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An Approach to COVID-19

by Steve Dumolt

The newest strain of coronavirus, designated COVID-19, has resulted in the physical and economic lockdown of most parts of the United States. The effects of COVID-19 itself have varied, depending on location. For instance, higher density areas like New York City have experienced a high incidence/rate of overall cases, hospitalizations, and deaths. Other parts of the country have experienced much milder effects, with many rural counties reporting zero cases of the disease.

How should we approach the situation? Here is my two cents worth:


Start by trying to contain the initial outbreak. COVID-19, like every other disease, had a point of origin. The vast majority of the evidence indicates that this point of origin was Wuhan, China. Recognition and decisive action by domestic health authorities, which could have contained the virus to the Wuhan area, was almost completely nonexistent. Hundreds or thousands of infected people were allowed to leave Wuhan, board international flights, and disperse around the world, infecting others along the way, resulting in a complete loss of containment before most of us even knew the virus existed.


Once a virus starts to spread through the population, control of the disease by treating individuals is usually the next step. This treatment usually takes the form of a direct approach using anti-viral or other agents, or an indirect approach in the form of widespread immunization.

Unfortunately, neither of these approaches has been applied with any great success to the family of coronaviruses. There are seven strains of coronavirus that have been identified as affecting humans, going back to 1965 (55 years). The development of anti-viral agents or vaccines has never reached the stage of general application for humans. While there is speculation that anti-viral agents and/or vaccines for COVID-19 are just around the corner, it would be foolhardy to bank on the timeliness and effectiveness of those solutions, given the history with this family of viruses.

At the time I am writing this (May 2020), there is a crash program being carried out to develop a safe and effective vaccine. The candidates have been winnowed from over 100 to 14 and the next stage of testing is about to start. The best-case scenario is that, if a safe and effective vaccine can be developed at all, the earliest date for the initiation of widespread immunization program will be some time in 2021.

Also, there have been reports of various anti-viral agents, such as hydroxychloroquine, exhibiting varying degrees of success in specific situations but, at this time, none has been shown to be universally effective.


Without containment or a "cure", eventually the disease will spread through the population. Currently, lockdowns and social distancing are being employed to reduce the rate of the spread of the disease in order to limit the burden on the health care system for those who need hospitalization. While these are useful temporary solutions, they cannot hold off the spread of the disease permanently. Sooner or later the dam is going to break.

All indications (at this point) are that the effects of COVID-19 can vary greatly among the population. Maybe half - or more - of the people infected experience mild to no symptoms. On the other end of the spectrum, a very small percentage suffer from fever, headache, extreme respiratory distress, and eventually death. Of those who die, most are elderly and suffer from additional health complications.

There is no indication that the rate of the spread of the virus will determine the number of symptomatic cases or death due to the virus itself. Any excess deaths will probably take place due to the overwhelming of the health care system due to a high rate of the spread of the virus (and correspondingly greater number of hospitalizations) coupled with the inability of local health care systems to effectively manage the serious cases. The number of hospitalizations with respect to the availability of health care is the critical attribute that needs to be considered; the number of total cases and deaths are not factors that determine the burden on the health care system. At this time, with the exception of a few high population density locations like New York City, local health care systems have easily handled the number of cases of COVID-19 that require hospitalization.

As with most diseases, it appears that once someone has been infected with and recovered from COVID-19, immunity is established. At present, it is unknown whether immunity is short-term (maybe a few years) or effectively permanent. Infectious diseases will remain in a host population as long as there are people to infect. The disease ends when it can no longer infect anyone. This happens when most, but not necessarily all, of the host population is immune or deceased. A phenomenon known as herd immunity occurs once a critical percentage of a given population is immune, which minimizes the overall danger posed by the disease.

Given that an effective vaccine or anti-viral agent is not even on the horizon, allowing the disease to spread through a willing population in a controlled and intelligent manner would produce widespread immunity but not overburden the health care system. At the same time, we can move to protect vulnerable segments of the population. How the disease is allowed to spread would be determined by local conditions and vary by local conditions - population density, population demographics, state of the disease, etc. The "opening up" process will need to balance the rate of spread of the disease with the availability of health care. During this process the number of people getting sick, with some dying, would be greater for a given time period than during a complete lockdown but as long as the number of hospitalizations stays within the ability of the health care system to cope the virus can work its way through the population in a manner that we have some degree of control over.

Rather than all of us taking a rather helpless-sounding "we're all in this together" attitude and hunker down while wishing for some potential solution to possibly drop down from the sky at some point down the road, I think it is more appropriate to adopt the proactive workable and effective answer described above.

Exposing most of the population to a contagious, and in some cases deadly, disease may seem counterintuitive at first but the alternative - attempting to keep 330 million people in an indeterminate physical and economic lockdown that relies on a vaccine or anti-viral agent that lies somewhere over the horizon and may never actually arrive - is the far riskier option.

In summary, I don't think COVID-19 is a virus we can afford to avoid. Rather it is something we should intelligently and carefully encounter.

ADDENDUM: After writing the above comments and thinking them over for a while, I became very concerned about what our apparent national response to COVID-19 actually means. I keep hearing phrases like "We’re all in this together" and "Stay safe". What I don’t hear is any kind of plan that will allow us to move toward the end of the pandemic. By staying home and social distancing it appears that we are trying to "freeze" the disease in place while we hope for a miracle cure to appear at some undetermined point in the future. It’s a national version of jumping into bed and pulling the covers over our head. THERE IS NO PLAN "B". What do we do if an effective vaccine or anti-viral agent can’t be produced soon (or at all)? Do we keep trying to lock our society down and keep printing money? How long can we do that before the economy and society crater?

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Last Update: 20 May 2020
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