My life has been a series of catastrophes. It’s a little annoying sometimes.

I lost two condos in the financial crash of 2008, one to foreclosure and the other in a short sale. I lost my first house to lava during the 2018 lava flow in Leilani Estates. I lost my father and a business in the same year.

I’ve learned, by necessity, to live with constant change. To prepare for the worst and to have backup plans.

My disaster lifestyle may have given me a different perspective on the latest catastrophe — COVID-19 — than your average Jane or Joe. I take it very seriously, but I also have come to recognize, after obsessively reading everything about it for the last four months, that we are probably going to have to learn to live with this virus.

It seems that we are going to have to learn to breathe with COVID-19. Let me explain.

Whole Foods Market team member Kim Do disinfects carts at the Kahala location on May 13. The state will have to adapt to COVID-19 conditions for some time to come. Cory Lum/Civil Beat/2020

Governor Ige’s “stay at home” executive order, a type of economic lockdown policy, was changed in early May to the current “safer at home” order, which allows some nonessential businesses to reopen with social distancing in place, and for parks to be used for exercise but not social gatherings.

The governor changed “safer at home” to “act with care” earlier this week, a timely further step on the road to recovery. But most businesses remain closed and our unemployment rate remains among the highest in the nation. We are drowning economically, despite federal stimulus funds.

Hawaii has had relatively few cases of COVID-19 and is, luckily for us, enjoying one of the very lowest per capita infection rates in the U.S. (647 cases, as of May 22, in a population of 1.42 million).

Figure 1. Comparing states by COVID-19 infection rate per capita as of May 11 (source). 

More important than infection rates, we’ve also had very low hospitalizations and deaths.

The next question we should ask is this: Will infection rates start to go up as we start opening up and eventually attempt to “get back to normal”?

We will certainly get some new cases and any goal for maintaining zero cases in an interconnected world is not realistic.

The rate of new cases, however, can’t be known ahead of time.

How To Fully Reopen

In light of this fundamental uncertainty, policymakers should consider a few important factors in considering when and how to fully reopen. More cautious policymakers — mostly Democratic governors in the U.S., for various reasons — have been urging extension of stay-at-home orders because of the risk of increased outbreaks and potentially overwhelming health care systems if infections spike.

But this set of policies (I’ll call them “lockdown policies” for short) assumes that a vaccine is coming that will make it, eventually, safe to reopen once there is a widely available vaccine.

If we know a vaccine is coming relatively soon we can and perhaps should endure the great many negative effects that lockdown policies bring, including infringement of many basic civil liberties, massive unemployment, massive bankruptcies, massive increases in public debt, increases in suicide, overdoses, heart disease, cancer, lung disease, domestic abuse, acute hunger around the world, and many others.

Maybe we’ll get lucky and find an effective vaccine earlier than history suggests. Very early results from Moderna, a U.S. company, came out earlier this week for a new potential vaccine. But emphasis is on the word “early.”

We can’t say much at this point about the likelihood of these and other early results panning out with widely available vaccines. And can we literally let our economy and our collective health rest on the hope of getting lucky in developing a widely available vaccine in the near-term when this has never been done before on anything like the time frame we need?

Figure 2. Timeline for potential coronavirus vaccine development. 

Last, the COVID-19 vaccine will surely not be 100% effective anyway. The seasonal flu vaccines developed every year or two for the latest strain of seasonal flu is on average only about 45% effective in preventing serious illness. All viruses mutate, so it’s impossible to develop a universally effective vaccine for such viruses.

What are we to do then?

The alternative to lockdown policies is to recognize these difficulties with the vaccine path and to plan accordingly. I’ll call these alternative policies “reopening policies.”

This means gradually easing our current lockdown and attempting to (cautiously) get back to normal life without waiting for a vaccine to save us. We will, under this scenario, use available antiviral medicines (like remdesivir, which has shown a lot of promise in recent trials) and gradually achieve herd immunity by slowly allowing much of the population to become infected over time, while protecting our most vulnerable.

This isn’t as bad as it sounds. A number of antibody surveys have already found relatively high levels of infection in various U.S. and international populations (up to 20% in some populations), with the vast majority of people not even showing symptoms, let alone getting sick, being hospitalized or dying. We are also still early in the global spread of the virus, so it is a certainty that we will see asymptomatic spread increase significantly over time. We just don’t know by how much.

In either scenario — lockdown or reopening — we are certain to see some additional infections in Hawaii. But we are below seasonal excess deaths so when we are weighing the very serious negative effects of lockdown in Hawaii against the potential for adding more hospitalizations and deaths from relaxing lockdown, it seems clear that the balance of risks favors steadily returning to normal life, while keeping our most vulnerable protected.

Reopening doesn’t mean being stupid.

In other words, once we recognize that a vaccine is unlikely to save us, we need to learn how to breathe with COVID-19 — both literally and metaphorically.

Governor Ige is doing this now to some degree — we are now in “act with care” reopening, as mentioned above — but I fear that there will be a renewed push for lockdowns again if/when we see an uptick in new cases, as we quite likely will.

Reopening doesn’t mean being stupid. We need to keep our guard up, particularly for the most vulnerable among us — the elderly, those with hypertension, obesity, diabetes. But we can and should get back to normal life while still being cautious with our most vulnerable.

With such low infection numbers in Hawaii, we can and are using contact tracing policies to identify and isolate new infections before they lead to new outbreaks.

Under any scenario, it will take some time for Hawaii to return to normal – will we ever? – but recognizing that a vaccine may not be on the way any time soon, and maybe never, will allow us to more seriously consider learning how to live with some risk from the virus in the coming years.

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