A Tale of Four Shortages

We all want to know when things are getting back to normal. Or failing at that, a new acceptable reality. I strongly believe there are four, and only four measures that truly matter. It’s not the amount of cases, or increase/decrease. Nor is it the death rate, or amount of total deaths. That’s not to minimize these things. A death is a huge deal. Even more so if you know the person who passed. I’ve read many obituaries of COVID-19 victims, and it’s hard not to feel a real sense of loss.

But cases and deaths are outcomes, not causes. And even if those numbers improve dramatically, we can’t be sure there won’t be a resurgence of doom in the fall/winter. By most estimates, a reliable, tested vaccine is 12 to 18 months away. Should things in America, Western Europe, and other currently afflicted regions return mostly to normal over the summer, we’ll still have a strong sense of unease. Unless we solve three shortages. Fixing these will then cure the fourth.

Masks/other PPEs

Ventilators

Tests

Toilet Paper

Fixing the mask (and when I refer to mask, I really mean all of the commonly used Personal Protective Equipment pieces) shortage is both really easy and really hard. Ramping up is far easier than we’re making it look. There’s a good argument that part of the problem is how many ways more could get manufactured. There’s a whole industrial base that’s otherwise shut down or immobilized right now. There’s 3D printing. There’s the thousands of people who are already crafting masks at home.

We currently have no clue how many are getting produced on a daily basis, and there’s no coordinated system to distribute them upon completion. It’s a combination of the multitude of sources and a gaping lack of leadership at the federal level (Sorry, I like being non-inflammatory and all, but President Trump has shit the bed from a logistical standpoint. Even if you like his daily podium routine, this part is inexcusable.)

There’s no goal. When American industry was converting from consumer goods to war products to win World War II, FDR set an explicit goal of 50,000 airplanes per year. It seemed insane at the time, but the goal was reached. Regardless of how much prior American industrial capacity is now sitting somewhere in China, there are more than enough domestic factories to make all the masks we could ever use. How many should we make?

At a guess, 20 billion is a decent stockpile. And then enough to make sure we always have 20 billion lying around ready to move about the country as quickly as if Jeff Bezos’s net worth depended on it. That’s 60 or so masks for every American. A two month supply if you’re using one per day. And likely enough inventory for medical personnel to swap out more frequently.

When this all started, the World Health Organization and other experts advised that the general public should not rely on masks. I’m not privy to the board meeting that covered this, but the sense is this was partially an understanding that there weren’t enough masks for everyone to wear one every day, and partially a concern that improper usage would cause infection and/or overconfidence. But both of these are correctable in semi-short order. The world can produce trillions of masks per year if we prioritized them. Virtually all humans have learned how to master skills more complicated than proper mask usage. I’m assuming there are plenty of instructions on YouTube at present.

Most importantly, several Asian countries (South Korea, Japan, Hong Kong, etc.) have implemented civilian mask usage and both avoided our need for social distancing/quarantining and had lower incidence and death totals on both an absolute and per-capita basis. More masks means more freedom and less death.

If masks are on the prevention side, ventilators are on the corrective/recovery side. The shortage of hospital beds and ventilators are making the consequences of catching the virus more deadly, along with harming the mortality rate for those experiencing all the regular personal medical crises that aren’t taking a break for Rona. We’re starting to make progress on creating extra hospital space, converting convention centers and other mothballed public spaces. But they still need ventilators.

They’re more expensive than masks. And they take longer to build. But we have plenty of capacity. Another 50,000-100,000 of the sort most frequently used in hospitals, plus another 100,000-150,000 that are more portable, perhaps even optimized for home use, and in conjunction with having plenty of masks, we’re probably good. Even if it turns out we need more, once the capability to build them quickly exists, the spigot can get turned on again.

Before we continue, you might be thinking about expenses. Don’t. This episode is conservatively going to cost the U.S. Government $6 trillion, and result in the Federal Reserve creating $10 trillion in new capital. This is a comparative pittance. Not even worth running the numbers on. You know how prevention is cheaper than waiting to deal with something after? Yeah, that.

Even more important than masks and ventilators is testing. A couple days ago, the United States reached the million test milestone. In a country of well over 300 million people. Color me unimpressed. We’re oscillating around the 100,000 per day mark at the moment. Which means we have no clue who has it and who doesn’t. Or who already had it, didn’t really notice, and likely has some solid temporary immunity. If we could test everybody, or at least start testing 5 to 10 million people weekly, many of the current mysteries would evaporate.

Much like the mask and ventilator issues, it’s a matter of setting a goal, making sure those doing the production have enough resources, and having an actual plan for distribution. If we can truly figure out who has the virus, who had the virus, and who has never had it, decisions about who needs to quarantine and who can go out and play get a lot easier. If those who go out and play have plenty of masks (and know how to use them), and there are plenty of ventilators lined up in case something goes wrong, then we can return to an acceptable normal in the next couple of months and remain there.

Sure, there’s a chance social distancing will do almost enough on its own. And maybe Rona doesn’t knock angrily on our doors when it gets cold again. Or possibly a vaccine is perfected quicker than expected. But we shouldn’t assume this. The cost of the three pillars of safety is far lower than even a couple week economic dislocation if we need to retreat to our homes again.

Even more importantly, this won’t be the last pandemic. We got lucky in 2003. SARS didn’t get as far, didn’t kill or infect anywhere near as many people. The 2009 H1N1/Swine Flu was pretty, pretty, pretty bad, but because it was a form of flu, vaccination was quicker, and being combined with the normal flu season, the public kinda didn’t realize quite how bad it was at the time. It’s still very possible COVID-19 will kill fewer people. Then there was MERS in 2012, and a stellar job shutting down Ebola in 2014. You get the point.

Masks are almost always useful. Respiratory issues are common with any pandemic causing virus. And though the test will be different next time, the requirements for turning out millions of tests quickly and being able to distribute them efficiently will be very similar. This is a capacity we need both for now and later. While Ford and General Motors went back to building cars after the war ended, a military-industrial complex remained to win the Cold War. We need a very basic pandemic-industrial complex, one that is far cheaper and far more economically beneficial than the military version.

While I think I know the necessary quantity of these three safety elements, there’s a way to tell when we’re at least at a level that is making people feel better. As soon as you can go to the grocery store, Costco, or Walmart of your choosing and find all the toilet paper you could ever want on the shelves, then you know we’ve returned to at least temporary equilibrium. As of this morning, we’re not there yet. The shelves were empty when this household went on a grocery run.

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