COVID-19 continues to have a global impact on public health and the world’s economies. In the U.S., infections continue to rise, and officials still see the worst ahead. This means that the economy remains virtually on pause while politicians, economists, and health officials attempt to construct the most rational response. To learn more about this response, GLG’s Michael Weissman spoke with Jeff Colyer, former governor of Kansas. His comments below have been edited for space and clarity.
Dr. Jerome Adams, the U.S. surgeon general, described the looming situation as the U.S.’s Pearl Harbor moment or 9/11 moment. These are very strong words. We wanted to get your thoughts on what we’re seeing and what we’re likely to expect.
I think this is the most difficult period since the Civil War within the United States. This discussion is an attempt to lay some groundwork to prepare people for what they might hear. I hope there will come a time when this is over-preparing, but this is not that moment. When they describe what’s to come as a Pearl Harbor moment, we’re looking largely at New York, but also at other places experiencing outbreaks today.
We’re now seeing hotspots in New Orleans, northern Louisiana, and many of Louisiana’s rural areas. Even as this happens, we’re also seeing some relatively good news. For example, California, all things considered, is a much lower toll than what many people had predicted. That may reflect more that they didn’t have many diagnosed cases until about two weeks after New York. But that also may mean that some of its mitigation activities are having an effect.
But I anticipate for the next week to 10 days that death tolls will be between 1 and 2,000 daily.
How do you expect COVID-19 will impact rural communities vs. urban centers like New York, Miami, and New Orleans?
Rural areas are at a much higher risk because the population is older. For example, almost a third of Kansas’s counties have a population where a third of people are over 65. There are 1,350 critical access hospitals – these hospitals have fewer than 25 beds and an emergency room, and are more than 35 miles from the nearest major hospital. About a quarter of those hospitals were already under severe financial stress; I know two that had been hit very hard and are more than 75 miles from a major metropolitan area.
Many of these critical care hospitals also have on-campus nursing homes. Many of those were old buildings that were converted. In a wing of one senior citizens’ home, 12 of its 14 patients are COVID-19 positive, along with several staff. The hospital is more than 70% positive. Most critical access hospitals do not have many ventilators. They can intubate somebody, and then they would typically ship a severely ill person to a major hospital.
This shows how vulnerable these hospitals are. What’s more, many literally live paycheck to paycheck. They may have a payroll of $100,000 or maybe $200,000, but they sometimes have difficulty meeting that. Now that most of their activities – largely outpatient activities – have been shut down for two or three weeks, some are under extreme financial stress as well. We haven’t seen them collapse yet, but they’re certainly bending in some places.
How long do you expect initial shelter-in-place orders to last?
That’s the million-dollar question at this point. It’s clear that these will last through the end of April. Most orders have stated that; that’s the federal suggestion. If we consider two weeks as a quarantine period, getting through two or three quarantine periods can have a giant effect.
I think you could see something potentially in May, but I can also clearly see it going into June, depending on the state or city. But we likely won’t have a clear line of sight for probably another two weeks. I would say, roughly, April 15 is when we may be able to look ahead at where we’re going to be by the end of April and the first part of May.
What the other side of this looks like will depend on the location. I don’t anticipate most states will just say go “back to normal.” I think we’ll stair-step out of it. Finally, there’s the compliance issue. Will people comply with a given suggestion or with that stay-at-home order?
What type of guideposts would you recommend using before reopening the economy?
I would consider this from two different perspectives: a healthcare perspective and an economic perspective.
From the healthcare perspective, you have the number of vulnerable people, the number who have the disease, and then the number who have recovered from COVID-19 and are now likely immune. People who recover from the disease are not 100% cured, but that’s how it typically works for viral infections. In simple scientific terms, there are antibodies called IgM and IgG. IgM are the antibodies detected at a virus’s onset and you’re starting to fight it off. IgG is longer and more protective. If a blood test finds only IgM antibodies, then you’re probably early in the illness. Once you have IgM and IgG, you’re probably fighting it well, but it hasn’t completely cleared your system. And then when you’re finally down to only IgG, you should be relatively protected.
Using these scales will be something we’ll see in the U.S. and in other countries where you might have an IgG card or a database. But how you can provide enough safety that your workers want to be there and feel safe enough to be there, not just because they need a paycheck?
That’s the economic side. You’re going to see lots of these workplace attempts to provide safety. So the speed at which we get those lab tests out and approved by the Food and Drug Administration (FDA) will certainly have a bearing on this going forward. I think states will go about this differently over the next few weeks.
Given this is an election year, we wanted to get your thoughts on how COVID-19 is likely impacting these typical dynamics, primaries, conventions, debates, and voting.
I think people are going to judge and comment on a leader’s performance. Did that person do a good job for me or not? I think this will extend to Congress, the Senate, and the president. But it will likely impact local elections where you typically knock on doors and talk to people. That’s gone now. It’s also a challenge for people who raise money for campaigns. I wouldn’t be surprised if many congressional candidates between now and the general election raise less than 20% of what they’ve raised to date. It’s going to be that hard for them. That will give a benefit to known quantities, candidates with name recognition. But in the end, people will talk about how a candidate performed in a time of extreme crisis.
What will the new normal look like into 2021? What industries will likely see a change, whether that be more telehealth or more space between restaurant tables?
We’ll see this boom in telehealth but also a pent-up demand for people to physically see their doctor. Telehealth will go up and then back down. But it will stay significantly higher. It’s more convenient, a nice way of making people not have to wait for hours in a waiting room.
There will be pent-up demand. You’ll still need your knee replaced. The roof on your house still needs repairing, or lots of things like that. But some of that pent-up demand will be tempered by economic hardship.
But while it would be nice to wake up on June 1 and then go back to the way things were, that’s not going to happen. We’re going to wake up and tolerate some more risk and do more things, but we’re going to be changing. The question is how much pent-up demand are we going to lose forever? How much might we get back? Is it 70%, 60%, 80%, 90%? I don’t know the answer, but in two weeks, we’re going to have a much better snapshot of what that looks like.
About Governor Jeff Colyer
Governor Jeff Colyer was the 47th governor of Kansas. He founded Virtus Consultants to advise business and governments. He served on numerous boards and business ventures in diverse fields, including artificial intelligence, tech, agriculture, trade, LNG, health, and international, and has held multiple roles to assess, start up, negotiate, and implement large programs in multiple countries. Governor Colyer was a White House Fellow to Presidents Reagan and Bush, where he was involved in foreign aid, major disasters and conflicts, Asia, and Eastern Europe. Governor Colyer pioneered stereotactic, volumetric computer-assisted reconstruction and served as a medical director/advisor for warzones, craniofacial teams, wound care centers, and trauma. He is known for working in warzones and complex emergencies.
This article is adapted from the April 6, 2020 GLG teleconference “U.S. Response to COVID-19.” If you would like access to this teleconference or would like to speak with Governor Colyer or any of our more than 700,000 experts, contact us.
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