Current Response to COVID-19 is Not the Best Response

By Barry Farah
Guest Editorial in The Gazette, March 25, 2020

Source: https://gazette.com/opinion/guest-column-current-response-to-covid–is-not-the/article_e6ff7c72-6dda-11ea-9bdb-67023b822ad8.html

The Imperial College of London produced a report released March 16. In this report, an impressive team of pandemic experts used mathematical models to predict the outcomes of three potential responses to COVID-19. Those responses are do nothing, suppression or mitigation.

Informed in part by this study and using the levers of emergency powers, a rendition of the suppression response has been imposed upon us. After a deep dive into the data, here is a summary of the three potential responses and the reasons why I recommend mitigation instead of suppression.

Do nothing. If we do nothing and let the virus run its course, hospitals will be overrun in April to a peak of 30 times capacity by June. After two months of chaos in May and June, the nation will be effectively immunized by late summer.

The alarming concern with this option is the prediction of 2.2 million deaths in the U.S. However, the death rate is likely less than predicted with the do nothing strategy since millions of people are doing something, like washing hands, using Lysol and social distancing.

Suppression. This is the current approach and includes general quarantine, except for food and medicine, self-distancing, closure of schools, businesses and potential lockdowns. With suppression, we are counting on having a vaccine. If an effective vaccine is developed in 12 to 18 months, it could reduce deaths to below mitigation. But it is a long slog with a huge negative impact socially and economically. The Imperial College admits that this strategy has “enormous social and economic costs which may themselves have significant impact on health and well-being in the short and longer-term.” The suppression strategy also seems to be driven by ICU bed capacity.

Suppression involves the quarantine approach until September, and then rotating quarantines through September 2021. It doesn’t allow for a process to build “herd immunity,” and likely results in 1.3 million deaths from November through December of this year. It could become the worst Christmas in American history!

The Imperial College recommends that the quarantines be turned on and off until the immunizations are in full swing.

So, after five months of initial lockdown (which we are in) you relax things for a week and then lock everything down again for three weeks on a rotating basis. In many instances this just delays deaths by a few months. Yet, it crushes the economy and the human spirit as the world shuts down.

Mitigation. If we mitigate by urging those with symptoms or who have tested positive for the virus to self-quarantine, the projected death toll is 1.1 million (or less with better general hygiene). It would also decrease ICU demand by 67% over the do nothing strategy.

According to Imperial College, the most effective mitigation strategy is limited to these three tactics:

Home isolation for people with symptoms for seven days after symptoms are gone

Home quarantine for the other members of the household where one or more people have symptoms or have been diagnosed, for 14 days after the onset of the symptoms

Social distancing relative to those over the age of 70 especially those with preexisting conditions

In addition, with mitigation we should reopen schools, allow businesses to be back in business, and permit people to fly within the U.S. We will see some slowdown of the advance of the disease and relatively quick “herd immunity.”

Closing schools, as in the suppression approach, actually increases the death rate. Keeping schools open allows younger people to get infected faster and recover faster, while using the home isolation/home quarantine approach.

Note that with any of the three options, the vast majority of the deaths will occur with people over the age of 70.

If we act now and change to a mitigation strategy, we can reverse the economic free fall caused by suppression.

We also need to clearly articulate — so businesses can rely upon it — that government authority can no longer expand emergency powers beyond mitigation.

Barry Farah is a business executive, author and speaker and previous candidate for governor of Colorado.

The following long version of Barry’s comments on the response to COVID-19 along with graphs is provided here:

 

The Best Response to COVID-19 is Mitigation, not Suppression

By Barry Farah

 The Imperial College of London produced a report released March 16, 2020.  In this report, an impressive team of pandemic experts used mathematical models to predict the outcomes of three different potential responses to COVID-19.  Those responses are Do Nothing, Suppression or Mitigation.

Informed in part by this study and using the levers of emergency powers, a rendition of the Suppression response has been imposed upon us. After a deep dive into the data, here is a summary of the three potential responses and the reasons why I recommend Mitigation instead of Suppression.

 Do Nothing. If we do nothing and let the virus run its course, hospitals will be overrun in April to a peak of thirty times capacity by June. After two months of chaos in May and June, the nation will be effectively immunized by late summer.  (See Graph A below with Do Nothing info box)

 The alarming concern with this option is the prediction of 2.2 million deaths in the U.S.  The graph demonstrating this approach is included in option three below. As a comparison, the flu took 61,200 in the US in the 2018-19 season. And, the 1918 H1N1 took the lives of 675,000. At that time, the population of the US was 103 million.  That is the same death rate of 0.6% of the population that is predicted here. This assumes: “…the (unlikely) absence of any control measures or spontaneous changes in individual behavior…”Therefore, it would likely be much less, since the prediction does not factor in new hygiene, cleaning and social distancing.

 

Mitigation. If we mitigate by urging those with symptoms or who have tested positive for the virus to self-quarantine, the projected death toll is 1.1 million (or less with better general hygiene).  It would also decrease ICU demand by 67% over the “do nothing” strategy.

According to Imperial College, the most effective Mitigation strategy is limited to these three tactics:

1)     Home isolation for people with symptoms for seven days after symptoms are gone

2)     Home quarantine for the other members of the household where one or more people have symptoms or have been diagnosed, for fourteen days after the onset of the symptoms

3)     Social distancing relative to those over the age of 70 especially those with pre-existing conditions

In addition, with Mitigation we should re-open schools, allow businesses to be back in business, and permit people to fly within the U.S.  We will see some slow-down of the advance of the disease and relatively quick “herd immunity.” A lot of people will get sick. And, most will recover. Closing schools, as in the Suppression approach, actually increases the death rate. Keeping schools open allows younger people to get infected faster and recover faster, while using the home isolation/home quarantine approach.

Note that with any of the three options, the vast majority of the deaths will occur with people over the age of 70. The infection fatality ratio for 80+ is almost double that of a 75-year old and quadruple that of a 65-year old and 15.5x that of a 55-year old and an average of 315x that of everyone under 40.

In conclusion, the study admits that the Suppression strategy has a long overhang, stating that “The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed… We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound.”

The current state of affairs, where we are all subject to the Suppression strategy, begs the question, why is it considered “the only viable option”?

It seems that the assumption by the World Health Organization and Center for Disease Control is that ICU capacity should drive the decision.  Is it that the strong challenges in the first few months of Mitigation is too much to stomach?

But, what about the social and economic costs of Suppression. The authors of this study can only do so much with a mathematical model that does NOT factor in the impact on the economy.  As they admit, “We do not consider the ethical or economic implications of either strategy here…”

Though with Mitigation more people die faster, there are fewer deaths overall.  I also believe you end up with a stronger population who live with less fear and likely less despair.  In addition, “In this scenario, population immunity builds up through the epidemic, leading to an eventual rapid decline in case numbers and transmission dropping to low levels.”

If we keep going headlong with a Suppression strategy, what happens when another virus comes along? It is just not possible to continue to throw 10% of the GDP at a pandemic. Mitigation would not have required a $2 trillion stimulus to give to US citizens and businesses while people hunker down and live in a constant state of fear and uncertainty.

 Marriott, Hilton and Hyatt will be closing many of their hotels, GM, Ford and Chrysler will close plants and dealerships, retailers not already on the brink will close, pick an industry, things will shut down and tens of millions of citizens will be without a job.

Suppression is economic suicide.  In addition, I am greatly concerned that we will lose something much more important than our net worth; we could lose our soul as a country by stripping people of their dignity and purpose for long periods of time. People need their job for more than economic reasons – it gives them purpose and dignity and even has shown to provide healthy guardrails against bad behavior, like abuse, addictions and crime.

Even if you argue that many can survive online from home, what about the 67+ million in the US who work with their hands out in the field? Many of these people do not have ready skills to work from home.

Suppression is too extreme and there are not enough benefits to it: “The main challenge of this approach is that NPIs <non-pharmaceutical interventions, like shutting down businesses> (and drugs, if available) need to be maintained – at least intermittently – for as long as the virus is circulating in the human population, or until a vaccine becomes available. In the case of COVID-19, it will be at least a 12-18 months before a vaccine is available. Furthermore, there is no guarantee that initial vaccines will have high efficacy.”

If we act now, we can reverse the economic free fall. At a minimum, we need to clearly articulate (so businesses can rely upon it) that Government authority will not expand emergency powers beyond mitigation.

Mitigation is effective. It is reasonable. Leaders can stand strong for freedom, private property rights and health and safety. As the study states, “…the most effective combination of interventions is predicted to be a combination of case isolation, home quarantine and social distancing of those most at risk (the over 70s).”

To paraphrase Patrick Henry, I love life, but, given a choice of freedom, with the possibility of an earlier death or delaying my death a few months under suppression, please give me freedom.

Barry Farah is a business executive, author and speaker and previous candidate for Governor of Colorado.