The purpose of the shelter in place requirements was not to reduce the total number of cases, but to keep a surge in cases from overwhelming our medical capabilities. Isolating the highest risk people and avoiding crowds that allows it to spread faster made good sense and still does. There is still many unknowns about the disease, but as new data is absorbed we need to adjust our response. Flexibility is essential; the worst thing we can do is become emotionally or politically attached to early information and responses.
New data indicates that the disease arrived here much earlier than we thought, has already spread to many more people than we thought, and based on the estimated cases as compared to diagnosed cases the mortality is much less than we thought.
From The Wall Street Journal, The Bearer of Good Coronavirus News:
That will require more testing. Dr. Ioannidis and colleagues at Stanford last week published a study on the prevalence of coronavirus antibodies in Santa Clara County. Based on blood tests of 3,300 volunteers in the county—which includes San Jose, California’s third-largest city—during the first week of April, they estimated that between 2.49% and 4.16% of the county population had been infected. That’s 50 to 85 times the number of confirmed cases and implies a fatality rate between 0.12% and 0.2%, consistent with that of the Diamond Princess.
According to New York City data, the fatality rate for those over the age of 75 is 2.5 times greater than those between 65 to 74, eight times higher than those between 45 and 64 years, and 69 times than those 18 to 44 years. A recent Stanford study found that those under 65 with no underlying conditions such as diabetes or hypertension made up 1.8% of deaths in New York City.
The virus dissipates from one of two paths: herd immunity or a vaccine. A vaccine is maybe a year or more away and shutting down the economy that long may be like dropping the speed limit to 5mph to reduce traffic deaths. Testing only solves a part of the problem. If you test not to have the antibody you are still at risk if you mingle with those that do. It is better to identify the high risk and protect them as much as possible, and to continue the new hygienic protocols we are accepting. Who would have though a few months ago we would see so many in public wearing face masks?
Is it better to take the risk while the weather is warming than bear exposure during the fall and winter? No. If you want to time infection it is better to get it later than sooner. We develop better treatment options from better data and that takes time. You do not want to get it when the treatment facilities are stressed.
New York City is the epicenter of the virus and also being our major media center, the coverage has obscured the much lower infection rate in much of the rest of the county. Fear and outrage generate clicks and that is the new currency in modern digital media.
For those who want to get into the weeds on the applicable statistical models you may find this interesting: https://www.youtube.com/watch?v=UJnJxFYVlFs&feature=youtu.be This somewhat clarifies how much of the lower than expected growth is from a different statistical path than the effectiveness of the shelter in place regimen.
Shelter in place and attentive hygienic practices have saved lives and would have with any flu epidemic, but it appears that is only a part of the better results we are seeing. Flexibility is essential; hospitals with low Covid-19 caseloads should not be restricted in proving care for other illnesses. Cancer and heart disease do not volunteer remission because a new virus has captured the headlines. Even routine care can mitigate advanced illnesses.
New data is valuable but still preliminary. Tradeoffs remain and there is risk in any decision. Sound decisions do not always yield good results. Openness and flexibility are essential.
I hope we can objectively assess this pandemic as it passes to be better prepared for the next.
I called Cox technical support last night- cable went down during The Battle of the Bastards in Game of Thrones (first world problem). The support representative was obviously working from home and had a chihuahua and a poodle barking in the background. I found it amusing; it made the interaction more human than normal.