Northam Is Using the Wrong Metric to Guide Lock Down

Written for Bacon’s Rebellion by James A. Bacon.

Governor Ralph Northam says he won’t begin phasing out COVID-19 lockdown measures in Virginia until he sees a decrease in the number of coronavirus cases for two full weeks. “We are nowhere near 14 days,” he reminded everyone in a virtual town hall yesterday.

Here’s the rub: The Governor has no idea whether the number of COVID-19 cases is increasing or shrinking. The state’s capacity to administer tests is so inadequate — Virginia tests per million population lags that of 49 other states, even Guam, says Jim Sherlock in a previous post — that the Governor has appointed a working group to fix the problem. He has provided no estimate of when the shortfall will be resolved to his satisfaction.

But there is another set of metrics — a more reliable and, arguably, a more useful set — that could guide the Governor should he choose: Hospitalization data. As can be seen in the graph above, taken from the Virginia Hospital and Healthcare Association COVID-19 dashboard, the number of confirmed COVID-19 patients in hospitals has reached a plateau and is increasing very slowly. The number of severely ill patients in ICUs and on ventilators has actually decreased over the past two-three weeks.

The Virginia Health Department COVID-19 dashboard indicates that the results of 3,740 more tests were registered yesterday. That was a near record and a substantial improvement from the past two weeks. But it doesn’t come close to providing a representative sample of Virginia’s population. Testing by the VDH and hospitals is guided by strict protocols that prioritize patients showing unmistakable COVID-19 symptoms, health care practitioners in the front lines of the medical fight, and potential hot spots such as nursing homes and correctional facilities. Random testing in other states and countries suggests that the actual number of people infected by the virus could be ten times higher. Thus, the number of “confirmed cases” in Virginia reflects (1) the number of test results that make it to VDH inboxes and (2) state testing protocols, and tells us almost nothing about the incidence of the virus in the population at large.

It’s not clear what level of testing would make Northam comfortable with loosening the draconian restrictions he has put on Virginia’s economy. It’s not even clear what kind of tests he would deem acceptable. For instance, would he consider tests that detect the presence of COVID-19 antibodies? Whatever he decides, the level of testing he wants is likely a much bigger than what we’re seeing now, which means Virginia could be weeks or months away from meeting his criteria for relaxing the lock down.

Remember, the original justification for imposing the lock down was to “flatten the curve” and protect hospitals from being swamped by COVID-19 patients. We didn’t want to become Italy. Northam’s restrictions have bought Virginia’s hospitals time. Hospitals have canceled elective procedures, made more beds available, expanded ICUs and stocked up on ventilators. The shortage of personal protective equipment is still an issue but it’s easing. Nowhere near full capacity, Virginia hospitals can handle many more patients, if need be.

The best thing about hospitalization data is that it’s hard data. It may not be perfect, but it’s not a shot-in-the-dark number like the number of confirmed COVID-19 cases.

Northam should be using hard hospitalization data to guide his decision on relaxing the lock down, not the number of VDH-confirmed cases that tell us almost nothing.

But Northam has moved the goal posts. He is hardly alone in doing so — other elected officials and the media have done the same. The media relentlessly tracks the total number of deaths. Today’s VDH dashboard tells us that 372 Virginians have died from the disease so far. Reminder: That compares to roughly 70,000 Virginians who die from all causes every year. (The exact number was 69,353 in 2018.) The media message can be summed up as: Panic! Hyperventilate! Panic! Hair on fire!

But it is folly to focus on COVID-19 deaths to the exclusion of everything else. We cannot risk the collapse of our economy, the bankruptcy of thousands of businesses, and the layoff of hundreds of thousands of employees. Wholesale economic destruction has healthcare consequences, too. We may not measure them, but they’re just as real. The Governor must shift to a more relevant set of metrics and move more aggressively to remove the shackles from Virginia’s economy.