I've been highly critical of the social distancing strategy, which leads to lockdowns, mass house arrest, and suspending of public worship. I've criticized that on economic, theological, and Constitutional grounds. The obsessive, myopic focus of so many public officials in pursuing a containment strategy has led to the neglect of other options. So what's my alternative?
Of course, I'm no expert, but for what it's worth:
1. Until a vaccine is developed, the best policy is a combination of:
2. Mass testing. Those who test positive are treated if they require treatment and quarantined. But most who are infected will have mild symptoms, don't require treatment, and don't need to be quarantined. They can work and keep the economy afloat. Not to mention those who aren't infected.
3. Qualified herd immunity. This would be for those who are not at high risk, or have mild symptoms. The high-risk groups would be quarantined for their own protection.
However, it's probably too late to implement this policy during the current cycle. We don't have the resources for mass testing a population the size of the USA. Not to mention that testing might need to be repeated since you could be uninfected one week but infected the next week. And, of course, the best available treatment options are debatable.
That said, we begin reallocating more resources to these alternatives. And since this is not the last pandemic we're going to see, we'd be in place to implement an alternative strategy to cope with the next pandemic.
A few thoughts:
ReplyDelete1. I think this is a reasonable position.
2. Short of a vaccine, the harsh reality is it's impossible to save everyone. Some or many people will die.
3. As such, the real question seems to be which group a society will place at most risk of dying. Some group has to bear the brunt of the risk in order to safeguard the rest of society. So I think it's more about who's going to take the risk. It seems obvious the answer should be the younger should protect the older, the healthier should protect the unhealthier, those less at-risk should protect those most at-risk.
4. However, I think the basic ranking in our secular society is that physical lives are more important than people's livelihoods which in turn are more important than people's spiritual lives. Yet many people (save secular atheists) have been willing to sacrifice their livelihoods and their physical lives for their religion. Likewise many people have been willing to go to work to provide for their families even if it means it damages their physical health.
5. At the individual level, we can voluntarily self-isolate if we are sick in general (without knowing if it's coronavirus or not). If we feel sick, stay home. If we need to go out, then we can stay away from people who might be vulnerable, practice good hygiene.
6. At a community level, we can have point-of-care testing. That is, testing at a doctor's office. If a patient comes in with flu-like symptoms, then a clinic can immediately do a quick swab to test if it's a flu or coronavirus. Ideally that could be ready in a matter of minutes. (This already routinely happens at many places every flu season.)
7. If it's coronavirus, then they can go home and rest and self-isolate. Like a flu. See if it worsens or if it gets better. At present it looks like approximately 80-85% of people with coronavirus will get better simply by being at home and resting and so on.
8. The additional detail is that if they are positive for coronavirus, then we need to know if they've come into contact with any who are vulnerable (e.g. the elderly). Kind of like tracking down the sexual partners of someone who has an STD and warning them about it.
9. We can have drive-through testing as another kind of safety net for society.
10. Places like Hong Kong and Taiwan have phone apps that will show them if someone is sick and where they have recently eaten or shopped. I think this is done voluntarily. Or at least it should be voluntary. Although this might risk damaging businesses. But maybe it'd be better than having all businesses shut down. Not sure.
11. If someone starts being unable to breathe well, then they can call their doctor or they can go directly to the hospital. Usually the ER is where people turn up. They'll either be sent back home if it's manageable at home or admitted into the hospital if it's bad enough.
12. An issue is people who have the coronavirus but are asymptomatic. There's debate over how extensive this actually is. So I'm unsure how concerned we should be about this. Are we worrying over something that isn't really there or isn't significant enough? However, we can use serology to test for the presence of antibodies in their blood.
13. We can implement mass surveillance as Scott Gottlieb has outlined here (though I haven't read it yet).
Gentlemen--
ReplyDeleteSounds quite reasonable with one caveat: many family homes are multi-generational (including mine). What do we do with these families, particularly prevalent in certain minority ethnicities...some of which are already at higher risk for COVID?
You cannot isolate AND develop herd immunity at the same time and in the same place.
i) Each policy has tradeoffs. Each policy is a compromise. Each policy hurts some group.
Deleteii) True, you can't have systematic isolation while developing herd immunity. So you try to strike the balance that's feasible. There are practical limitations on what we can do.
iii) I'd add that living a long had carries tradeoffs. That's not risk-free. Beyond a certain age there's increasing risk of developing a ravaging disease like Parkinson's or senile dementia. Or unfunded mandates like Social Security and Medicare going bankrupt.
Steve--
ReplyDeleteAccording to Pew Research, 64 million Americans live in multi-generational households. That's 20% of our total population! That's a pretty sizable chunk to be leaving out.
Sure, all policies have trade offs, but we usually fine-tune them to avoid UNNECESSARY trade offs.
Being a youngster with an underdeveloped immune system also carries great risk. Are you similarly willing to just let them go...as a trade off?
From Steve Taylor's song "Life Boat":
Throw over grandpa 'cause he's getting pretty old.
Throw out the baby, or we'll all be catching its cold.
Throw over fatty, and we'll see if she can float.
Throw out the retard, and they won't be rockin' the boat.
i) 64 million Americans living in multigenerational homes doesn't entail that 64 million Americans in that group will contract the coronovirus. Likewise, it doesn't entail that of those who do, most of them will develop a life-threatening condition.
Deleteii) Each policy has tradeoffs. Lockdowns and mass house arrest have tradeoffs. If we have a national or global depression because we shut down the economy, how many people will die as a result of that policy? Or be homeless? Turn to property crimes to support themselves? Turn to drugs and alcohol to cope? Suffer clinical depression?
In addition, the policy is cratering the healthcare system as well. So there won't be a healthcare system to fall back on when the dust settles.
iii) It's a pandemic. People die in pandemics. People have always died in pandemics. That's an unavoidable tragedy. The question is what we can do to mitigate the harm, given our very limited ability to control the situation.
I didn't create the lifeboat situation (to use your metaphor). And there's no scenario in which all the passengers survive. Many passengers are thrown overboard when they lose their means of livelihood under a lockdown/curfew policy.
I didn't suggest that some individuals are less deserving of life than others. For the record, I'm in a high-risk group to contract the virus. So I'm not speaking out of personal self-interest.
Steve--
ReplyDeleteI think we're speaking past one another a little bit here. I'm not suggesting that we don't make plans to open up the economy soon. What I am suggesting is that, when it comes to mitigating harm, we act like everyone is as deserving of life as everyone else.
In general, we need to isolate those at risk and send the rest of the populace back to school and back to work. All that I am saying is that we could ameliorate the situation for multi-generational households by allowing them to hold back children from school attendance (and having them finish their work at home) or by allowing parents extra unpaid leave or by furnishing alternative housing (campers/tents) for those who are out and about or by giving instructions on how to cordon off sections of a house to protect the vulnerable....
Well, I support homeschooling anyway.
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