100% Safe? When!
A Rational Policy for the Pandemic, May 2020
When COVID-19 entered the community of Broomfield, Colorado, fear and panic descended on my home town. As a retired physician, little information was available about this novel Coronavirus. In March, 2020, City Council mandated “fifteen days” to flatten the curve. Humans are social creatures. Many aspects of normal daily life which all of us take for granted, family gatherings, visiting the library, eating in a restaurant, attending school, and recreational sports, ceased. As 15 days became 30 days, then 45 days, more information became readily available about the virus. I began to question the wisdom of such a draconian policy named “Lockdown”. My intellectual curiosity lead to my submitting a letter to the editor of our local newspaper, The Broomfield Enterprise. Julie Baxter, the editor at the time, graciously published it in May, 2020. The information we now have after almost two years is much better than when I wrote my letter. It needs a few minor tweaks. Nevertheless, the basic principles were a much better way forward for producing far less collateral damage. Facts, not fear, should have driven policy decisions. Fear won the day! Below is my letter.
Broomfield 100% Safe? When?
When is every Broomfield resident going to be 100% safe from COVID-19? NEVER. In the US 2017-2018 influenza season, 61,099 deaths were recorded despite widespread availability of flu vaccine and antiviral medications. Flu vaccination which has saved thousands of lives has an effectiveness of only 19%-60%. Even if an exceptional COVID-19 vaccination is developed ,100% prevention is essentially zero.
How many people have been infected in Broomfield? As of 5/12/20 there are 210 confirmed cases with a population of about 72,000. Random COVID-19 antibody tests in NYC and Geneva, Switzerland, looking for a protein marking of a prior COVID-19 infection, demonstrated that for every one confirmed case there were ten more people who had been infected but never sought medical care due to extremely mild symptoms or none. A herd immunity of 60-70% is required to prevent more illness if social distancing is lifted. We are at 3% after 7 weeks. We have flattened the curve and flattened herd immunity. Will warm weather completely eradicate the virus?
How deadly is the virus? Early on based on documented symptomatic cases, the mortality rate was 3% Since we now know that over 90% of those infected never feel ill enough to seek medical care, the mortality rate is much lower, about one tenth of what was originally thought.
Who is most vulnerable in our community? Almost all the deaths in Broomfield have occurred in those over 80. In NYC those over 75 years old had a mortality rate 3000 times higher than those under 17.
Let's wait for more testing so we can contain the spread? Most people who are carrying and spreading the virus do not feel ill. Testing every single person in Broomfield is not logistically feasible. Anyone leaving and returning to Broomfield could re-introduce COVID-19.
In March, social distancing measures were appropriately initiated based on the limited, available knowledge of this novel virus preventing our health care system from becoming overwhelmed, and thereby saving lives. Unfortunately, closing schools, sporting events, churches, parks, businesses, etc. cost dearly. Unemployment increases depression, alcohol abuse and suicides. How many people are going to die from delayed cancer screening or are too frightened to go to an ER for life threatening chest pain? And still 97% of our residents remain susceptible to COVID-19.
Balancing the adverse effects of COVID-19, mortality from infection versus community collateral damage from restrictive social distancing, is challenging. The virus has not blown out of town. Basic health measures like wearing masks in supermarkets and frequent hand washing should continue. Our senior care facilities need stringent testing and screening. The elderly should strongly consider social distancing much longer. For those younger, consider returning to a normal life after investing time discussing your unique health profile with your personal physician. Never having family reunions, never eating in restaurant,, never attending worship services, never attending school, never playing sports until 100% safe means NEVER. Life has risks and requires wisdom to be lived well.
Richard Erickson