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Early Thoughts on Reopening Our Family

Covid-19 situation in the United States has deteriorated fast since our last post. Although our initial read holds well, it cannot be said the same thing for the Federal government's response. We are lucky to be in California where the policy choices are sensible for now, while with enough financial cushion to simply stay-in-home.

With all the new information available, it is time to recognize the harsh new reality that the United States as a whole has failed. Even individual states can hold a line for some time, we cannot crush the curve. It may be flattened, but Covid-19 is going to stay with us for extended time, even into 2022. Hot spots and outbreaks are going to happen in different regions across the United States from time to time. Some will have effective containment, some will just run through its course.

As a family of two, YZ and I were fortunate enough that we could stay-in-home majority of the time during the crisis until now. We had enough supplies thanks to our farmers and the brave groceries workers. However, this cannot go on for another 2 years. It is not healthy for individuals, mentally and physically. We also cannot just go on with our lives like nothing happened. That would be irresponsible.

For the society, we can have policy choices to reopen for people who have positive antibody test results (the specifics can be more nuanced since there are unreliable reports of antibody dependent enhancement (ADE) cases). For individuals however, since YZ and I started stay-in-home early, there is a high chance we haven’t exposed to the virus. Nor would we like to in order to gain access to society again. That puts us in a peculiar situation to evaluate carefully at each step when slowly easing ourselves into the wild again. Here are some early thoughts on this topic. To be warned, these thoughts are incredibly selfish, and it is intended to be so. A society is composed of many selfish individuals, we can only make the optimal decision as a whole with many optimal selfish individual decisions.

First, we need to have a much better handle at the mortality rate and the infection pattern. Simple division puts the United States mortality rate around 5.3% as of today. This is certainly not correct. We know there are a large number (anywhere from 2x to 10x) of asymptomatic carriers, but we don’t know whether they ever hospitalized, and how many of them. We also don’t know the mortality rate at our age group, nor our personal conditions (no obesity, but with some other medical issues). There was a reputable early antibody test report suggesting the mortality rate in northern California is around 0.1%. It is skeptical too, particularly on the selection bias and false positive rate for the test (it is not FDA approved at the moment). On the balance, a 0.5% to 1% mortality rate is likely (without effective treatment, which is what we are at right now). This mortality rate has too much uncertainty to justify a regular hangout in the public.

Second, we need to have better knowledge on local hot spots to avoid risks. With its sub-urbanization, the United States is unlikely to have one big red hot spot (New York is an exception not the rule). A county-by-county hot map is a welcome first step. But a more comprehensive projection based on R number, contact tracing and demographic-adjusted mortality rate would be both realistic and tremendously valuable for individuals to make risk assessments.

Third, we need to have more accessible personal protective equipment. Wearing N95 masks and gloves shouldn’t be a luxury. Particularly, 50 N95 masks should cost around $25 and purchasable in groceries stores and Amazon. Non-contact thermometers may be an interesting addition to the mix, but there needs to be more evidence that active body temperature measurements can help at the individual level given the large number of asymptomatic carriers.

By carefully observing the above 3 metrics, our family will reopen in phases. The reopening assumes that we will try our best to avoid exposure to Covid-19. If there is an effective treatment that makes the overall mortality rate well below 0.1%, we may change our strategy quite dramatically.

First phase, we can start to participate in some outdoor activities such as hiking and running. The requirement to enter phase 1 needs to have some handle on mortality rate and local hot spots. As of today, we have a pretty good guess at mortality rate (0.1% to 2%) to justify reasonable outdoor activities. However, we don’t have a good understanding of our local hot spots to pick where to go.

Second phase, we will start to go shopping and visit trusted friends if we have adequate protective equipment in possession (without a question, this also means that the essential workers already have their PPEs in excess for quite a while). This assumes that we have a good understanding of the mortality rate so that we can make sensible choices on whether it is worth it. These activities need to be prioritized accordingly.

Third phase, we will go to work and schedule in-person meetings with new people. This assumes we have a better understanding of infection patterns in close quarters to make proper choices on personal protections. The data is insufficient to say at least whether the third phase is wise or not at all, but we will speculate on the brighter side. For our family, it requires our age group mortality rate to be lower than 0.1% in any conditions to consider this phase. Otherwise, we need to carefully evaluate the importance case-by-case for these extended in-person gatherings.