This Is How We Can Beat the Coronavirus

Many readers have no doubt heard that what galvanized Trump to decisive action regarding Covid-19 was the presentation of a study done by researches at Imperial College, London. That study offered a worst case scenario if no action were taken. Trump took action. For those of you who believe that this is just a panic, you should know that what's behind it is epidemiological modelling such as formed the basis for the Imperial College study.

At The Atlantic today two doctors argue that there are more steps to be taken. I don't doubt that Trump and his advisers are already on top of most if not all of their recommendations.

For skeptics, I strongly recommend reading up on the 1918 flu pandemic to get an idea of what can happen with a novel and lethal pandemic. The 1918 flu pandemic was novel and lethal--on a scale few can really grasp. It targeted the young and healthy. We as a people have developed limited immunities to common varieties of the flu, but no vaccine is close to being as effective as we need--which is part of why flu is such a killer still. Covid-19 is also novel--it's a killer, it spreads rapidly, and we have no immunities. A wild card is that we may have some specific treatments in the form of anti-malaria drugs that have anti-viral properties as well.

Below are extensive excerpts from the article--but there's lots more at the link:


This Is How We Can Beat the Coronavirus

Mitigation can buy us time, but only suppression can get us to where we need to be.


.. A recent analysis from Imperial College is now making some Americans, including many experts, panic. The report projects that 2.2 million people could die in the United States. But the analysis also provides reason for hope—suggesting a path forward to avoid the worst outcomes.

We can make things better; it’s not too late. But we have to be willing to act.

Let’s start with the bad news. ... If we do nothing and just let the virus run its course, [the report] estimated that infections would peak in mid-June. We could expect to see about 55,000 deaths, in just one day.

Of course, we are doing something, so this outcome is unlikely to occur. ... the report predicts that a significant number of infections will occur, that more people will need care than we can possibly provide in our hospitals, and that more than 1 million could die.

... we are only engaging in mitigation.

Suppression refers to a campaign to reduce the infectivity of a pandemic, what experts call R0 (R-naught), to less than one. Unchecked, the R0 of COVID-19 is between 2 and 3, meaning that every infected person infects, on average, two to three others. An R0 less than 1 indicates that each infected person results in fewer than one new infection. When this happens, the outbreak will slowly grind to a halt.

To achieve this, we need to test many, many people, even those without symptoms. Testing will allow us to isolate the infected so they can’t infect others. We need to be vigilant, and willing to quarantine people with absolute diligence.

[In a previous post I recounted Dr. Michael Osterholm's experience with SARS in 2003. He discovered that there were "superspreaders" who made a mishmash of all the R0 theory. That's part of why testing is so important. However, at this relatively early stage and with out very limited resources, Osterholm recommends more targeted testing--and that appears to be what is going on. The testing appears to be aimed at insuring the integrity of healthcare facilities and personnel. For the time being.]

Because we failed to set up a testing infrastructure, we can’t check that many people. At the moment, we can’t even test everyone who is sick. Therefore, we’re attempting mitigation—accepting that the epidemic will advance but trying to reduce R0 as much as possible.

Our primary approach is social distancing—asking people to stay away from one another. ...

But these efforts won’t help those who are already infected. It will take up to two weeks for those infected today to show any symptoms, and some people won’t show symptoms at all. Social distancing cannot prevent these infections, as they’ve already happened. ...

But buried in the Imperial College report is reason for optimism. The analysis finds that in the do-nothing scenario, many people die and die quickly. With serious mitigation, though, many of the measures we’re taking now slow things down. By the summer, the report calculates, the number of people who become sick will eventually reduce to a trickle.

On this path, though, the real horror show will begin in the fall and crush us next winter, when COVID-19 comes back with a vengeance.

This is what happened with the flu in 1918. The spring was bad. Over the summer, the numbers of sick dwindled and created a false sense of security. Then, all hell broke loose. In late 1918, tens of millions of people died.

[Tens of millions. Have critics of the measures Trump is taking really internalized that possibility? This is a novel, highly infectious virus, that kills at an unacceptable rate. We can't afford to wait for a vaccine and, anyway, our experience with flu vaccines is not encouraging.]

If a similar pattern holds for COVID-19, then while things are bad now, it may be nothing compared to what we face at the end of the year.

Because of this, some are now declaring that we might be on lockdown for the next 18 months. They see no alternative. ...

But all of that assumes that we can’t change, that the only two choices are millions of deaths or a wrecked society.

That’s not true. We can create a third path. ... We could develop tests that are fast, reliable, and ubiquitous. If we screen everyone, and do so regularly, we can let most people return to a more normal life. We can reopen schools and places where people gather. ...

...

We will need to massively strengthen our medical infrastructure. We will need to build ventilators and add hospital beds. We will need to train and redistribute physicians, nurses, and respiratory therapists to where they are most needed. We will need to focus our factories on turning out the protective equipment—masks, gloves, gowns, and so forth—to ensure we keep our health-care workforce safe. ...

...

... We’ll need to build up our stockpiles, create strategies, and get ready.

If we choose the third course, when fall arrives, we will be ahead of a resurgence of the infection. ...

...

The last time we faced a pandemic with this level of infectivity, that was this dangerous, for which we had no therapy or vaccine, was a 100 years ago, and it led to 50 million deaths. The coronavirus pandemic isn’t unprecedented, but it’s not anything almost anyone alive has experienced before. We, are, however, much more knowledgeable, much more coordinated, and much more capable today.

Some Americans are in denial, and others are feeling despair. Both sentiments are understandable. We all have a choice to make. We can look at the coming fire and let it burn. We can hunker down, and hope to wait it out—or we can work together to get through it with as little damage as possible. This country has faced massive threats before and risen to the challenge; we can do it again. We just need to decide to make it happen.


AARON E. CARROLL is a professor of pediatrics at Indiana University School of Medicine.

ASHISH JHA is the K.T. Li Professor of Global Health at Harvard University, Dean for Global Strategy at Harvard T.H. Chan School of Public Health and the Director of the Harvard Global Health Institute.