Dierenbach: Is it time for a new approach to coronavirus?
In New York City, an antibody survey found that 21% of the city’s population had been infected with the coronavirus. This indicates that over one and a half million of New York City’s 7.2 million residents under the age of 65 had been infected. Furthermore, approximately 78% of them had no underlying medical condition that puts them at risk from coronavirus. Around the time of the antibody survey, New York City had recorded only 58 deaths of people under 65 with no underlying condition.
In the U.S., 79% of coronavirus deaths are people 65 and older. In the 23 states releasing long-term care facilities data, 27% of deaths have occurred in such places. The Washington Post reports the share of fatalities in nursing homes may be 50%. In Colorado, the share is 50%.
Yet our reaction isn’t to protect the elderly and those with underlying conditions. No, instead we decide to force over 214 million people under 65 with no underlying condition who are under virtually no threat from coronavirus to restrict their activities, socially distance from each other, and go into lockdown.
Instead of targeting the vulnerable population for assistance and infection avoidance, we shut down our economy. Many of the vulnerable are elderly and out of the workforce, yet we target the workforce and push 33 million people out of their jobs. We destroy countless small businesses, risk food shortages due to the supply disruption, drive oil prices so low that it could devastate thousands of Coloradans and cause political instability and international conflicts to rise, scare people who need medical attention away from emergency room visits, and cause domestic violence to rise.
What we’re doing is unsustainable.
Protests against the lockdowns are erupting across the country. Lockdown supporters call the protesters self-centered murderers who only care about getting haircuts or going to bars. Arbitrary orders create confusion and social unrest. In Michigan, you couldn’t sell seeds, while in Colorado, you can have a gathering of 10 people, but they aren’t allowed to play a game of basketball. The mayor of Los Angeles has threatened longer lockdowns as punishment for disobedience.
In the beginning, the logic behind locking down was sound. Coronavirus is a highly transmissible disease with a significant number of carriers who are asymptomatic and contagious at the same time. The experts said if the virus remained unchecked, it would produce a surge of victims that would overwhelm our healthcare system and result in excess deaths due to lack of care for both coronavirus sufferers and others needing medical attention. News from China and Italy confirmed this possibility.
But “flatten the curve” morphed into “hide until solution;” the solution being a possible vaccine or effective treatment at some undeterminable point in the future. States that never saw a surge went into lockdown and remain there today. New York City, which is well past their peak medical usage, remains on lockdown. Many states that are ostensibly opening up are doing so at an extremely slow pace. Colorado, which is supposedly opening up (but not really), is attempting to keep the coronavirus cases at a level that is so low, herd immunity might not be reached for years.
To combat the virus, every state is pulling the social distancing lever trying to figure out what level of distancing can slow the spread of coronavirus such that they are able to reach their goal of managed herd immunity, or slowing the spread while waiting for a medical solution. Some states pull hard and lockdown tight, while other states try to move forward with a lighter touch. But even the lighter touch states are acting in a way that kills jobs and restricts freedom to an unsustainable degree. For example, Texas has announced it is opening up again, but mandates restaurants only operate at 25% capacity.
A new approach is needed.
This difference in effects of coronavirus between people under 65 with no underlying conditions and those with underlying conditions and/or over 65 should be the primary driver of policy.
Extrapolating the New York City data, if the 214 million plus healthy U.S. citizens under 65 all contracted coronavirus, they would suffer around 10,000 deaths. Two thirds of our population would have immunity and we would be well on our way to herd immunity. By contrast, if 214 million randomly selected Americans were infected at New York State’s estimated infection fatality rate of 0.5%, over 1,000,000 people would die. The actual rate is likely closer to 0.36%, but even at that rate, there could be 770,000 fatalities.
This begs the question: What if the people who won’t die from coronavirus abandon social distancing? And totally abandon it: no masks, have social get-togethers, attend basketball games, start shaking hands again, etc. Is that possible and what would it look like?
The program would look like this: if you are not elderly or vulnerable, you would not practice social distancing among the non-vulnerable. If you get the disease, you get over it and move on.
If you are vulnerable, for at least the next several weeks as we push toward herd immunity, when in public wear a mask, self-quarantine as much as possible, and practice social distancing. A mask would be the sign to everybody that you wish to avoid the disease. The non-vulnerable population would respect your wishes and practice social distancing in your presence. At work, non-vulnerable employees could wear masks when they know they will be close to vulnerable co-workers. In parks and other public situations, the unmasked could be asked to respect those with masks and maintain their distance. Subways or buses could have special cars or sections where people with masks could maintain safe distances.
What this plan would do is speed up the process of achieving herd immunity while protecting the vulnerable to a degree comparable to what we are doing now. We have learned how to do social distancing over the past several weeks; we all understand the methods and reasoning. We can now take that skill and apply it in a targeted fashion to protect the vulnerable, potentially lowering fatalities significantly, perhaps by hundreds of thousands. Instead of waiting a year or more to achieve herd immunity, we could do so in weeks or months.
A first reaction may be that “targeted” social distancing is not social distancing at all since it is not being performed by everybody in society and therefore will not be as effective at protecting the vulnerable. However, that isn’t accurate: targeted social distancing still requires everybody, vulnerable and non-vulnerable, to participate.
Shops and other businesses could have special hours where extreme care would be taken to observe social distancing rules and provide an environment that is as clean as possible. For example, a grocery store could have early morning shopping where carts and commonly touched surfaces are vigorously disinfected and social distancing and mask wearing is strictly enforced, but could operate normally for the remainder of the day. Having the special time in the morning would allow for disinfection, both through active efforts and through the passage of time since the previous day’s crowds.
If the lockdowns ended for most of the population, government assistance could be targeted at the at-risk individuals. For example, a teacher with hypertension who wishes to isolate could be allowed to work from home teaching vulnerable students that are also staying at home. An at-risk store clerk could be given unemployment benefits. Such targeted assistance would be far less costly and more efficient than the current policy of mass disbursements.
Why delay the inevitable?
Most all of us are going to get coronavirus eventually, so why destroy our economy to delay the inevitable when the delay itself means higher risk for the vulnerable people? The risk for healthy people is miniscule and almost entirely non-existent for children. Healthy people are hiding from a phantom threat at the real cost of prolonging the very real threat to the vulnerable. Every day that goes by with coronavirus prevalent in our society is another day it has an opportunity to rip through a nursing home.
Finally, this isn’t ignoring the danger to others or claiming coronavirus is a hoax. The virus is absolutely deadly to the elderly and those with underlying conditions. This also is not trading lives for jobs. By accelerating the attainment of herd immunity via healthy, younger people, this path saves lives and jobs. It allows the economy to start up again and results in less loss of life than any other approach out there.
This is the healthy acting together and taking on risk to protect the most vulnerable among us in the most efficient and effective way possible. I understand doing nothing to protect yourself from a known virus is frightening, but if you are not part of the vulnerable population, the odds of being killed by coronavirus are incredibly low. This is the best possible solution to a horrific problem. We the healthy should accept the slight risk associated with a possible coronavirus infection, both to protect the vulnerable like our parents and to preserve our quality of life for our children.
Governor Polis relies on the COVID-19 Modeling Group to provide to him estimates of outcomes for various responses to the pandemic. The Group is comprised of public health experts, mathematicians and others. So far, it appears if they have presented various options where everyone in Colorado practices the same level of social distancing. The Group should model a bifurcated social distancing regimen where the vulnerable self-quarantine and remain in lockdown, the non-vulnerable practice social distancing when in the presence of the vulnerable, and the non-vulnerable abandon social distancing among themselves.
As described above, this plan could potentially reduce overall fatalities and economic hardships so please urge the Group and the Governor to at least explore the possibility.