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Balance Is Needed in the Fight Against the Coronavirus

(REUTERS/Jeenah Moon)

Since there is no vaccine coming anytime soon, the only way to properly handle this pandemic at this time is to allow the population to develop natural immunity to it in a controlled manner that avoids overloading the healthcare system.”

Well, that blew up fast. What started as assurances that the coronavirus pandemic will be mild and transient has rapidly morphed into widespread lockdowns, panic, and shortages of everything from canned food to hand sanitizers and toilet paper. “We can beat this virus” is the refrain most often heard, along with platitudes such  as “We’re all in this together” and “Americans always persevere,” etc.

Here are some key facts necessary to understand what is happening today:

1. The SARS-CoV-2 virus cannot be “beaten.” No expert believes that is possible. This infection will spread everywhere and will only stop permanently when either (a) an effective vaccine is available, which is unlikely to happen for about another two years, or (b) enough people are infected and thereby immunized (i.e., herd immunity develops).

The important takeaway is that this virus is here to stay, even if it takes a break in the summertime. Like measles, influenza and other coronaviruses, it will probably never disappear. The acute phase of the current pandemic will eventually peter out, but the causative organism will likely continue to infect people every year as it mutates, much like other such viruses have before it. (Even widespread vaccination would not stop new viral variants from spreading again, as happens annually with influenza and the first SARS coronavirus that appeared in 2003 and still infects new victims every year.)

Messages in the news media (and on social media), exhorting people to “beat” this virus are pointless and misleading, causing many to believe that if they hunker down at home they can avoid ever acquiring COVID-19. This is not true. Infection is effectively unavoidable in the long run. We can delay it, not prevent it. You and everyone you know will probably be infected at some point with SARS-CoV-2, either this season or at some point in the future—and there’s a good chance you won’t even know it.

2. COVID-19 is, for most people, a mild respiratory illness lasting a few days. That much is known. Also true is that all infectious diseases, especially respiratory ones, are life-threatening to some people—particularly those with preexisting illnesses and/or compromised immune systems. Whether it’s the flu, a simple cold, or a fall, those with compromised immune systems are at high risk of complications. Of course, we should try to protect them all we can, but everyone eventually acquires some infection, whether it’s bacterial or coronavirus or flu or fungus or some other organism. Without a competent immune system, long-term survival is not possible.

3. Extreme social distancing and isolation will obviously slow the spread of the virus. But such measures will only work permanently if everyone stays isolated permanently, an impossible scenario. As soon as people start congregating again, the pandemic will return.

4. The most common COVID-19 transmission modality is contact with infected persons or tainted surfaces. Your probability of acquiring it if you come into casual contact with an infected person is low, estimated in a study published by the World Health Organization (WHO) at between 1% and 5%. The more casual the encounter, the lower the probability. Contrary to media reports, “the current scientific consensus is that that most transmission via respiratory secretions happens in the form of large respiratory droplets…rather than small aerosols,” and those heavy droplets typically fall soon after they’re released. This is important, as it directly impacts the usefulness and advisability of extreme social distancing measures. You have to be quite close to an infected person for a significant length of time, or unlucky to acquire the infection through droplets in the air.

5. The actual fatality rate of COVID-19 is probably quite low. John P.A. Ioannidis, professor of medicine, epidemiology, public health and biomedical data science at Stanford University, has estimated its mortality rate at between 0.05% and 1% (i.e., potentially even lower than that of the flu (0.1%), and much lower than SARS and MERS (prior coronavirus outbreaks)). Most fatalities are in patients with underlying conditions that make them susceptible to any respiratory (or other) infection, including the flu and the common cold.

6. Italy is the one country most often cited as the cautionary case in point. “Shut everything down or America will become the next Italy.” But Italy is much more susceptible than any other Western country; its population is the oldest in Europe (23% are 65 years old or older) and much older—on average—than that of the United States. Furthermore, the Italian population is marked by rampant smoking, diabetes and other chronic illnesses in its most vulnerable population segments. The average age of Italians who have died from coronavirus-related issues is estimated at 80 years. And according to a study published by Italy’s national health authority, 99% of that country’s COVID-19-related fatalities involved people suffering from previous medical conditions. There is no reasonable comparison equating Italy’s situation to that of the United States.

Therefore, there is no choice now but to allow SARS-Cov-2 to spread and focus instead on controlling the velocity of its spread to avoid system overload—while still allowing enough people to develop immunity to it, thus preventing (or at least blunting) future waves of this pandemic.

Since there is no vaccine coming anytime soon, the only way to properly handle this pandemic at this time is to allow the population to develop natural immunity to it in a controlled manner that avoids overloading the healthcare system. By imposing unnecessary draconian social distancing rules such as “shelter-in-place,” we can very easily overshoot the mark and leave ourselves open to future waves of infection. Our aim must be to find the right balance between two competing goals: 

  • Goal 1 — Slow the spread of the virus enough so that our healthcare systems are not overloaded.
  • Goal 2 — Allow the virus to spread enough to generate significant immunity in the population. Failure to achieve this second goal will lead to future waves of infection, condemning us to repeat all our efforts—with all their attendant social and economic disruptions—an unknown number of times.

Bottom line: We must not try completely to stop the spread of the virus, as our political leaders are frantically doing now. If it were possible to permanently stop COVID-19 by any means currently being tried, pulling out all stops would be correct. But it is not possible. Therefore, there is no choice now but to allow SARS-Cov-2 to spread and focus instead on controlling the velocity of its spread to avoid system overload—while still allowing enough people to develop immunity to it, thus preventing (or at least blunting) future waves of this pandemic.

We need balance, not thoughtless draconianism.

Unfortunately, we are now facing a perfect storm of social devastation stemming from a dangerous interplay of medicine, media, and government:

  • Most medical professionals are aware of the facts, but very few are out there explaining how overreacting to this pandemic will only prolong it. It could be a matter of prolonging it possibly for years to come if the politicians holding the levers of power don’t come to their senses. Dr. Anthony Fauci needs to be spreading this message, not just toeing the government’s policy line.
  • The media are fanning the flames of fear and overreaction by harping on the pandemic 24/7 and constantly conveying misleading messages about how the virus can be “beaten” if we just “stick together” and follow the government’s proscriptions, with nary a mention of the importance of allowing people to develop natural immunity or the inevitability of eventual exposure to the virus.
  • Government is the most damaging element of all, by far. Too many politicians are now racing to demonstrate to their constituents how virtuous, proactive, and brave they are as they enact an endless list of ever-more draconian measures of quarantine and economic shutdown. The worst offenders have been New York’s Governor Andrew Cuomo and California’s Governor Gavin Newsom, while more leaders join the fray every day. No politician wants to be perceived as weak or “soft on the virus,” so they all pile on to join the national overreaction, with no apparent understanding of how their actions could lead to the prolongation of this pandemic as well as the unnecessary life-destroying breakdown of our social order.
  • The clearest exception to date has been—somewhat surprisingly—the Federal government, whose response lately has been notably rational, calm, measured and helpful, much like the Centers for Disease Control and Prevention (CDC) has been. We must hope this approach continues, and that it eventually filters down to the governors, who are causing most of the damage.
  • In any event, politicians are not very qualified to be making these decisions; after all, they have ulterior motives that have nothing to do with your safety or the good of the country. They are in the business of getting elected and re-elected. Giving them the levers of physical power in our society can be a huge mistake, as we are now experiencing.

The Most Successful Countries Did It the Right Way

The countries most successful in fighting COVID-19 to date have been South Korea, Taiwan, and Singapore. They were able to “flatten the curve” of the spread of COVID-19—while refraining from imposing draconian rules—by implementing aggressive testing and patient tracking using multiple advanced technological tools, allowing near-normal free mobility (while also providing intensive education and rules on hygiene), quarantining known cases, and protecting the most vulnerable (elderly and infirm).

South Korea now expects additional waves of infection, a possible early indication—and warning—that it is important to not be too successful in the efforts to slow the spread of this virus.

But even those most successful countries—despite eschewing overreaction and attacking the pandemic without lockdowns or economic shutdowns—may have over-flattened their curves. South Korea now expects additional waves of infection, a possible early indication—and warning—that it is important to not be too successful in the efforts to slow the spread of this virus. This coronavirus pandemic ultimately cannot be stopped (short of universal vaccination). The key now is balance.

China took a different path. They implemented draconian measures, which worked but only temporarily. Additional pandemic waves are expected there and may continue for years to come. Furthermore, data from China cannot be considered reliable, due to an authoritarian government and the absence of a free press.

Why have most Western nations adopted China’s faulty draconian solutions—and in the process wrecked their economies—rather than following the lead of countries like Taiwan and South Korea, whose results have been far more desirable (and much less destructive)? Maybe because until very recently we lacked the testing capacity needed to make the more-intelligent solutions work. If so, as more tests become available now, the need for China-style draconianism should disappear.

Testing Is Key

Now that more tests are finally becoming available in the United States, we need to back off authoritarian-style isolation rules and allow the natural but controlled progression of this virus to happen. We should follow the lead of countries that have met with the most success, while fine-tuning their methods to achieve the best possible outcome.

Lately, there have been calls to stop all testing except for those who are most ill. This is dangerous foolishness. Without thorough testing, we cannot have accurate prevalence data or reliable mortality assessments or effective anti-pandemic planning. This would lead to more panic and overreaction and would worsen the economic damage that has already been done.

Unintended Consequences

There is now near-irrefutable evidence that COVID-19 does not spread easily through casual social contact. It spreads mostly through intimate or prolonged contact (i.e., exactly what is happening in millions of homes as more and more “shelter-in-place” orders propound across the country). Children forced to stay at home with adults can now readily (and unknowingly) spread the disease to the more vulnerable adults around them. Meanwhile, trillions of dollars are being wiped out; families are financially stressed, and panic is growing. Many heads of families will be forced to work even if they’re feeling ill, which feeds rather than slows the spread of COVID-19. It takes money to fight a pandemic, and families are running out of it as the economy is forced shut by misdirected politicians.

There is simply no point in continuing down this path. The human cost is too great and the benefits too scant.

One of the most pessimistic reports to date—published in mid-March by the Imperial College COVID-19 Response Team in collaboration with the WHO—concluded that the most effective measures against the spread of COVID-19 would be “case isolation, home quarantine and social distancing of those most at risk,” while “stopping mass gatherings is predicted to have relatively little impact.” And, according to the CDC’s guidance on school closures, shuttering schools will have little to no effect.

Is no one reading what the scientists are actually saying? Why are we shutting down huge sections of our economy if it will bring so little benefit?

Our leaders’ overreactions could well turn out to be much worse than useless. Every new draconian measure designed to slow the spread of the virus may turn out in the end to have prolonged it. Unintended consequences might well rule the day. The final tally probably won’t be calculated for years to come, but there is little doubt that the cost in human suffering (resulting directly from the panic that the authorities have created with so little scientific justification) will be huge.

What We Must Do

The United States must adopt the Taiwan/South Korea/Singapore model of dealing with this pandemic. Do not blindly shut down the economy. Do test aggressively and apply our immense technological prowess to identify, track, and appropriately isolate and treat known cases. And let nature take its course: Allow people to develop immunity to this virus while controlling its spread enough to avoid overwhelming our healthcare systems. Find balance.

Most importantly, our leaders need to calm down and stop worrying more about their political reputations than the good of the country. Let science guide us, not politics. Most Americans today are rightfully more worried about what is happening to our society as a result of governmental actions than they are about the COVID-19 infection itself. If leaders had the courage to stand up and speak the truth, even the media would eventually stop spreading panic and fear.

Protect Yourself

So what can you do to protect yourself? Of course, as you’ve probably heard many times by now, pay close attention to personal and social hygiene and safety: Wash your hands, wear gloves, cough/sneeze carefully, and take all other reasonable measures.

Stay healthy. The only defense against an infectious agent for which there are no pharmaceutical therapies is to maintain a healthy and robust immune system. To that end:

  • Don’t smoke.
  • Get enough sleep. Sleep deprivation weakens your immune system.
  • Check with your healthcare provider about getting off unnecessary medications (such as statins and steroids, both of which suppress the immune system), when feasible.
  • Avoid dehydration.
  • Eat correctly: Avoid all sugar (including sweet drinks and fruit juice); avoid junk food; minimize grains, especially sweet breakfast cereals, bread, pasta, etc.; stick to vegetables and protein sources; drink plenty of fluids.
  • Make sure you get enough of these nutrients: Vitamins D, C and A, plus zinc and selenium, in addition to a healthful nutritional plan. 

Conclusion 

Stop panicking. The end is not nigh. Not now, anyway. Someday, a virus may come that really will threaten humanity. (Imagine if, when it first appeared, HIV had the ability to spread like SARS-CoV-2 does. Most of us wouldn’t be alive today.) Coronavirus is not that threat.

Leaders: stop overreacting. Stop ruining our economy, destroying people’s means of support, and making life much harder than it needs to be. Coronavirus isn’t ruining our society. You are.

We should be following the example set by the countries that have met with the greatest success in fighting this pandemic, adjusting as needed for optimal results. Remember that this virus is uncontainable, but the disease it brings is usually mild and manageable. The few patients who require intensive care cannot all be saved no matter how hard we try—no matter how much healthcare capacity we have. This is the natural order of things. Coronavirus does not change reality.

Joshua Leichtberg, M.D. is a medical doctor specializing in internal medicine and is based in Southern California.

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Bonnie
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Bonnie

I am a RN and my husband is a retired research virologist. We think the problem is that our nation is so woefully unprepared for handling this pandemic. So before we do as you suggest, we ought to have our ducks in a row. Rapid accurate testing, excess stocks of PPE and more being manufactured in the USA, not depending on a supply chain halfway across the globe and any other necessities. You get the idea. Otherwise we expect you have made good points.

William Scott Scherk
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William Scott Scherk

This article would have benefited from copious references, especially for the occasional strong “There is now near-irrefutable evidence” claims. Not that your opinion is unwarranted, but warrants for the claims would make the article much more cite-able.