Back to Normal, Controlling COVID19

On April 16, my article How to re-open the country and control COVID-19 #coronavirus was published by WUWT. Some of the main points of the article are:

  • It is paramount to measure the percentage of infected and immune individuals in the population, across all age groups, and in many locations. This requires random population sampling, similar to public opinion polls and marketing surveys, but necessitating physical contact. Traditional Sentinel Surveillance programs, which rely on physician reports, are not applicable to COVID-19. 
  • States and counties with low COVID-19 infection levels have no justification for maintaining lockdowns or keeping businesses closed, with a few exceptions. These areas should not wait until the number of “new cases” begins to decrease, for a few reasons: 
    • The current number of “cases” is not a meaningful metric. It does not represent how many people are actually infected, only how many were tested positively for the coronavirus.  
    • Now we have more knowledge and effective treatments for COVID-19, including hydroxychloroquine .
    • The high fatality scenarios have been associated with lack of knowledge (Wuhan, Lombardy, New York) or an abundance of panic (New York). In these cases, medical facilities became infection amplifiers.
  • The most important and relevant metric is the percentage of infected and immune persons, determined by random sampling of the population. The only other useful metric is the utilization of the local medical facilities, necessary for handling COVID-19 patients. 
  • One size doesn’t fit all. COVID-19 is dangerous to older (65+) and ill people. They need more protection. Young (<50) and healthy individuals are largely safe. They should not be burdened with restrictions designed for the more vulnerable groups. This suggestion works well in the US, where older people typically live separately from their adult children. Other countries may want to exercise caution, as younger people can be unaware carriers of the virus and infect their elderly relatives. 
  • A Go-Stop-Go normalization strategy would allow for better control of the disease and faster normalization, than a gradual lifting of restrictions. Go-Stop-Go means lifting a large chunk of restrictions for a predefined short period (2-5 days), then restoring the previous restrictions (subject to the Constitutional limitations) for another 5-9 days to evaluate the impact, then lifting them again if no significant spikes are observed.
  • CoV2, the pathogen causing COVID-19, is a novel zoonotic virus. However mild at this time, it could mutate into a lethal strain. It has not explored its “viable mutations space,” unlike old human coronaviruses. Thus, proper monitoring and preparedness for possible highly lethal outbreaks is essential. This requires opening the economy and freeing the workforce to take action.
  • No level of the US government has the authority to order mass house arrests or lock-downs.
  • Opening schools is a necessary condition for normalization. When exposed to the novel coronavirus, most children have no symptoms and probably gain immunity to it. The parents might get infected but are likely to have mild symptoms, except for rare instances where the parents are  65+ or have certain health conditions. Grandparents and other elderly family members should be kept away for some time, as their risk of serious illness is much higher. 

It might be beneficial for young and healthy people to naturally gain immunity by moderate exposure to CoV2.

Neither CDC sentinel surveillance network not its EU sentinel surveillance equivalent  are efficient for COVID-19 surveillance because its speed of contagion and large percentage of asymptomatic infections.

Update: Boston Globe, April 17: Nearly a third of 200 blood samples taken in Chelsea show exposure to coronavirus 

These samples were drawn randomly, in a public square. This is a good, although not perfect, example of population sampling for CoV2 antibodies. If the results are representative of the whole population, 32% of Chelsea has in fact been infected and recovered, compared to the 1.9% who have tested positively.  Most of the infected were unaware, although nearly half of them mentioned at least one symptom, in hindsight.

Originally published on April 17. Updated on April 19.

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