There are two schools of thought on containing COVID-19. Both are right.
“Most public health officials are urging extreme measures of social distancing to contain the spread of COVID-19. There is a small group of dissenting scientists who prefer to concentrate efforts on identifying the positive cases and attending to them, as WHO has done in the past. Both are right. The issue is between relative numbers and absolute numbers.”
By Israel Zwick, March 22, 2020
About the author: Israel Zwick holds advanced degrees in biology, science education, and school psychology. He recently retired from working as a school psychologist for the NYC Department of Education. Before that he taught biology and chemistry for 15 years. Prior to that, he worked in the microbiology laboratories of the NYC Department of Health.
Author’s Note: As much as I tried, it is difficult to obtain accurate statistics on the spread and effects of COVID-19. Good numbers are just beginning to come in. There are still widespread variations on the global, national, and local levels. As such, the numbers presented here should be viewed as approximations and simplifications for illustrative purposes. Readers should not respond that my numbers are inaccurate. I know that they are inaccurate. They are approximations for instructional purposes only.
The world is amidst a public health crisis unprecedented in modern history. Most public health officials are urging extreme measures of social distancing, and even lock downs, to contain the rapid spread of COVID-19. There is a small group of dissenting specialists who prefer that efforts be concentrated on identifying positive cases and their contacts, while attending to their treatment and quarantine. This has been the general practice of the World Health Organization in dealing with past epidemics. So, who is right? We can recall the scene in “Fiddler on the Roof” where the rabbi is asked to resolve a dispute between two individuals and he responds with, “They are both right.” The same is true here. The issue is between relative numbers and absolute numbers. Both need to be considered and properly balanced.
Let’s assume, as some evidence suggests, that 99% of the COVID+ cases will begin with mild to moderate symptoms or no symptoms at all. That suggests that if 1000 people test positive for COVID-19, then 10 will soon present in a hospital emergency room with respiratory distress requiring medical assistance in the form of mechanical ventilation or intubation. Of the 10, six will recover in a week or two, and four will unfortunately die. Those that die will most likely be elderly with underlying medical conditions. This is a tragedy but does not yet present a public health crisis.
Now let’s get back to the other 99%. It is estimated that each of those can infect at least two other people before they show any symptoms. If that occurs, then COVID-19 will begin to spread at an alarming rate in a geometric progression. Before long, 100,000 may test positive for the disease. Now 1000 will present in emergency rooms with respiratory distress requiring medical assistance. But the hospitals have neither the staff nor the equipment to put 1000 people on ventilation. People may be dying in the emergency rooms before they even get to see a respiratory therapist. This is the onset of a crisis that must be addressed. If COVID-19 continues to spread like this, the scenes in the hospital emergency rooms will be catastrophic. Emergency room staff will have to decide who should get the few ventilators that are available, if any.
So how can we prevent such a dire situation? There is convincing evidence that extreme social distancing coupled with rigorous personal hygiene is effective in slowing the spread of a respiratory virus. But the extreme distancing measures and lock downs that we are experiencing have their own untoward consequences:
- The most obvious is the disastrous effects on the global economy. It will be a long time before airlines, hotels, restaurants, shopping malls, theaters, sports facilities, and pension funds will be able to recoup their huge losses.
- There are many people with other serious medical and dental conditions who will not be able to obtain proper medical assistance because of the attention given to COVID-19. This includes those requiring elective surgery, cardiovascular interventions, diabetic treatments, and chemotherapy – the same ones most vulnerable to COVID-19. There will be fewer medical staff available because they will be under quarantine themselves.
- The panic, fear, stress, and anxiety that are being experienced now also have medical consequences. That coupled with inactivity, depression, and increased obesity, can have dire consequences for the same people that social distancing is trying to save.
- It won’t be long before essential household equipment such as refrigerators, washing machines, and communication devices, start to breakdown. With the lock downs, it will be almost impossible to repair or replace these essential items. In the State of Israel, large families living together are already struggling with clogged toilets.
- Before long, the infrastructure required to ensure the flow of clean water, sufficient energy, and communication services, will also begin to go into disrepair. This could directly impair the ability of hospitals and emergency response teams to function effectively.
So, is there an alternative to these lock downs? We may have missed the opportunity. During the Ebola virus epidemic about five years ago, a number of public health officials urged governments to establish an emergency medical-military response system to stop the inevitable next viral outbreak which we are experiencing now. The United States military stockpiles ammunitions around the globe and has aircraft carriers and submarines around the world that could respond to a military emergency in minutes (though it didn’t work so well in Bengazi). The State of Israel is even better prepared. Pilots sleep by their aircraft so they could respond to an emergency military crisis in seconds. Soldiers must carry rifles with them all the time, even when attending services in a synagogue. The same was recommended by officials from the World Health Organization to quickly stop the spread of a viral epidemic. Emergency medical equipment and supplies should be stockpiled around the globe. Trained emergency medical teams would be dispatched by military vehicles as soon as there are signs of a local outbreak. Positive cases would be treated and isolated before the disease could become pandemic.
Unfortunately, the Western governments that had the ability to implement this plan never did so. Perhaps they had more pressing issues such as Afghanistan, Iran, North Korea, climate change, and disposable plastics. It’s not for us to judge. However, had they done so; we wouldn’t be in the mess that we’re in today. Let’s not miss the opportunity to stop the next inevitable viral outbreak.
Sources: Below is a list of sources for the information in this article. It is not complete, but sufficiently comprehensive.