A Strategy To Get Past The Shutdown?

We don't have that strategy yet--or, at least, not one that's been publicly promulgated. However, two articles today may point the way. Nothing in the articles is exactly new, but taken together the elements of a workable strategy to combat the disease and take some pressure off the economy--and working people--may be close to falling in place.

For now, we're still concentrating on keep the Attack Rate (Rate of Infection) as low as possible. That's what social distancing is all about. If that rate isn't constrained the then inevitably the Case Fatality Rate will begin to climb. All that and much more is discussed in Why the Shutdown Is Necessary: This is not just a bad flu. The article is heavy on statistics, but without that knowledge you'll be left thinking the recent upward trend in the Case Fatality Rate in supposedly model countries like South Korea and Germany are somehow inexplicable. Those trends are not inexplicable and were entirely predictable. It's not that South Korea and Germany are doing something wrong--they're doing it right, but this virus is really that dangerous if allowed to rampage through the general population. Pretending this is just the flu, or something very like it, isn't an option and is simply a denial of basic science.

Having said that, there is hope, and the hope lies in testing. But not the testing we're all familiar with from standard scorecard type stats: Total case, New cases, Total deaths, New deaths. If you read through the article linked above, slowly digesting it, you'll understand why those stats are deceptive unless they've been carefully sifted.

The second article--A better way to handle the coronavirus?--gets into the testing more deeply. We've mostly all heard about the usual testing for the virus. But other types of testing are coming online, and these types provide hope that we may soon be able to distinguish between those who are truly at risk and those who are not or are no longer at risk. (Other genetic factors may also play a role in this, but are too speculative for any practical application at this point.) We're talking about antibody tests:

We now have the ability to conduct antibody tests that are quick and inexpensive.  These tests will identify patients who have immunity (IgG antibodies) versus current infection (IgM antibodies).  An immune person can likely safely return to work and be out in public, as would also be the case with an immune customer.  A five-minute test prior to entering a store or restaurant would allow both a worker and a customer to safely return.  A person who has neither antibodies (not yet exposed) would be stratified into a risk category to determine activity.  

Of course, the real question is not whether we "have the capability"--it's a question of logistics, deploying that capability, making it widely available. However, once that can be accomplished, the stratification of the general population into risk categories becomes more feasible.

The author of this blog provides a breakdown that, admittedly, can't be ironclad. Once you start listing "risk factors" you may be surprised at how much of the population are included. For example, in the "high risk" category are "older Americans, 60 and above, and those who are immuno-compromised." Wow! That's a lot of people. Smokers, fat people, diabetics, those with heart conditions of all sorts, male homosexuals, and on and on the list goes. Nevertheless, this stratification suggests a way to come up with a more flexible social distancing strategy.

Here are the authors' tentative categories:

1. High Risk (with no antibody protection) 

Taking guidance from the CDC, those who are at the highest risk are defined as older Americans, 60 and above, and those who are immuno-compromised.

...   

2. Medium Risk 

If you are experiencing flu-like symptoms, you should self-quarantine and be tested and retested to confirm COVID-19 or to rule it out. 

If you live in an urban population center in New York, New Jersey, Michigan, Louisiana, or California, you are at higher risk of contracting the coronavirus and should take precautions to protect yourself and your neighbors.

If you are healthy but live with someone in a high-risk category, you should take precautions to protect your loved ones and consider testing to know the status of immunity. 

3. Low Risk or confirmed antibody protection 

If you are young and healthy and live in a more suburban or rural setting, your risk of contracting COVID is low.  While you should continue to practice "social distancing" measures and wash your hands regularly, you should be permitted to go back to work and begin to socialize in small group settings.

The third factor in the strategy is actually closer to becoming widely available. That is the availability of specific medical treatments of various sorts. When combined with flexible social distancing based on risk categories as well as prudent precautionary measures--gloves and masks--we may be nearer than we think to a strategy that would address both medical and economic concerns. However, it is key that we not jump the gun--not attempt this comprehensive strategy before all the parts are in place.