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Multiple Proposals
Being Made For Going Forward Against COVID-19
Despite the success of
ongoing mitigation or social distancing measures in dampening the
spread of COVID-19, the strategy’s high social and economic costs have
brought forth a flurry of new proposals for how best to control or
even eliminate the disease from this point forward.
How We Got Here
After the first
appearance of the COVID-19 cases in the US, the initial control
strategy was to test ill persons to identify and treat cases, trace
exposed contacts, and quarantine persons when indicated. This
containment strategy failed to stop the chains of transmission
stemming from the earliest imported cases. This occurred for a variety
of reasons, including the fact that not all infected persons were
symptomatic, and testing with rapid results was not widely available.
As community
transmission took hold, the fear that hospitals and other providers
would be overwhelmed and that deaths would rise even higher encouraged
or even necessitated the use of severe social distancing measures to
slow the rate of spread even at the cost of severe economic impact.
This mitigation strategy has been widely referred to as flattening the
epidemiologic curve. It sought to buy time for hospitals, health care
workers, first responders and other service providers by slowing the
demand for services and thereby preventing deaths that would have
occurred in a completely overwhelmed health system.
Not all countries
bought into these
containment or
mitigation strategies as the best approaches.
Different
Approaches
Sweden
took a much less restrictive approach with the idea of allowing the
population to acquire disease and create a level of population
immunity that might become high enough to provide herd immunity
against future outbreaks. The United Kingdom also gave consideration
to this approach early on until epidemiologic models predicted that
this strategy without social distancing measures could produce half a
million deaths. The same models predicted over 2 million deaths in
the US without aggressive social distancing measures and reportedly
influenced the US decision to undertake widespread mitigation. These
model estimates of expected deaths have subsequently been lowered to
reflect the new realities created by implementation of strict measures
in the UK and the US.
Crushing The Curve
New Zealand took a
more extreme strategy to not merely flatten the curve but to crush the
curve. The goal here was to implement such strict measures that the
imported virus could actually be eliminated and future importations
blocked or new chains of transmission contained through testing,
contact tracing, and quarantine.
Current Situation
Now that mitigation
efforts have proven effective
in slowing
spread in in several of the viral hotspots where SARS-CoV-first
appeared, some of the negative impacts on the economy and the quality
of life in the US have become clearer. It is apparent that the
restrictions imposed by the social distancing strategy must be eased
at some future point and discussions have intensified about what the
best way forward might be and what the optimum balance is of public
health and economic and social measures. Making these choices will be
fraught with uncertainties about the new virus such as whether it will
exhibit seasonality or whether it will occur in additional future
waves of infection.
Lives Saved Do Far
A
recent Wall Street Journal investigation reports that mitigation
efforts in the US have saved more than 100,000 lives by mid-April and
will have saved 500,000 lives by the end of the month. Putting the
statistical value of a life at $10 million, the benefits of mitigation
equalled an estimated $1 trillion by mid-month and $5 trillion by end
of April. A second estimate in the report is that social distancing is
saving 1.7 million lives worth $8 trillion for three months of social
distancing. The cost to the economy is estimated at $3 trillion
through 2022 and the article calls this trade-off worth it in an
accounting sense. These estimates are derived in part from the work of
Alessandro Vespignani and his team of modellers at Northeastern
University. He told the WSJ, “The decisions that will be made in the
next few weeks must include economists and epidemiologists and public
health people to find the trade-off between those two viewpoints.”
Articles in this issue
of the Epidemiology Monitor provide details about some of the new
proposals being circulated.
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