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The data is starting to be compelling that Italy has reached its peak and the epidemic is beginning to recede:
Deaths are lagging indicators so that when you compare the slopes of the two graphs above they make out a distinct decline in COVID-19 cases in Italy. This, of course, does not mean the illness is over or that the deaths will not continue to mount. But it does mean that there will be less illness and death going forward.
The US, nationally, is about 14 days behind Italy. But our data is heavily skewed by the NYC area. Ironically, the peak for NYC is about 7-10 days away because they do not have a flat curve, while the peaks for other localities that have flattened the curve are some weeks away. Until people see that NYC is over its peak it will be difficult to have the real conversation: when do we let people go back to work?
Apropos of that, the latest scare is that the COVID-19 indeed can be aerosolized and that everyone should be wearing the best face-covering they can manage. But the reporting on this does not address the irony that this represents: If the virus is aerosolized then many more people are exposed/infected than cases confirmed. If many more are exposed/infected then the percentage of all persons suffering serious illness and death from COVID-19 is even smaller than currently envisioned. This changes the risk profile. It also means that simply having a comorbidity is not a death sentence as the numbers of persons with a comorbidity is very large.
That is not to say that the persons who are afflicted with a severe case of COVID-19 are not suffering greatly. There are also some number of persons (as yet undetermined) who will suffer from chronic pulmonary insufficiency even after recovery. There is no need to trivialize the severity of this disease. But from a public policy standpoint, the weighing of health harms between the disease and poverty becomes more skewed in favor of poverty just based on the numbers.
And that is where an excellent article by Craig Medred, an independent reporter out of Alaska comes in. I have referenced his reporting periodically. His latest piece is Fear fear. In it Craig outlines the evolving cost-benefit considerations of lockdowns versus other public health strategies:
“Lockdown is going to bankrupt all of us and our descendants and is unlikely at this point to slow or halt viral circulation as the genie is out of the bottle,” they wrote. “What the current situation boils down to is this: is economic meltdown a price worth paying to halt or delay what is already amongst us?”
The idea has gained some traction in the medical community, but not much. Political leaders, meanwhile, have largely gone in the opposite direction. The United Kingdom suggested it might let the virus spread enough to create what is known as “herd immunity,” but quickly backed away when some scientists and the public protested.
The Dutch suggested the same idea, backed away, but are now studying it. Meanwhile there is the suggestion from many scientists that herd immunity is in some way inevitable.
In Singapore, which dealt with an early outbreak of COVID-19 and is now facing another wave of infection, Teo Yik Ying, the dean of the Saw Swee Hock School of Public Health at the National University of Singapore, on Thursday told CNBC, he expects hot spots of infection to shift around the globe until enough people who have caught it develop antibodies to fight it off.
At that point, the disease becomes unable to easily jump from person to person and fades out. This is herd immunity. Unfortunately, some pathogens – most notably the flu – are able mutate and again return.
Katz and Heneghan have suggested that the best way to get herd immunity might be to shelter those vulnerable to fatal COVID-19 infections and let the disease run much like the flu in the rest of the population.
“The data from South Korea, where tracking the coronavirus has been by far the best to date, indicate that as much as 99 percent of active cases in the general population are ‘mild’ and do not require specific medical treatment,” Katz argued in his NYT op-ed. “The small percentage of cases that do require such services are highly concentrated among those age 60 and older, and further so the older people are.”
But responding to COVID-19 in this way at a population-level generally runs counter to the beliefs of Western societies that prize individuals. The mere possibility that a previously unknown disease could kill younger people – and it has – appears to terrify much of the Western world.
Thus Katz’s suggestion of an alternative approach aimed at protecting the elderly and those at risk because of ill health while putting everyone else back to work has to date gained no political support.
Whether it will ever gain serious consideration is an unknown, but there are more than a handful of scientists who share Katz’s concerns about long term problems inherent in the current strategy.
And so should we all. I am going to make a prediction: by Easter, New York will be past the peak. When that happens, but sadly not much before that, the President can entertain his initial instincts that opening up America for business again needs to happen sooner rather than later.
Italy has turned the corner. China (although its totals are suspect) has done so as well. Spain will turn the corner about the same time as New York. By Easter, most health officials will still be focusing on understanding the disease, but the picture will clearer that the health crisis is receding and the economic crisis has to take priority.
[Note: Links to all my CoVID-19 posts can be found here.]Published in