What An Alternative COVID-19 Containment Strategy Might Look Like
by Brian T. Lynch, MSW
Forget the Swedish model I referenced in my prior diary. I’m sorry I linked the CDC data to it. The linkage just created unintended confusion. What I failed to do is crystalize the possible alternatives to a blanket shutdown of the country as the only means to control the coronavirus. What I hope to do here is give a glimpse of what might be possible if COVID-19 really is differential to age categories and to other factors, such as those that allow people to be exposed without developing any symptoms at all. As a type of thought experiment, consider the potential implications of that CDC data which shows that 97% of the population at risk of death are over the age of 45-years-old. (data reproduced below from the prior diary).
Here is one way of imagining an alternative COVID-19 containment model:
1. The ultimate goal is to achieve herd immunity from vaccinations, or by any other means, with the least loss of human life.
2. The CDC data shows that 97% of COVID-19 deaths are of people 45-years-old or older. Also, deaths are much more likely in people with underlying health conditions. Therefore, we know from this that this demographic group needs to be highly isolated from infection. Also, any adults caring for anyone in this demographic category, whether at home on in a facility, need to be isolated from the virus to the greatest extent possible. Collectively, this is the high-risk group.
3. There is data that suggests as many as 50% of the population may become infected with the COVID-19 virus while remaining symptom-free. A careful analysis of the demographics and other characteristics of this group should be conducted at once. This group can be a silent vector for spreading the disease. They must be kept apart from the high-risk group and still must maintain social distancing and take other prevention measures when out in the general population. However, this is a large group of people who do not need to socially distance themselves from others who fall into this category. They can serve as an office crew, for example, while their more vulnerable colleagues work from home. If research can reliably identify who is likely to be asymptomatic after exposure to COVID-19, then allowing this group to socialize among themselves may be allowed. If they become exposed to the virus without symptoms it will hasten the percentage of the population that develops immunity to COVID-19. Collectively this is the low-risk group.
4. The low-mortality risk group of people who are likely to develop mild to moderate symptoms if exposed to the COVID-19 virus could then be identified as those under the age of 45 who don’t have the characteristics of asymptomatic people (providing a means to identify asymptomatic people is successful). This intermediate-risk group of people would have to practice exposure prevention measures rigorously and limit their social interactions. They are the group that would most require testing, isolation, and contact tracing to control the spread of the virus. When members of this group become ill with the virus and then recover, they will presumably have developed an immunity. They can (cautiously, after anti-body testing) reintegrate with others who have recovered and join with the group of people who are unlikely to develop any symptoms if exposed.
5. This tiered method of controlling the virus, based on the demographic characteristics of the illness itself, would permit a gradual, natural, and safe means to reopen the economy and relieve the economic burdens on us all. It would humanly hasten the development of herd immunity while we wait for an effective vaccine. It would allow us to direct medical and economic resources to where they are most needed and most necessary. When a vaccine is developed, it pre-identify those who need to be inoculated first, this not wasting precious doses on those for whom it isn’t immediately needed. This isn’t a plan or a suggestion, but rather a concept to be considered and more fully, more scientifically explored.
Is it pie in the sky? Maybe, but it seems worth consideration, especially as an alternative to states that are opening up restrictions for everyone in the face of rising new cases within the state. That course is a recipe for disaster.