In the April 23 paper, we had an editorial cartoon of Pandora's Box with a key on the floor, labeled "Reopening Soon.” And then CDC director Dr. Robert Redfield warned that a second COVID wave in the fall may be worse than the first.
Protests against the lockdown are a preview of the coming class/generational warfare we're facing as governors struggle to find the political balance between the tragedy of job loss and fear of COVID-19. Everyone working with this mysterious new virus is missing important puzzle pieces, awaiting future research.
In general comparison to influenza, which itself varies widely from year to year, COVID is maybe twice as dangerous (death rate of 0.2% instead of 0.1%), and three times as likely to have no symptoms at all (60% to 20%). Nobody has any immunity from past infection or vaccination.
Throw in the lack of testing for infection or recovery, and you can see why this pandemic is a nightmare for the health care system.
How do our yearly epidemics end? With influenza, "herd immunity" develops when 50%-60% of the population is protected by immunization, cross-immunity from past epidemics, or recovery from infection. COVID will resolve itself when we achieve herd immunity, find an effective treatment, or develop and distribute a vaccine.
The current strategy is to "flatten the curve" of infection to avoid overwhelming our ICUs, then play quarantine whack-a-mole as adequate testing allows teams of public health workers to identify cells of infection.
The Achilles heel of this approach is that herd immunity will not develop. The hope is to simply hold the line until we get a vaccine. The problem is that it took five years to develop an Ebola vaccine, and only time will tell with COVID.
If, as emerging data seems to indicate, the true death rate for infected individuals turns out to be closer to 0.2% than 2%, and CDC statistics continue to show that 7% of deaths occur in the under-55 age group, the risk of death in that group will approximate 1.4 per 10,000.
Furthermore, since it only takes infection in 60% of the population to achieve herd immunity, that rate drops to 1 in 10,000. If we have 100,000 citizens in Shawnee County under age 55, that’s just 10 deaths.
At that point it becomes clear that the Swedish strategy, perhaps with more aggressive isolation of older, sicker, unemployed citizens, would have allowed the economy to pretty much go on as usual. And we still would have had March Madness to amuse ourselves as we practiced modest social isolation to "flatten the curve" of hospital admissions.
This hypothetical scenario, now past, makes the current "debate" about re-opening the economy look pretty silly. Just admit we made a mistake, with inadequate information and the best of intentions, isolate the high-risk population until herd immunity emerges, and let people go back to work.
Admitting honest mistakes is admirable and defensible, although difficult for politicians.
Under the present strategy, COVID will do an encore in August. Are we again going to close schools, restaurants, theaters and sports events?
As the economy opens up in the next month or two, it’s time for a discussion about our COVID strategy. There are well-respected epidemiologists who think rolling lockdowns are not the answer. In military terms, no strategy survives first contact with the enemy.
Let’s re-evaluate the battle plan.
Doug Iliff, MD, FAAFP, has been a family physician in Topeka for 34 years.