Now What?
Now that health experts have convinced governments world-wide to encourage/enforce “social distancing”, some uncomfortable questions appear. How much social distance is enough? No school? No meetings of ten people are more? No friends visiting for dinner? And how long do these measures have to be maintained? Weeks? Months? Years?
Social distancing is premised on the idea that fast spread of the disease is more dangerous than slow spread. With fast spread, the small fraction of people who become sick enough to require hospitalization will number in the millions and quickly overwhelm the health care system. Slow spread will reduce pressure on hospitals even if it does not reduce the number of cases. If natural spread of the disease requires twice the number of available hospital beds (or intensive care beds, ventilators, or any other finite resource), than hospitals will not be able to care for many of the people who need medical attention, presumably harming and even killing many patients. Slowing the spread of the disease will reduce the number who need treatment at any time.
The problem is that if social distancing does not actually reduce the number of patients, the price of making the medical emergency less intense is making it longer. It is easy to see a quick economic and social recovery from a month of cancelled flights, docked cruise ships, closed restaurants, empty hotels, school-from-home, and the rest. What if it’s three months? Or six months?
What if we have to keep this up till a vaccine is available? That could take over a year.
A Crazy Idea
My son Benjamin thinks we are all making a big mistake by putting ourselves in indefinite quasi-quarantine. He has a crazy idea for an alternative.
“I’d rather get sick faster. Expose me to coronavirus now! This way I just go into quarantine for a couple of weeks, and then I can live out rest of my life without being trapped in the house with you.”
Something that makes this idea a little rational is the low risk to young people. If all COVID-19 does to a young adult is a brief flu-like period of fever and coughing, then the cost of infection is pretty low. The benefit to Benjamin of getting it over with is post-infection immunity and freedom. He doesn’t have to stay confined to the house with his parents anymore.
The benefit to society is a pool of “infection dampers” – people whose immunity will reduce the spread of the disease.
If everyone is trying to avoid getting sick, then we have a trade-off between the creation of infection dampers and the cost of those people getting sick. The more successful social distancing is, the fewer immune people to slow the spread. Speeding up the spread of disease among the people who are not harmed by it reduces the spread to vulnerable people without the suffering and resource overload of unchecked spread among the general population.
If this crazy idea were to be implemented, people in low-risk groups would be intentionally exposed to the virus and quarantined. They would then be allowed to go back to normal life. In fact they could perform many functions that older, at-risk people should avoid while the epidemic is still spreading.
Before You Start Organizing Infection Raves
If we want to know if this is a good crazy idea or a bad one, we need to answer some questions.
What is the risk to “low-risk” populations? The Chinese CDC reports that death rates for people confirmed to have COVID-19 were .2% for ages 10-39, .4% for 40-49, 1.3% for 50-59, and increasing up to 14.8% for 80 and up.
A death rate of .2% sounds low, but the United States has about 80 million people in the 20-39 age range (about 1/4 of the 330 million total). If they all get the disease, that rate implies 160,000 deaths. The same Statnews article quoted above notes that health conditions such as diabetes, cancer, and cardiovascular diseases greatly increase the risk of death. For a healthy person under 40, the risk of death may be much lower than .2% But I don’t think anyone knows how low.
How long is a patient infectious? There is some evidence that people with a mild illness from COVID-19 are unlikely to be infectious more than 10 days after the start of symptoms. However, this result was based on only 9 patients.
Are people immune after recovery? One recovers from a virus through the immune system overcoming the virus. The general assumption is that once this happens, the immune system can quickly suppress the virus upon any future exposure. There are some reports, however, of people undergoing either a relapse or re-infection after apparently recovering from the disease.
How long will this last? South Korea (see figure) and China seem to have turned a corner on infections relatively quickly. Can we reproduce that in the US? I hope so, but its not clear. For one thing, we may be catching it later than South Korea and may not be able to get the same level of compliance as either Korea or China. For another thing, unless the disease is completely wiped out, it seems that reducing it to a small number of cases and then relaxing social distancing measures will simply start the epidemic all over again.
Conclusion
I have none. This is an interesting idea. Many interesting ideas are also wrong, and in the case of dealing with a deadly disease, wrong ideas can be disastrous. Still, current strategies for COVID-19 may also be wrong.