Responding to new virus spikes

As COVID-19 cases are increasing, the issue of how best to manage the outbreak is being recycled.

There are those calling for lockdowns to be reimposed. At the other end of the spectrum, a group of scientists with stellar credentials have issued what they call the Great Barrington Declaration.

The declaration begins with the contention that lockdowns themselves have large, negative public health consequences. It calls for “focused protection” for the vulnerable population. Other than that, people should live their normal lives until herd immunity is achieved or a vaccine is broadly available.

There is, however, a wide range of policy options between lockdowns and herd immunity.

There are several building blocks for a sound policy to manage the risk of COVID-19. The first is that the risk varies greatly based on individual circumstances. The disease is a serious threat to those who are old and have certain medical conditions, such as heart issues, respiratory impairments and diabetes. For others, the symptoms are usually relatively mild.

Second, to the extent there is social interaction, transmissions will increase. And with them, hospitalizations and deaths.

Third, the objective of sound policy should be to achieve a balance in risk management. Minimizing COVID-19 hospitalizations and deaths shouldn’t be the only policy consideration. Keeping the economy alive and reducing the public health consequences of unemployment and social isolation should also be considerations.

To many, that will sound callous. But minimizing adverse consequences is rarely the single policy consideration. We could minimize injuries and deaths from car accidents by banning driving. But we don’t do that.

Sound policy based upon these building blocks would, indeed, start with “focused protection” for the vulnerable population. This was clear from the time the virus hit our shores. Yet, rather than a focus on the vulnerable population, we had a scattershot public health response that spread scarce testing resources broadly rather than narrowly.

As a result, COVID-19 deaths have been higher than they needed to be, perhaps significantly so. During the previous spike, deaths were overwhelmingly occurring among nursing home residents, in Arizona and throughout the nation. Nursing homes are just now being given the focus they should have had from the beginning, through priority distribution of rapid-results testing kits. Perhaps that can finally relieve the devastating social isolation in these and other congregate care facilities.

Lockdowns are an inefficient and destructive way to provide focused protection for the vulnerable population. And, until the disease runs its course or a vaccine is widely available, their effects are transitory, as we are witnessing in the United States and Europe. When they are lifted and social interaction resumes, transmission increases.

The United States and European countries lack the resources, and the will, to impose the quarantining and contact tracing regimens that have allowed Asian countries to make the gains from lockdowns stick. Nor are the resources, or will, going to manifest themselves in quick order now.

The inadvisability of lockdown yoyos – on, off, on again – doesn’t argue, as the Great Barrington Declaration does, for those not in the vulnerable category to resume life as normal as part of a drive toward herd immunity.

While COVID-19 is substantially less risky for those not in the vulnerable population, it is not risk-free.

However, individuals differ on where they land on the risk spectrum and the degree of risk they are comfortable taking.

There

are

certain

precautions

that make sense for everyone: wearing a mask; maintaining social distancing; avoiding crowds; preferring outdoor settings to indoor ones; washing your hands until they are chapped.

But, generally, people should be free to make their own risk evaluations and act accordingly.

That’s de facto what is occurring anyway. There are government mandates but little enforcement. Officially providing public health guidance rather than regulations probably wouldn’t have a material effect on compliance. It would be more sustainable and not subject to question regarding government authority.

Businesses should be accommodating to those comfortable returning to the office and those who remain uncomfortable. Schools should likewise be accommodating to teachers and students regarding returning to the classroom.

Different people will make different decisions about what risks they are comfortable taking. Those in the vulnerable population but not in congregate care should socially isolate to a much greater degree than others.

There’s little evidence that government making these decisions for everyone produces better results, or a better balance, than allowing people to make them for themselves.