relied even more heavily on this approach.22 At the extreme end of the spectrum, in Germany, there has been no net loss of jobs during the pandemic. This sort of approach may prove more effective than America’s at getting the economy back up to full speed quickly, though the US approach could have an advantage in facilitating adjustments from declining economic sectors to growing ones.
CAN WE RESUME IN-PERSON SCHOOLING?
While it’s sometimes thought that the only value of school lies in the diploma, schooling improves cognitive ability, and perhaps more important, it helps us develop a variety of noncognitive skills — sociability, discipline, punctuality, and much more — that pay off later in life. Schools can operate entirely online. But in-person schooling is better for a significant share of students — particularly those in less affluent families, who tend to have less access to the internet, less supervision and assistance from family members, and more distractions. For children in low-income families, school also can be a critical food provider; about 20 million American children get free school breakfasts and/or lunches. Moreover, many parents can’t afford to pay for childcare, so if their children aren’t in school, they have limited ability to work.23
Children are much less likely than adults to get seriously ill or die from Covid-19. It also appears that children under age 10 may be less likely than adults to spread the virus. It might therefore be possible to return safely to in-person schooling, at least for children in early grades.24
There are three main obstacles: physical space to keep students distanced; money to pay for additional instructors, new classroom space, barriers in common spaces, improved air circulation, increased cleaning, ramped-up virus testing and health services; and high infection rates in the surrounding community. The space constraint can be dealt with by using cafeterias, gyms, sports fields, and even nearby streets if needed. The money problem too can be overcome, but thus far Republicans in the Senate have blocked federal government financial assistance. The biggest impediment may be the very high infection rate in many parts of the country, which makes teachers, staff, and students’ parents and grandparents hesitant to see a return to onsite classes. As of early August, K-12 schools in some districts around the United States had announced plans for hybrid schooling in the fall, with classes to meet in person only a few days a week or just part of the day. Large school districts in Atlanta, Houston, Los Angeles, Nashville, Phoenix, San Diego, and some other cities have decided schooling will be online-only in the fall.25
WHEN WILL IT END?
“Herd immunity” is achieved when the share of the population that is immune to a disease is large enough that transmission slows to a crawl, because infected persons come into contact with few people who aren’t immune. As a result, the entire community is protected.
Experts estimate that herd immunity for Covid-19 requires that about 60% of the population be immune.26 (For comparison, the share for measles, which is more contagious, is 94%.) As of early August, the total number of confirmed infections in the United States is about 4.7 million. If the true number of infected persons is approximately 10 times higher, as the CDC suggests (see above), that would be 47 million. That’s about 14% of the US population. At this pace, it would take another 16 months for the United States to reach herd immunity.
The best path to herd immunity is a vaccine. Development of a vaccine usually takes several years, and in some instances decades. (Scientists have yet to find a vaccine for HIV-AIDS.) Completing the process in 12 to 18 months would be unprecedented. A prospective vaccine is initially tested on laboratory animals. Then, phase I and II trials on hundreds of people evaluate effectiveness, appropriate dosage, and safety. Phase III trials involve tens of thousands of individuals, including a control group that receives a placebo. More than 100 research teams currently are working on developing a vaccine for Covid-19. Once an effective and safe vaccine is identified, there remains the challenge of manufacturing it in large quantities, distributing it across the globe, and inoculating billions of people.27
WILL THE PANDEMIC PERMANENTLY CHANGE US?
The Great Depression of the 1930s led to creation of some of America’s key public insurance programs — Social Security, unemployment insurance, and aid to low-income families with children — along with labor union protections, reformed banking, enhanced public infrastructure, increased public employment, and government support for homeownership. The Great Recession of 2008-09 spawned passage of the Affordable Care Act (ACA). Will the Covid-19 pandemic result in big, lasting advances in social programs?
It’s tempting to presume that the pandemic will boost public support for an expanded social safety net — that with their eyes newly opened to the precarious circumstances of frontline service workers, black Americans, people with preexisting medical conditions, the homeless, small-business owners, and an array of other vulnerable groups, more Americans will demand that policymakers broaden the size and scope of the country’s public social programs. However, 50 years of public opinion data suggest that economic downturns don’t typically produce sustained rises in progressive sentiment.28 The same appears to be true for political and health crises. Polling data from earlier eras are limited, so it is unclear whether the Great Depression produced a meaningful shift in Americans’ attitudes toward government. But if the New Deal was the product of a popular shift to the left, it was the exception, not the rule. The 1918 flu pandemic was followed by the “Roaring Twenties” and a turn away from the progressive reforms of the two previous decades. Likewise, the economic, political, and foreign policy crises of the 1970s and early 1980s — the oil embargoes, stagflation, Watergate, the US withdrawal from Vietnam, the Iranian Revolution, and the Soviet invasion of Afghanistan — ushered in not a new progressive era but rather the age of Ronald Reagan.
Why don’t crises produce a surge in progressive attitudes? Some people quickly forget or turn their attention elsewhere, so their beliefs and preferences snap back to where they were before the crisis. Some respond to economic downturn by worrying about their own financial well-being rather than the welfare of others. And welfare state opponents and deficit hawks invariably warn against new public spending, arguing that the country can’t afford to take on additional debt.
Another way a crisis can produce lasting change is that temporary expansions of the safety net are made permanent. However, this too has rarely happened in the United States. Time and again during downturns, the federal government has intervened to help people who lose their jobs and to rejuvenate the economy — by extending access to unemployment benefits, making stimulus payments, and declaring payroll tax holidays, loan payment delays, and more. Yet these temporary measures nearly always end once the economy recovers.
When public social programs have been enlarged for good, it has tended to happen via the ballot box. Crises help whichever party is out of power, and once in power, Democrats have sometimes passed progressive legislation despite an ambivalent public mood. That was the story of the 1930s, when voters punished the Republican Party for its management of the economy and ushered in a decade of Democratic control of the presidency and Congress. Big Democratic majorities in Congress also made possible the passage of President Lyndon Johnson’s Great Society programs in 1965 and 1966. Similarly, the Great Recession contributed to passage of the Affordable Care Act not by causing a leftward shift in public opinion but by helping to dislodge Republicans from the White House and the Senate in the 2008 elections. So if the Covid-19 pandemic does produce a sustained expansion in government social policy, it is most likely to do so by helping Democrats win the presidency and the Senate in November of 2020.29
Are there other lasting changes the pandemic might induce? Many companies and employees have found that working from home is more productive and convenient than they had anticipated, so work in offices may decline. This in turn could have knock-on effects on commercial real estate, particularly in cities, with the possible result that residential space will increase, making cities more affordable to live in. Schooling, too, may accelerate its already-ongoing shift toward greater use of online courses. Preferences for separating healthcare and childcare from employment may get a boost. Confidence in government might increase, or it might decline.30
Yet as Claude Fischer has noted, it is striking how little impact the 1918-20 pandemic seems to have had on Americans’ attitudes, behaviors, institutions, and government policies.31 It’s conceivable the same will be true of this one.
PREPARING FOR FUTURE PANDEMICS
Pandemics occur fairly frequently. The one in 1918-20 killed an estimated 50 million people worldwide. The 1957 pandemic killed 1.1 million, and the one in 1968 1 million. We don’t yet know Covid-19’s final death toll.
There will be more pandemics. What can we do to reduce their likelihood and minimize damage? Most recommendations center on efforts to anticipate the particularities of future disease outbreaks and to get a head start on preparation of vaccines. For instance, Peter Daszak, a disease ecologist, recommends a three-part approach: (1) identify as many as possible of the hundreds of thousands of pathogens that could threaten humans; (2) monitor blood samples of people in areas where new diseases are most likely to appear; (3) use these data to develop potential vaccines.32
- Apoorva Mandavilli, “Actual Coronavirus Infections Vastly Undercounted, CDC Data Shows,” New York Times, 2020. ↩
- Tara Parker-Pope, “What’s the Risk of Catching Coronavirus From a Surface?,” New York Times, July 8, 2020; Linsey C. Marr, “Yes, the Coronavirus Is in the Air,” New York Times, July 30, 2020. ↩
- Tara Parker-Pope, “How Safe Are Outdoor Gatherings?,” New York Times, July 3, 2020. ↩
- Joseph Goldstein, “Did Floyd Protests Lead to a Virus Surge? Here’s What We Know,” New York Times, July 1, 2020. ↩
- Donald G. McNeil Jr, “The Pandemic’s Big Mystery: How Deadly Is the Coronavirus?,” New York Times, July 4, 2020. ↩
- The CDC’s estimate of the rate for the United States is 0.4%. The WHO estimates the worldwide rate to be 0.6%. Various meta-analyses by teams of scientists yield similar estimates. McNeil, “How Deadly Is the Coronavirus?”; John P.A. Ioannidis, “The Infection Fatality Rate of Covid-19 Inferred from Seroprevalence Data,” preprint, posted June 8, 2020; Smriti Mallapaty, “How Deadly Is the Coronavirus? Scientists Are Close to an Answer,” Nature, June 16, 2020. ↩
- CDC, “Coronavirus Disease 2019: Older Adults.” ↩
- New York Times, “More Than 40% of U.S. Coronavirus Deaths Are Linked to Nursing Homes,” July 7, 2020. ↩
- Katherine J. Wu, “Study of 17 Million Identifies Crucial Risk Factors for Covid-19 Deaths,” New York Times, July 10, 2020. ↩
- Keith Collins, “Is Your State Doing Enough Coronavirus Testing?,” New York Times, July 14, 2020. ↩
- J. Mahon, J. Oke, and C. Heneghan, “Declining Death Rate from Covid-19 in Hospitals in England,” Centre for Evidence-Based Medicine, University of Oxford, June 24, 2020; Derek Thompson, “Covid-19 Cases Are Rising, So Why Are Deaths Flatlining?,” The Atlantic, July 9, 2020. ↩
- Thomas L. Friedman, “Is Sweden Doing It Right?,” New York Times, April 28, 2020; Adele Lebano, “Sweden’s Relaxed Approach to Covid-19 Isn’t Working,” Boston Review, May 8, 2020; Josh Michaud, “Sweden’s Coronavirus Strategy Should Not Be the World’s,” Foreign Affairs, May 20, 2020. ↩
- Charlotta Stern and Daniel B. Klein, “Give Sweden a B-Minus in Coronavirus 101,” American Institute for Economic Research, May 29, 2020; Thomas Erdbrink, “Sweden Tries Out a New Status: Pariah State,” New York Times, June 28, 2020; Peter S. Goodman, “Sweden Has Become the World’s Cautionary Tale,” New York Times, July 7, 2020; Benjamin Born, Alexander Dietrich, Gernot Müller, “The Effectiveness of Lockdowns: Learning from the Swedish Experience,” VoxEU, July 31, 2020. ↩
- Ariadne Labs, “Emerging Covid-19 Success Story: South Korea Learned the Lessons of MERS,” Our World in Data, June 30, 2020. ↩
- Lothar Wieler, Ute Rexroth, and René Gottschalk, “Emerging Covid-19 Success Story: Germany’s Strong Enabling Environment,” Our World in Data, June 30, 2020. ↩
- Lane Kenworthy, “A Decent and Rising Income Floor,” The Good Society; Kenworthy, “Stable Income and Expenses,” The Good Society; Kenworthy, “Shared Prosperity,” The Good Society. ↩
- Elis Gould and Heidi Shierholz, “Jobs Report,” Economic Policy Institute, July 2, 2020. ↩
- International Monetary Fund (IMF), “Policy Responses to Covid-19.” ↩
- Jason DeParle, “Vast Federal Aid Has Capped Rise in Poverty, Studies Find,” New York Times, June 21, 2020. ↩
- Jason DeParle, “Why Hunger Can Grow Even When Poverty Doesn’t,” New York Times, July 28, 2020. ↩
- David Autor et al, “An Evaluation of the Paycheck Protection Program Using Administrative Payroll Microdata,” July 22, 2020. ↩
- Jonathan Rothwell and Hannah Van Drie, “The Effect of Covid-19 and Disease Suppression Policies on Labor Markets: A Preliminary Analysis of the Data,” Brookings Institution, April 27, 2020. ↩
Matthew Yglesias, “Reopening Schools Safely Is Going to Take Much More Federal Leadership,” Vox, July 8, 2020; Sarah Darville, “Reopening Schools Is Way Harder Than It Should Be,” New York Times, July 23, 2020
- Pam Belluck, Apoorva Mandavilli, and Benedict Carey, “How to Reopen Schools: What Science and Other Countries Teach Us,” New York Times, July 11, 2020; National Academies of Science, Engineering, and Medicine, Reopening K-12 Schools During the Covid-19 Pandemic, 2020; Apoorva Mandavilli, “Older Children Spread the Coronavirus Just as Much as Adults, Large Study Finds,” New York Times, July 18, 2020. ↩
- Editorial Board, “Reopening Schools Will Be a Huge Undertaking. It Must Be Done,” New York Times, July 3, 2020; Jennifer Couzin-Frankel, Gretchen Vogel, and Meagan Weiland, “School Openings Across Globe Suggest Ways to Keep Coronavirus at Bay, Despite Outbreaks,” Science, July 7, 2020; Belluck, Mandavilli, and Carey, “How to Reopen Schools”; Dana Goldstein and Eliza Shapiro, “Most Big School Districts Aren’t Ready to Reopen. Here’s Why,” New York Times, July 14, 2020; Matt Barnum and Claire Bryan, “Despite Stress of Closures, Most Parents Wary of Rush to Return to School Buildings, Polls Show,” Chalkbeat, July 14, 2020; Ezekiel J. Emanuel, Saskia Popescu, and James Phillips, “Opening Schools Won’t Be Easy, but Here’s How to Do It Safely,” New York Times, July 29, 2020. ↩
- Apoorva Mandavilli, “Coronavirus Infections Much Higher Than Reported Cases in Parts of U.S., Study Shows,” New York Times, July 22, 2020. ↩
- Carl Zimmer, Knvul Sheikh, and Noah Weiland, “A New Entry in the Race for a Coronavirus Vaccine: Hope,” New York Times, May 20, 2020; Jane E. Brody, “The Race to Develop a Covid Vaccine,” New York Times, June 22, 2020; Christopher Rowland, “A Race Is on to Make Enough Small Glass Vials to Deliver Coronavirus Vaccine Around the World,” Washington Post, July 13, 2020; Jonathan Corum, Denise Grady, Sui-Lee Wee, and Carl Zimmer, “Coronavirus Vaccine Tracker,” New York Times, July 14, 2020. ↩
- Lane Kenworthy and Lindsay A. Owens, “The Surprisingly Weak Effect of Recessions on Public Opinion,” in The Great Recession, edited by David B. Grusky, Bruce Western, and Christopher Wimer, Russell Sage Foundation, 2011. ↩
- Lane Kenworthy, “The Coronavirus Won’t Usher in an American Welfare State,” Foreign Affairs, May 1, 2020. ↩
- David Leonhardt, “It’s 2022. What Does Life Look Like?,” New York Times, July 10, 2020. ↩
- Claude Fischer, “Covid-19: Balancing Short-Term Solutions and Long-Term Effects. Are There Lessons from 1918?,” Made in America, March 23, 2020. ↩
- The Economist, “Pandemic-Proofing the Planet,” June 25, 2020. ↩