Harsh measures preferable to unproven strategies
Iagree that we need more data regarding COVID-19 and that the data that we currently have available is suboptimal.
That is to be expected considering this particular novel coronavirus had not entered humans before November 2019. We learned almost nothing about it in December when there was some denial on the part of public health officials in China, and only in January did information start to emerge. At the time we had data from Wuhan, China, that suggested that over 30 per cent of admittedly small samples were infected with the virus. The flu often peaks at 10 per cent to 20 per cent of a population, as do other common respiratory viruses. We know the coronavirus infection rate is at least as bad as the flu and perhaps worse. Therefore, there really is only one transmission comparison in the past 100 years where we had 30 per cent to 40 per cent penetration, and that is the 1918-1919 influenza pandemic.
Mortality rates from the Spanish flu pandemic were extremely high because it predated modern medical practice. We didn’t have antibiotics for a bacterial superinfection, and we didn’t have ventilators.
The lockdown of the greater Wuhan and Daegu area, and the social distancing measures practised in other regions of China, and to a lesser extent in South Korea, seem to have worked; The infection rates in both countries are declining rapidly. Then we have the Lombardy region in Italy and much of Spain where the intervention is simply too late or too undisciplined. So looking at these two different models gives us enough information on how best to respond to this particular pandemic.
We know we’re unprepared and do not have the bed capacity, ventilator capacity, or personal protective equipment ( PPE) capacity that we need to respond to this crisis. We also know that broad- based social distancing, hygiene, travel restrictions, testing in isolation, and hospital-based control measures practised in China and South Korea have helped stop the spread of the virus. What we don’t know is whether implementing a model whereby isolating the elderly and the vulnerable, while letting the less vulnerable go back to work, is an effective solution. We have no clue. This method has not been tried and it has not succeeded. Take this metaphor: we are in the midst of a California wildfire, and a vulnerable family has decided to stay with a fire hose to protect themselves. Will they save themselves as some do, or will they be immolated by the overwhelming burden of the wildfire? I think it’s easier and more effective to implement a harsh protocol of a national, social-distancing strategy to protect the vulnerable and blunt the impact on the health- care system than it is to take a chance on an unproven strategy.
In 2004, the global response to SARS was very aggressive and drove transmission to zero in places like Hong Kong and Toronto. And we did not see the virus reoccur in humans in the next respiratory viral season. I do hope, without evidence, I admit, that perhaps we could accomplish the same here. If we can limit the spread of COVID- 19 in communities and essentially wipe out transmission by the summer or late summer, is it possible that this novel coronavirus will not reoccur in the fall? Now, this is a lot more transmissible than SARS was, so I might be completely wrong, but I believe that if we are aggressive in our response to this particular outbreak we could conceivably drive it down to such low levels that there wouldn’t be a source of global transmission in the new respiratory flu season.
MEASURES PRACTISED IN CHINA AND SOUTH KOREA HAVE HELPED.