Listen: The Ethical Calculus of Reopening

Dugdale: That’s right. It’s a shock. It came upon us very quickly, and sort of unlike the flu, which drags out over months, it just slammed us. I think the degree to which it was absolutely preventable is a matter of debate, honestly. Because you can’t lock down everyone forever, right? Even for me, working as a doctor during this time—there’s thousands and thousands of people related to health care that are being exposed and have to be exposed for the sake of caring for their patients. There’s no absolute lockdown possible.

Wells: So the idea that no one would ever be exposed is impossible, but we can make choices about how many people are exposed and how necessary those exposures are, right?

Dugdale: That’s right. We can. So we’ve all seen the curve, right? And we’ve all been told, Flatten the curve. The curve is really the number of cases over time and that area under the curve is the number of people who either get sick or die, depending on which curve you’re looking at. The question then is, if we flatten the curve—which I really believe we did in New York—does the actual area under the curve, meaning the number of people who die, does that change? Or does it just get stretched out? And that’s what we don’t know.

Wells: Meaning, is the absolute number of deaths the same no matter how fast or slow it goes?

Dugdale: There was a lot of hope initially that while we flatten the curve, we’d come up with a vaccine, or a treatment, and then we’re out of the woods. But so far that hasn’t played out.

Wells: Jim, we’ve been talking about this. It doesn’t seem like a vaccine is going to come within any reasonable period of time, right?

James Hamblin: No, not in the near future. It’s not going to come in one pill or one magical practice that suddenly makes this a totally survivable condition. But doctors are at least getting better at identifying crashes and managing people to some degree, right?

Dugdale: We’ve definitely made advances, for sure. But there’s still so much we don’t understand about this virus. There’s no magic bullet. I think in American medicine, Jim, as you know, people are really looking for that magic bullet. What pill I can take so that I can get up and walk and go home.

Wells: I’m just going to ask you this really directly because it hasn’t been as clear to me as I would like it to be. You both think that we are at a point where a vaccine is not going to come in time to make a meaningful difference in the number of deaths we have, at least in the United States?

Dugdale: That’s right. Yeah, not in the next year, probably.

Wells: And so the important question to be asking is how do we get through the reality that the pandemic is just going to tear through our country? How do we get through that in the most ethical and least horrific way possible? Is that right?

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