When you have a huge hole where your nation’s leadership should be, it is wise to borrow the best of other people’s leaders. They can’t make America’s big decisions, but they can fill in some of the gaps.

In the Covid-19 pandemic, we can take comfort in their competence and use their wisdom to guide us about what we each should do.

Right now, the US and many other nations are considering easing social distancing and other restrictions if and when their new coronavirus cases and hospitalizations become flat or start to fall. And German Prime Minister Angela Merkel (who happens to have scientific chops) has an important lesson that we should all listen to.

On Wednesday, she laid out important logic about the coronavirus pandemic that hasn’t been communicated clearly enough here in the US. In simple and clear terms, she explains why Germany doesn’t have much “wiggle room” in its hospital capacity. Because of this, any lifting of its lockdown, like allowing some shops to open next week, will remain “on thin ice.”

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Merkel’s explanation, which went viral, is centered on the metric called R0, or basic reproduction number. It represents the number of people a sick person will infect on average in a group that’s susceptible to the disease (meaning they don’t already have immunity).

She says that if Germany’s R0 were to shift from a flat rate of 1.0 to 1.1, the nation’s hospitals will be crushed by October, without sufficient resources to care for all of the severely ill Covid-19 patients. If the R0 goes up to 1.2, that overload hits in July. And so on.

Covid’s current global average R0 is 2-2.5, but Germany has done a good enough job of managing its outbreak to get its reported estimated R0 down to 0.7 as of April 17. That’s low enough for Merkel to sanction “a tentative easing of restriction.”

America, for many reasons, has even less wiggle room than that. Germany has eight hospital beds per capita compared to America’s 2.7 beds. In ICU beds, Germany has 8.3 per capita while America has 6.6.

It is also testing for coronavirus at twice our rate (21 vs 9.8 tests per 1,000 people). Without robust testing, you can’t keep good tabs on R0 or the related Rt — and you can end up flying blind, risking health system overload and avoidable deaths.

Covid-19 spreads in an exponential way, and it’s worth emphasizing exponential growth’s dynamics. Tiny shifts in risk grow very quickly, leading to deadly results as this useful tweet thread shows:

The small choices we each make about risky behaviors are like playing Russian Roulette, but with a machine gun. You may have thought that if you’re not in a high-risk group (like older adults), and the case fatality rate is around 1 percent, then the threat isn’t so great. Surely we can loosen restrictions?

But that’s like being locked in a room with 100 people, where your collective behavior determines how many bullets are live in the machine gun that’s about to strafe all of you. You might not die, but others surely will.

Covid-19 is already the leading cause of death in many areas, including New York state, Louisiana, and Washington, DC. Do you want to add ammunition to its arsenal?


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