Ahead of the Curve

From my op-ed in today’s New York Daily News.

Governments around the world seem to have one of two horrible options: Shut down entire economies or face the same tsunami of deadly disease that overwhelmed Italian hospitals. With that choice, most have chosen to tell the vast majority of people to stay at home unless absolutely necessary.The impact of lives shattered as businesses are destroyed and countless millions lose their jobs will haunt us for many years to come. Accounting for the public health impact in terms of physical and mental well-being will be more challenging, but I expect those costs will be staggering as well.

So how do we find a line between public health disaster and economic collapse?

We must act. But is there a more measured, targeted approach that minimizes collateral damage?

I believe so.

The best way to think about COVID-19 is as two diseases. In children and young adults, this is like a bad case of the flu. Even the flu can put a young person in the hospital, but we don’t shut down the economy to prevent it. In the elderly and infirm, it is similar to SARS. That virus was even more deadly than the current variant, but the COVID-19 virus is far more contagious and difficult to contain.

Because we do not have a cheap, simple way to test for the disease yet, we have been unable to contain it through the conventional approach of quarantining the infected and their contacts. As a result, we are effectively quarantining everyone. But this is causing economic devastation and is not sustainable.

COVID-19 will not stop until we have herd immunity, and the only way for that to happen is through the development of a vaccine, exposure to the disease itself or some combination of the two. With that in mind, a more measured approach would focus on protecting the most vulnerable, while we radically ramp up testing so we can identify and isolate the ill and infected.

Specifically, we should do the following:

1. Develop a vulnerability index, such as the one described recently by British researchers to determine who is most vulnerable and aggressively protect them with full community and mental health support. This sort of algorithm can and should be revised as more data become available and as treatments improve.

2. Make the development, testing, and production of an antibody screening test, such as the one recently developed by researchers from Australia, Finland, and New York’s Mt. Sinai Medical School, a top priority with the goal of determining exposure to the virus in the entire population. Those who test positive should be quarantined if needed and then allowed full freedom of movement. Those who are immune would be ideal candidates to work with those infected or at risk because they will have immunity.

3. Universal screening will allow us to understand the true prevalence of the virus and to track the development of herd immunity. With that knowledge, we can consider allowing those who test negative, but are at low risk of serious disease, to return to normal activities with reasonable precautions to prevent viral transmission. At the same time, a plan for regular rescreening of the population can be developed to track population immunity levels.

4. Provide full support for ongoing efforts to develop and test vaccines for the novel coronavirus (SARS-CoV2).In other words, protect the elderly and infirm as if this were SARS, protect the young and healthy as if it were the seasonal flu, and aggressively monitor for emergence of the disease.

We need to strive to prevent deaths without destroying lives. The choices are complex and there is no zero-risk strategy, but as the immediate crisis fades, we need to consider the full impact of our actions and be guided by our minds, not just our fears.