April 29, 2020

The Coin-Toss Approach to COVID

by James Whiting, MD, FACR

In March 2020, a public-health physician wrote in The New York Times, Is Our Fight Against Coronavirus Worse Than the Disease? The Trump administration echoed this sentiment as Boris Johnson slowly shifted his plan to more conservative measures as the threat of the virus increased.

Any approach depends, of course, on the expected 12- to 18-month delay for a vaccine and the absence of any effective pharmaceuticals, neither of which is more than a coin toss.

The development of herd immunity requires that we allow a segment of the population to become infected and develop immunity to the agent. It is accepted, but not spoken, that some people will die during this process. The benefit will be to those sequestered, the most vulnerable (of whom, ahem, full disclosure, I am one) — when released from confinement — will be very unlikely to encounter the virus since the survivors will be immune to infection.

Unfortunately, the sequestered (those over 70) are the least valuable segment of the population. They are beyond childbearing years, aren’t productive workers (look at the politicians) and don't spend as much money. This group will remain vulnerable when the virus resurrects, as coronaviruses tend to do (take for example, the flu epidemics every year or so).

The advantage of herd immunity is that the economy, wounded but still vital, continues to provide resources for both segments of the population, sequestered and not. In addition, restaurants and bars are open and thriving, not throwing employees onto the street.

If we apply what happened with the Diamond Princess, 80 percent of those exposed will not become infected, for one reason or another (including genetic or inherent insusceptibility). Of those infected, about half will be asymptomatic. About 1 percent of the infected will die, almost all of them elderly. Yet these numbers are based on an insufficient sample as well as previous performance and are not a predictor of future performance.

What are the consequences of another Great Depression, arguably much worse than 1929 when the world didn't produce as many goods or spend nearly as much money? Your speculation is as good as mine. The devastation could include the loss of businesses more essential than restaurants and bars, loss of trained workers and the anguish that ensues from such hardship.

I find it hard to accept that outcome, and I am willing to bet my life on it. This does not mean we should resume concerts, ball games and lectures. But we could consider our options a little more carefully, using the sequestered as our historical guides.