What If Our Strategy Was Wrong?
In a chilling op-ed in The Wall Street Journal on April 24, Joseph C. Sternberg asks the unaskable question. Were the experts right the first time when it came to the novel coronavirus from Wuhan? What does he mean?
If you go back a few weeks, you will remember that the reason for using the mitigation strategies of extensive hand washing, social distancing, and quarantining, was that these rather modest strategies were aimed at “flattening the curve” of covid-19 cases. That curve was presumed to be bell-shaped, something that has yet to be proven, and that if we reduced the intensity of the number of diseased people per unit of time, the health care system could keep up with the stress. Mitigation was not going to reduce the total area under the bell-shaped curve (the one that may or may not exist). It was not to decrease overall disease or death. It was to spread it out over time so the hospitals could manage the patient load and that the coming of warmer weather in the Northern Hemisphere might cause an abatement in the number of cases as it does for seasonal influenza (something else that is at best wishful thinking, thus far).
But that’s not what has been sold to the world (except in some places like Sweden). What has been sold to the world is that the closing of the economies and commerce of these countries would decrease the suffering and death from the new disease and surely in 12 to 18 months we would have a vaccine (despite the fact that there has never been a coronavirus vaccine successfully devised yet). Why did we change our tune?
The truth about the original strategy was that it was counting on the eventual onset of herd immunity—when a sufficient number of people in a population have been infected with a virus, they are immune to subsequent infection (also never proven for coronaviruses). This is true for measles and small pox. We may learn if it is true with coronaviruses if Sweden does not see a second wave of infections because it has acquired a level of infection in its population that gifted that population with herd immunity. If all of Western Europe and Asia sees a rebound in the fall, we will know that mitigation does indeed “work” in decreasing early caseloads, but may not work in preventing the lingering of the virus in a population or the total number of sick or worse.
I say all of this because I believe that the media and the Trump Administration have sanctioned the mitigation approach without reminding people of the purpose of the strategy—spreading and flattening the curve, not decreasing the area under that curve (total coronavirus infections and deaths).
The economy of the world has been adversely affected by the chosen response to the coronavirus. In places like New York, there was no choice. Without mitigation, the hospitals there would have been overrun. That may well be true everywhere in the United States, but no one should be complacent about the end result. It was to flatten the curve, not eliminate the virus. Neither mitigation nor parenteral bleach will do that. That will probably take a vaccine or a treatment that can turn a potentially serious disease into the common cold.
I say all this because the original science made sense, but the payoff was not politically acceptable. It appears from the recent demonstrations, even mitigation might not be politically acceptable for long.
So it’s not whether or not the coronavirus is just a bad flu year. It’s that it is not eradicated and will not be by mitigation. No coronavirus vaccine of any kind exists yet nor does a viable treatment for those with the covid-19 disease. Herd immunity is a hope and hope is not a strategy. It is time for the leaders of the world’s countries to be honest with their people. This is not likely to go away and people will continue to die. Whether that leads to a strategy of foreseeable mitigation or a drive to herd immunity by opening up the economies of the west and Asia is a decision each leader will have to make. But each of those leaders needs to be forthright with his or her constituents.
I have a vision for the future.
I have a plan to get there.
It won’t be easy.
It will be worth it.
That is clearly not the message of the Trump Administration nor of most other countries around the world and that’s too bad because we are not even at the end of the beginning of this challenge and we haven’t been honest with the people.
Like with cancer, the only proper response to facing the coronavirus is humility. The virus is in charge.
Lockdowns were a choice. In some places a necessary one, as in New York. In others, we shall see if the choice was a wise one.