Now that the COVID-19 pandemic is finally hitting us hard and the administration and the American public are finally realizing that this is not a hoax or something that will go away miraculously, now that the stock market has tanked, now that store shelves are empty, now that hospitals are running out of supplies, public health experts are finally being listened to and debates are being held on the best strategy to defeat the Coronavirus.
Here, we present a summary of the Imperial College report and examine its recommendations. We also look at other strategies that have been suggested by many experts. We then ask our readers for their opinion on what strategy might work best.
The Strategy recommended by the Imperial College Report
The trump administration changed its tune this week, following the publication on Monday of a UK government-commissioned report from Imperial College London’s COVID-19 Response Team, which models different strategies and outcomes, for the UK and the US. An early copy of the report was shared with the White House over the weekend.
The authors of the study consider 3 main scenarios and use simulations to predict fatalities in each scenario.
# |
Scenario |
Deaths |
Notes |
1 |
No mitigation steps |
4 million |
80% of Americans will get the disease
Deaths will peak in June
Seniors and those with pre-existing conditions will experience a higher fatality rate.
The study mentions 2.2 million deaths with the assumption that sufficient ICU beds are available for the critically ill; in reality, the the number of ICUs is a small fraction of that required. Hence the 4 million number.
|
2 |
Mitigation steps for 3 months |
2 million |
All symptomatic cases and their families in isolation/quarantine. All Americans over 70 social distancing.
Flattens the curve a bit but not by much
Death rates fall by 50% compared to scenario #1
|
3 |
Suppression and mitigation steps for 5 months |
1000’s |
#2 + social distancing for the entire population, all public gatherings/most workplaces shut down, schools and universities closed.
This step will have to be repeated periodically for over 18 months until everyone gets vaccinated
|
The authors claim that scenario #3 is the only viable option at this time (assuming there are no vaccines or drugs that can significantly slow down the virus).
Paradoxically, while #3 is implemented, people and politicians will feel that the steps are overkill since the death rate will be so low.
Please take a look at diary “The Imperial College Report paints a dire picture of the future and What we must do” for more details about the report.
Strategy #2
Not everyone agrees that scenario #3 above is the only solution or even a viable one. Many experts think that something like scenario #2 with aggressive testing and isolation will get the job done with less disruption to people’s daily lives. They point to S. Korea as an example of this approach.
Prof. Bedford (and others) propose large-scale testing, prioritized testing of likely cases and isolation of infected cases as the strategy, but no aggressive suppression or nationwide lockdowns.
Here are the 3 parts to this “isolation” strategy —
- Do a huge rollout of testing capacity to catch infections early. Positive test cases should self isolate and reduce onward transmission. Testing can be done with home delivery of swabs and drive-thru centers with lab-based processing.
- Use mobile apps to track people and perform automated contact tracing. Once a positive case is identified, others who have been in the vicinity of the person during the previous few days are notified. Alerted cases should self isolate and get tested. This strategy targets testing capacity at most likely cases and serves to detect exposure events early, when isolation is most valuable.
- Run antibody tests on recovered patients to determine when they can return to work. This is needed to keep society functioning and is especially important for those at the clinical front lines.
This strategy also targets one of the key findings of this pandemic — most infections are spread in the early days of asymptomatic infection. And hence if we catch and isolate infection cases early, we can greatly reduce R0. Social distancing among the full population is also a must.
Lawrence Gosling mentions the practical and legal impediments in ordering and enforcing a nationwide lockdown.
There are many other experts that have been beating the drum on similar approaches — Tom Inglesby, Dr. Tom Frieden, Jeremy Konyndyk, Caitlin Rivers, Dr. Angela Rasmussen, Ian M Mackay, and Scott Gottlieb to name a few.
There are variations on this strategy that blend this “isolation” strategy with the “suppression” strategy.
A Note on Cell phone based tracking
Cell phone based tracking has been employed in China and S. Korea as a tool to tackle the COVID-19 epidemic; we covered this topic in diary “Coronavirus Control - Novel High Tech. Solutions or Mass Surveillance?”.
China deployed an app for cell-phones that assigned a colored QR code to each user, based on factors like health and travel history, duration of time spent in infected areas and proximity to potential carriers of the virus. A green code allowed freedom of movement, while those with yellow or red badges were required to self-quarantine. Various checkpoints, shops and apartments around the nation admitted people with green codes only. Codes can change dynamically based on a user’s contacts, their status and the user’s movements.
Mobile apps in South Korea can alert users if they are in the vicinity of someone suspected of infection or if their current location has been visited by someone suspected of infection in the recent past. They can also display infections in the vicinity of a user and in small geographical areas.
Will these techniques be effective here? Will people submit to such privacy intrusion? Will government find ways to misuse such data? Do tech-giants have similar user-location data anyways?
Other Strategies
- Let most of the country get infected to build up immunity. The elderly would be protected via isolation until the rest have recovered; they would then be protected by “herd-immunity”. This crazy and inhumane idea was floated in the UK and is also advocated by some republicans. They claim that it will kill “only” 3%-4% of the population and cost very little.
- Shut everything down for a couple of weeks. There are many (esp. in the administration) who think that this will take care of Coronavirus.
- Wait for summer; the heat and humidity will fix everything (this was one of the right’s talking points).
- Wait for drugs and vaccines to get tested and deployed
Other Steps
Note that there are several other preparedness and mitigation steps that must be deployed regardless of the primary strategy -
- Build more hospital facilities to manage the surge in hospitalizations
- Increase the medical workforce
- Produce more test kits and related material and equipment
- Manufacture more face masks, ventilators, hospital equipment. Get industrial giants (e.g., auto manufacturers) to retool and produce hospital equipment.
- Deploy the army engineering corps and/or army reserves to help build hospitals and isolation facilities and also help with logistics
- More aggressive and coordinated R&D on drugs, vaccines, trials and experiments. Also, antibody tests.
- Prioritize health workers’ physical and mental health
- Prioritize prevention and mitigation among seniors and senior care homes.
- Provide economic stimulus
- Provide financial relief to individuals and small businesses
- Educate, inform and provide guidance to the population. Provide accurate information. Prevent false information from spreading, esp. on social media.
- Provide guidance on how to cope with a period with no family gatherings, working from home, store shortages, no vacations, no birthday parties, no weddings and no funerals.
- Encourage people to wear procedure masks (not N95). Yes, it helps prevent spreading since one may be infected and shedding but have no symptoms.
- Develop online and mobile information bases and tools
- Let scientists and healthcare professionals take the lead and get politics (and racism) out of the public health business (I know that is an impossible task for republicans).
- Stop lying and deceiving (another impossible task for republicans).
- All this needs to be done ASAP
In addition, there are lots of other ideas out there, each of which can contribute a little in slowing down the virus and allowing society to function somewhat normally instead of being shutdown for an extended period.
The Numbers
Here are the updated plots for the U.S., Italy and a few other countries. The U.S. infection numbers have been moving up sharply in the past 2 days, probably because of ramped up testing. Right now we are on a course to vastly exceed Italy’s growth rate. And we have not made great progress in testing, isolation or suppression yet.
Looking at case growth rate, Italy had slowed down although the trend over the past 3 days might be cause for some concern, while the USA is off to the races.
At the current growth rate, we will pass a million cases in about two weeks. We need to take bold action now.
The total number of tests conducted to date is 103,945, which of course is nowhere close to the promised 2 million number. The total number of infections is approximately 12% of the total number of tests over the entire period, as seen below. That sort of implies that testing is the bottleneck. What if we had conducted 200k tests by now instead of 100k? Would the number of infections have been 2 x 13.8k = 27.6k? Probably.
Epilogue
Given the right people leading this effort, we can overcome the COVID-19 pandemic. Irrespective of which strategy or some hybrid of multiple approaches we take, our world will change in the coming weeks. Let’s prepare physically and mentally for it.
There will be personal suffering and tragedies, as family members get infected and quarantined. Many of the elderly will die — alone in a hospital bed and be buried/cremated quietly. We need to prepare for that too.
Economic stagnation, shrinking nest eggs and job losses will occur. We need to prepare for it.
None of this will be easy since we have an administration and a ruling party that values loyalty and ideology over competence and governance. We all know, trump and the GOP will lie, take steps reluctantly, use the occasion to demonize Democrats, China, immigrants and all his “enemies”, spend trillions of tax and borrowed dollars to shore up businesses and their rich buddies, take credit for every little improvement (real or manufactured) and blame Democrats for all bad news. We need to prepare for that too.
How will this play out politically, how will elections be effected, will Democracy survive — these are questions that will be discussed by the punditry class over the next few months, writing and talking from the confinements of their homes. We need to prepare for that too.
After we come out of this, how should our system be changed to prevent future disruptions? How should our healthcare system change? How should our economic system change? How should our political system change? There will be time to debate that.
Now, let’s hear your informed opinions and take the poll.
Further Reading
- Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand — www.imperial.ac.uk/...
- The Imperial College Report paints a dire picture of the future and What we must do — www.dailykos.com/…
- Coronavirus - A Sobering Letter from Italy — www.dailykos.com/…
- Coronavirus - Data from Italy and Implications for US - www.dailykos.com/…
- Coronavirus Control - Novel High Tech. Solutions or Mass Surveillance? — www.dailykos.com/…
- Coronavirus - Some more Medical and Research News - www.dailykos.com/…
- Some Novel Coronavirus Treatments in the Pipeline - Antibody Harvesting and Plant Based Vaccines — www.dailykos.com/…
- Coronavirus - Some more research findings and advice about the virus — www.dailykos.com/…