Steve Blank on COVID-19.

The Covid-19 virus is not politically correct. It discriminates against the old and the unhealthy. The biggest risk factor in dying from the virus is age. If you’re 60 to 70 years old, you’re 30 times more likely to die from Covid-19 than if you’re under 40. And if you’re over 80, you’re 180 times more likely. It’s not that the young don’t get sick or die, but the odds are dramatically different.

In the early days of the virus epidemiologists, who believed that the virus would equally kill the young and old, predicting a million or more deaths in the U.S., wanted everyone to shelter. The result has crashed our economy. Meanwhile, economists view 15% unemployment as an unacceptable and unsustainable cost of protecting everyone and want the economy to rapidly reopen, accepting that some additional deaths are inevitable.

They both may be missing the obvious. We’ve created an equal opportunity recession when in fact, the pandemic is not equal at all.

If the data about the demographics is correct, it may be possible to dramatically reduce cases and deaths if we shelter those at greatest risk and pay them to stay sheltered until a vaccine is available. This would allow those with dramatically lower risk to get back to work and bring a faster economic recovery.  Here’s how.

We’ve spent the last 50 years working to not discriminate for age or disabilities so it’s hard to acknowledge what, if these number are correct, or even in the ballpark, the data seems to say that people over 60 are 30-180 times more likely to die of Covid-19. And ~1/3rd of those U.S. deaths have been in nursing homes.

  Age           Relative Death Rate
18 <40             0.07%
40 <50             0.31%
50 <60             1.00 (reference)
60 <70             2.09
70 <80             4.77
80+                  12.64

Compounding the age risk factor are chronic health problems (i.e. heart disease, high blood pressure, asthma and other respiratory diseases, obesity and diabetes.) In addition, racial and ethnic minorities seem to have been at greater risk.

A good visualization of the fatality rates by age is below. It takes data from South Korea, Spain, Italy and China. The relative fatality rates by age in the U.S. seem to track these.

For COVID-19, data suggests that 80% or more of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical, requiring ventilation.  If you’re under 40, the data says you’re five times more likely to die from Covid-19 than the seasonal flu.

Today, federal and state plans to reopen the economy focus on reducing the density and duration of exposure to the virus equally, across all ages. But little emphasis has been on focusing resources to keep safe the actual people who get sick and die.

We Got it Backwards – Protect the Old Versus Everyone
The consequences of mixing young, largely asymptomatic and much lower risk, with the old who are at significantly higher risk seems like a deadly game of whack-a-mole.

As states loosen shelter-in-place restrictions, mixing young versus old as we reopen restaurants, live entertainment (theaters, concerts, sports venues,) crowded office buildings etc. guarantees unnecessary deaths.

20% of those over 60 work. 12.5% of workforce is over 60
What if we acknowledged that the virus (much like the flu) discriminates against the old. As a thought experiment, how would we design a recovery that protected the old but required minimal restricting of our economy and a rapid return to normal?  Here are some ideas.

  • Continue sheltering in place adults over 60 (or some other age that the data shows most elevated risk), plus those with chronic health risks as well as other affected populations
  • Open up the economy to everyone else
  • Offer everyone over 60 (and those with chronic health problems) whose job can bedone remotely the option to work at home. Pay for their computer, network, etc. Offer their employer an incentive to compensate for lost productivity – until a vaccine is available
  • Provide Americans over 60 and those with chronic health problems whose job cannot be done remotely with a “personal payroll protection program” –pay to have them not show up at work – until a vaccine is available.
  • Focus our scarce testing tools first on nursing homes and their employees and front line medical workers, next to everyone over 60, then those whose illness puts them at risk and then to the general population
  • Provide this protected population with full health care
  • Provide resources ($’s for separate housing via empty hotel/airbnb rooms etc) to protect the elderly who live in multi-generational housing
  • Where possible continue wearing masks and distancing to the risks to those under 60
  • Broadcast the comparative risk of getting sick/dying from Covid-19 to typical risks we lived with pre-pandemic. This would allow everyone to make comparative informed decisions.
    • For example, car accidents ~39,000 deaths in 2019 and over three-fourths of a million dead since 2000, ~70,000 drug overdose deaths in 2019 and over three-fourths of a million dead since 2000. All of these are avoidable, but as a society we decided that we are not shutting down our economy to solve these problems.
    • Understanding deaths from seasonal flu in 2018/2019 ~34,000 deaths (~25,000 deaths >65, ~8,000 <65) provides a reference to the current prediction of 150,000 deaths from Covid-19 this year (5 times the risk of dying with seasonal flu.) Just for scale Covid-19 fatalities are closer to the 100,000 died in the 1968flu pandemic, and the 116,000 dead in 1957/58. We made different decisions in those pandemics. We may want to think about why.
  • Remove all business restrictions for workers and customers under a certain age. As a thought experiment, imagine restaurants serving only those under 40 (carding at the door). They would have no distancing requirements. Or that business rate themselves based on how age appropriate their virus safety is. Imagine movie theaters with special distancing showings for those over 60, nightclubs for under 30 or over 60. Same for sports and entertainment venues. Those who do attend will understand that the risks are not zero, but within the range of those they live with today.  Same with offices.
  • Create special hours and venues (stores, restaurants, workplaces, etc.) for those who need to shelter. Offer businesses who cater to them large financial incentives.
  • Create special mass transit options with over 60 subways cars, buses, etc.

This would do five things:

  1. We’d protect the most vulnerable at-risk population
  2. With those over 60 sheltering, jobs are now opened up for unemployed younger people
  3. Businesses can return to normal without the burden of significant additional overhead costs
  4. Businesses can make additional revenue catering to those who remain sheltered
  5. The potential burden on the healthcare system would be lowered by removing the vulnerable from risk
  6. And this plan would dramatically reduce the overall economic cost of sheltering and accelerate the recovery

We’ve spent the last 50 years fighting age discrimination, but the virus is the ultimate discriminator against the elderly. It’s unequal and unfair. But it exists. Let’s look for ways to move beyond the choice between exploding death rates and economic disaster by acknowledging what the data is showing. Shape a plan to protect the most vulnerable and let everyone else get back to work.

Note: the author is over 65 and willing to abide by these restrictions

Steve Blank is recognized for developing the customer development method that launched the lean startup methodology.  He is an adjunct professor of entrepreneurship at Stanford;[ lectures at the UC Berkeley Haas School of Business, and is a senior fellow at Columbia University. He has written four books: The Four Steps to the EpiphanyNot All Those Who Wander Are LostThe Startup Owner’s Manual, and Holding a Cat by the Tail.

 

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