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Sunday, March 15, 2020

Corona Virus–The Importance Of Individual Responsibility And Classical Epidemiology

As of this writing (March 15, 2020), the Corona virus has spread quickly to become a pandemic; and governments have taken draconian measures to stop its spread.  Countries like Italy have been shut down entirely with quarantine now enforced, and all public and private establishments closed.  President Trump has said he was considering certain federal actions to seal off virus hot zones and to enforce official quarantines.  The world economy has suffered with drops in equity markets the most precipitous and damaging in decades. Many small businesses, suffering from lack of patronage, are going under.  Airlines, already under a significant burden of debt because of necessary borrowing for new planes, cannot meet their payments because air travel has slowed to a trickle and every economic sector relying on fast, efficient, and easy travel has been affected.  In an inter-connected world economy, every industry will be hurt.  There is no business that will not be affected.

Image result for images coronavirus

But are the draconian measures to slow or limit the spread of the Corona virus necessary? Are the risks to health and the mortality and morbidity associated with the disease significant enough to cause such disruption, dislocation, and hardship from which it will take years to recover?

The latest CDC (Centers for Disease Control) suggest that the mortality rate from Corona is highly concentrated in one group – those over 65 and particularly those with underlying health problems, a group that accounts for approximately 15 percent of the US population.  The rest of the population is at very low risk, with most infections likely to be relatively minor or asymptomatic.

If the primary goal of public health is to reduce mortality – it has been and should continue to be - then a more reasonable and intelligent government policy might be as follows:

1. Encourage individual responsibility, i.e., that it is the responsibility of older Americans (full disclosure, I am one) to take the steps necessary to protect themselves and others – staying away from crowded places, avoiding close personal contact with others, practice frequent handwashing, etc.  Since the immune systems of elderly people are far less robust than those of younger people, they are more apt to contract the virus and to pass it on. CDC has already issued special warnings to older people to stay indoors.  While a 15 percent over-65 percentage is relatively low, the epidemiological importance of that group cannot be minimized.

2. Focus public health measures on this group – universal monitoring and testing and assuring proper medical care for those who become ill from the virus.  Proper epidemiological procedure is to determine the cause of the outbreak, to isolate those populations at its center who are most likely to spread the disease, and to enforce quarantine or isolation.  The AIDS epidemic because of political reasons was the first epidemic to be treated as ‘everyone’s disease’.  Identifying gay men as the principal vector for the spread of the disease would, social advocates said, would unfairly stigmatize an already marginalized population.  As a result, this group was not dealt with according to epidemiological protocol, and billions of dollars were spent on AIDS education and prevention for those at minor or negligible risk.  By clearly identifying older Americans as most at risk, and by devoting time, energy, and resources to keeping them healthy and out of health care facilities, the most serious consequences of the epidemic could be contained and cost limited.  Corona is not everyone’s disease.

In fact, the BBC reported today that the UK is doing just this, and is prepared to require self-quarantine of all residents over the age of 70 – a policy which will combine both 1 and 2 above.  It will ask older people to be responsible and do the right thing; and will prioritize its efforts on surveillance, testing, and treatment for members of this group.

Yet, many critics say, the disease is a pandemic which affects everyone.  If no isolation and separation measures are taken, then thousands Americans will needlessly get sick.  Isn’t such a targeted focus discriminatory and unfair?

While it is true that the enforced quarantines, lockdowns, and authoritarian government measures to isolate people will slow the disease – China and South Korea are good examples of the success of this approach – the damage to the US economy and, by extension, the world economy might not be worth it.  Most people who are not at risk – most of every country’s population - despite high 65+ demographics in certain countries like Italy and Japan -  will either not get infected, will be asymptomatic, or will be never sick enough for hospitalization.  This was the case during the 1968 Hong Kong flu, the most recent pandemic.  Not only that, but the likelihood that the spread of the virus is self-limiting and will slow or disappear during the hot summer months as all influenzas have is high. Finally, even the most serious influenzas such as the Spanish flu, have run their course in a relatively short time, and there is no reason to suspect that Corona is any different.

Image result for images hong kong flu

Yes, say the same advocates for universal protection, but what about morbidity?  Sick people represent personal suffering and a loss of economic productivity.  True enough, but once again risk and cost-benefit analysis are appropriate.  What is the cost of lowered productivity compared to the overall, systemic damage to an entire economy?  Very little.  As far as compassion is concerned, life is filled with unavoidable pain and suffering, and those who fall ill with cancer, heart disease, diabetes; or who die from traffic fatalities are numerous.

Unfortunately the United States has lost much of the communitarianism of the early days of the Republic.  America has become a highly individualized, self-interested country, a me-first generation which not surprisingly questions why government resources are to be spent almost exclusively on old people who are going to die soon anyway.  Keep us healthy and forget about the alte kockers who have outlived their usefulness in the first place, they might well say.  Perhaps even worse is America’s risk aversion.  In both civil and military matters avoiding risk at all cost has become its ruling ethos.  If there is even the slightest chance of something bad happening, no expense should  be shared to avoid it.

Pulling together so that thousands of jobs are not lost, businesses do not go bankrupt, life savings are not depleted, education is not interrupted, and important social actions can continue, might be the most important reaction of all to this epidemic.

There is always the possibility that the Corona virus may mutate into a more serious and debilitating form, a killer of the young as was the Spanish Flu of 1918; and in that case, the most severe restrictions and authoritarian enforcement might well be the proper if not the only course; but for now a government policy addressing its efforts to those at highest risk – those over 65 and particularly over 70 – might well be the most cost-effective and the most epidemiologically correct one of all.

Of course it is too late for second guessing.  The train has left the station, and we are approaching lockdown.  So be it.  However as with all government decisions, they should be examined, challenged, and fought if necessary.

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