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:
CONTAIN THE INITIAL OUTBREAK
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.
APPLY A "CURE" - IMMUNIZATION OR ANTI-VIRAL AGENT
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.
CONTROL THE RATE OF SPREAD OF THE DISEASE AS IT MOVES THROUGH THE
POPULATION
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?
Steve may be reached at:
Last Update: 20 May
2020