With no end in sight, here’s how to deal with COVID-19
The economy needs to reopen, but we need to tread water
As we reach the last quarter of 2020, there is no end in sight for the coronavirus pandemic. Europe is experiencing a second wave and starting to lock down again. The US, which never fully got out of its first wave, is seeing a resurgence in cases as the winter months arrive. This will be deadlier when influenza cases start to spike. The latest surge in cases is giving people lockdown fatigue, and many are calling for an end to restrictions and allowing the virus do its worst.
This has resulted in the revival of the debunked “herd immunity strategy” or, to use a popular euphemism, “focused protection.” This strategy calls for allowing the less vulnerable members of society to get infected in order to achieve herd immunity.
There are many problems with the herd immunity strategy. The biggest problem is the uncertainty surrounding the durability of immunity to Covid-19.
Does immunity develop in everyone who is infected? How long does immunity last? Antibody levels typically go down in infected individuals after a few weeks, as expected for most infectious diseases. Despite decreasing antibody levels, does the body retain some sort of long-term immunologic memory? Immunologic memory would result in no disease or milder disease upon reinfection, just like with measles and mumps.
Does Covid-19 come back from time to time, like influenza or the common cold? Based on large surveys of recovered Covid-19 patients, most people develop some immunity to SARS-CoV-2 for at least a few months. We are now, however, seeing multiple reports of reinfection, including at least one person with a weakened immune system who developed a worse second infection and died.
If Covid-19 reinfection is substantial, then a herd immunity strategy will fail. The virus will keep circulating and reinfecting. The vulnerable population cannot be locked up forever. Many countries have multigenerational households where old people who do not go out can easily get infected by younger people who do leave their houses.
For these younger people, mild symptoms do not necessarily mean absence of long-term consequences. There is increasing evidence that many young people suffer heart and lung damage.
Finally, the explosive increase in cases that characterize a Covid-19 outbreak can easily get out of hand and overwhelm hospitals and intensive care units. The high death tolls in Sweden, the United Kingdom, Italy, Spain, and France attest to how deadly Covid-19 can be if there are not enough facilities to accommodate the very sick. All these can happen before any reliable herd immunity can be established.
Last week, there was a news item that WHO had “backflipped on its coronavirus stance by condemning lockdowns.” This was a gross misrepresentation of the WHO statement. It is an example of how information can be distorted to sensationalize headlines. The WHO statement was that lockdowns as a primary response to the pandemic are discouraged. Lockdowns are temporary measures that can help overwhelmed healthcare systems cope with a surge in cases.
Early lockdowns have helped some countries flatten their curve, but some lockdowns have not worked out quite as well. Lockdowns are drastic interventions with a large economic cost. The objectives of lockdowns are to prevent widespread deaths, protect the healthcare system, and enable a country to build healthcare capacity. They were never meant to stay in place long-term because these widespread shutdowns are not sustainable.
Lockdowns work best when done while case numbers are low, before the healthcare system is inundated. This is especially true for countries with limited resources and few ICU beds. Ironically, countries whose economies are least able to sustain lockdowns are the ones that need to lock down early in order to prevent their fragile healthcare systems from being overwhelmed.
People get impatient during lockdowns. When there is a delay in reporting case numbers, people can get irritable. When livelihood is limited and personal mobility is curtailed, depression often sets in. Psychosocial and economic depression can lead to unrest, so sustaining lockdowns comes at a high price.
Individual country responses can be likened to a boat with many people and no lifeboats. When the boat sinks, strong swimmers can try to swim for the shore and survive. Some will succeed, and some will drown or get eaten by sharks. Weaker swimmers die if they try to swim for shore. The best option for weak swimmers is to tread water, conserve energy, and wait for rescue. Weak swimmers who can stay above water as long as possible maximize their chances of survival.
Countries with abundant resources such as China, South Korea, and Japan can pour resources toward the problem and succeed. China overcame logistical barriers to shut down Wuhan, and recently tested nine million people to control a small outbreak. Some countries with vast resources such as the UK, Spain, Italy, and France were initially overwhelmed when they did not respond fast enough. After case numbers went down, they rushed to open up, and now they are about to shut down again.
The worst among these responses was in the US, where people refused to adhere to evidence-based measures such as masks and physical distancing. Despite their massive resources, hospitals and intensive care units are near capacity. The healthcare system with one of the largest per capita expenditures in the world is near failure.
Countries with fewer resources are prone to bigger outbreaks. The worst performers in this case are India, Brazil, and Mexico, which have some of the highest caseloads and deaths. There are different reasons for their dismal performance, but at least part of it is due to delayed lockdowns, poor testing strategies, and densely populated areas where the virus can spread easily.
The Philippines has relatively few deaths despite being ranked 18th in the total number of cases worldwide. The relatively few deaths indicate that our healthcare system is able to cope. Our case fatality rate of 1.9 percent is well below the world average of four percent. Our response has not been as good as some of our neighbors, but we are coping.
The plan is to keep cases manageable while waiting for a vaccine. Social distancing, handwashing, mask-wearing, and focused lockdowns keep the numbers down. The economy needs to reopen. We have finite resources. Dealing with the virus by treading water instead of swimming to the nearest island is our best hope of survival.
If Covid-19 reinfection is substantial, then a herd immunity strategy will fail. The virus will keep circulating and reinfecting. The vulnerable population cannot be locked up forever.