Some say we need to keep sheltering in place until there's a vaccine or a cure. Some say we need to restart everybody's life, period. I'm describing a much more sensible, logical and focused middle path that gets people back to their lives and avoids overwhelming health care resources.
For COVID-19 to become history (even in just the U.S.), herd immunity has to be reached, or extensive testing (several million tests a day) and a potent antiviral medicine have to become available, or a vaccine has to become available to hundreds of millions. I've excluded tracking systems that enable targeted quarantines, as I believe American civil liberties and our culture of individuality will not allow those to exist broadly.
Thousands of antivirals have gone through clinical trials over the years, yet only a few dozen have ever been found safe and effective and approved to go to market (most of those target HIV, the result of decades of research and development). Getting huge volumes of a safe and effective antiviral targeting COVID-19 won't happen soon.
Vaccines are even harder to get to market. They have to be proven both effective and super-safe. If they aren't, the vaccine and the company that developed it are cooked, and more people will balk and become anti-vaxxers, which leads to horrible health outcomes, mostly for our children. The best-case timeline for a vaccine is the second half of 2021.
Herd immunity arrives when 60-70% of people have had the virus — whether asymptomatically or with mild to deadly symptoms. I believe that the federal government and state unemployment funding of people sheltering in place will soon be fatigued. Also, if shelter-in-place is allowed to continue for more months, layoffs will continue accelerating, and before long, many more companies will join those that have already gone defunct, their jobs not to return. Since neither a potent antiviral nor testing nor a vaccine are going to appear in huge volume soon, and since the financial downsides of further months of sheltering are untenable, we need a way to get to herd immunity ASAP.
A recent Stanford University study showed that only around 4% of Santa Clara County's 2 million residents have had COVID-19. Other scientists believe the study was done poorly and is wrong. Some think that perhaps 20% or higher is a better number. But with the shelter-in-place and only a few dozen new cases a day being logged by the county Public Health Department, it will be a looong time before we reach herd immunity — waaay too long to be tolerable.
That said, if a lot more people are to get the virus to achieve herd immunity, we need to be sure that a lot more people don't die from the virus. If you looked at Santa Clara County's website on April 27, you'd see that 86% of deaths were people who had "comorbidities," i.e., hypertension, heart disease, COPD, obesity, diabetes, etc. You also see that 63% of deaths were people over 70. Every year's deaths from flu are concentrated in much the same population.
We take a key step toward normalcy by strongly suggesting to people with comorbidities (especially those over 70) that they continue to shelter in place or be majorly cautious when going out. And we have everyone else rejoin their lives. The very vulnerable will need to exercise this level of self-care or likely end up in the hospital or dead. And everybody else can take modest precautions as they see fit. This will result in lots of people getting the virus. But most importantly, it will restart people's lives and income streams.
It's really the most vulnerable populations who would likely overwhelm health care capacity if they were to exit shelter-in-place. The county does a great job monitoring health care capacity, and models exist that can help the county tell a few weeks ahead of time if there's going to be a crunch — and to reinstall a higher level of shelter-in-place for a few weeks if necessary (but we'd still be on the way to herd immunity apace).
Moreover, a lot of the vulnerable older people are retired, so having to shelter in place isn't different for them economically. And restarting the economy will certainly help vulnerable older people's investments.
When kids of all ages go back to school and the workforce goes back to work, it will be a boon for almost everyone for obvious reasons. Yes, it's true that some of these people will get a bad case of the virus and be sick for weeks, some even hospitalized. And a small number will die, just as they have year in and year out from the flu — but we don't lock down the country for the annual flu season.
Still, it'd be best to avoid large gatherings, just so we don't overfill doctors' offices with cases spreading as happens in a bad flu season.
A really useful way to move forward is with pilot implementation. Santa Clara County is the perfect place for this. First of all, because of shelter-in-place, 86% of ventilator capacity and 44% of ICU capacity are available (18% of ICU beds are used by COVID-19 patients and 38% by typical ICU patients).
Second, now we know who is most vulnerable and we can avoid a demand surge on hospitals going forward.
Third, the county has excellent communication systems to reach residents (by phone, text and/or email). If there's an unforeseen need to restart shelter-in-place, the county can communicate quickly.
The steps for other geographies: free up hospital capacity (through sheltering); safeguard the vulnerable; let others rejoin life and be able to communicate changes quickly.
Even if scientists conclude that there's no herd immunity to be had for COVID-19, the above is still the best course of action until a safe and effective pharmaceutical solution arrives.
I urge Gov. Gavin Newsom and county Health Officer Dr. Sarah Cody to get this going — and soon. Thanks!
Palo Alto resident Andy Robin likes facts. He can be emailed at [email protected].