#149: Three Thoughts on the Coronavirus

May 1, 2020

I have three reflections on covid-19, one specific to N.Y.C., one on the government mandated lock-downs, and one grim final thought.

I. N.Y.C.

Many have speculated on the very high numbers of infected and dead in N.Y.C. in comparison with other cities and most of those speculations seem plausible. As in most cases, phenomena are most likely determined by multiple causes. I want to add yet one more such speculation, as well as what seems to me would be a reasonable precaution if it is true.

Yes, N.Y.C. and more specifically Manhattan are among the most densely populated places on earth and sheer density might well make some contribution to infection and death rates. But I would suggest that the general notion of density conceals a more specific and even addressable causal factor: elevators.

We now believe that the virus is airborne as well as on surfaces; we also believe that the virus can survive for possibly days outside a host. This suggests to me that elevators are excellent contamination chambers, retaining exhaled viruses from both symptomatic and unsymptomatic passengers well after those passengers leave the elevator.

If this is correct, then we ought first to modify our notion of social distancing by extending it from space to also time. Not only ought we be cautious of spatial proximity, but also temporal proximity. While we don’t want to be immediately next to another person in an elevator, neither do we want to be immediately after a person on an elevator. Wearing a mask may well be more important when entering an elevator than it is when taking a walk outside.

The consideration of elevator based contamination is of special importance when considering hospital elevators. If elevators are contamination chambers generally, then they are even more so when located in hospitals.

Secondly, if it is true that ultraviolet light destroys covid-19 viruses, then it would be prudent to have elevators equipped with ultraviolet lights which turn on automatically whenever the elevator is empty. This could be done by linking the lights to the panel controlling the elevator motion: the lights would be programmed to turn on whenever no floor destination has been chosen.

II. Government Mandated Lock-downs

There is now considerable discussion of the reasonableness of lock-downs. Since the spread of the disease is clearly from person to person, in the absence early on of an understanding of the virus’ mode of operation, keeping people away from each other seemed the obvious if crude solution to an immediate and crushing problem and, hence, reasonable.

But what had to be kept in mind was what was understood to be the clear and present nature of the crushing problem. According to the daily reports from state and federal governments the crushing problem being attacked was not the number of deaths and/or infections per se, but rather the overwhelming of available health resources.

This is an extremely important point when considering mandated lock-downs since it gives us a measure of the justification of those lock-downs as well as a measure to be used in adjusting the lock-downs.

Hospital beds and PPE equipment are currently far more available than at any time during the crisis. This would suggest that by the government’s argument for locking down, it is time to unlock.

At the same time, many are suffering and likely dying of non-covid related conditions which really should be addressed by the health care system. And this does not take into account the health implications of the catastrophic effect the lock-downs have had on the economy.

Since we know now that the threat of death applies almost entirely to the elderly with co-morbidities, our policy should clearly be the following.

1) Focus protection on on nursing homes and on the education of the elderly. And

2) Open the economy in stages, monitoring the impact covid cases on the health care system. In other words, we should use covid hospital usage as our instrument for governing the rate and extent of lock-down release.

III. One final thought

Since it is becoming ever more clear that the virus is not only present in far more people than previously thought (and most probably is still spreading at an exponential rate), we need to ask why it would be that in many places, the death rate is either stable or dropping. Is this evidence that social distancing is working? Possibly. But perhaps more likely is the grim possibility that the virus is slowly running out of victims. 

We may wind up with an entire elderly generation dead and the remaining population infected, but not suffering.