Note: Exactly 18 months after writing this post I have reviewed it in a new post to see what I got right and what wrong on my initial reaction to the pandemic.
The road to the lockdowns
As many other people, I started hearing about the new Coronavirus that had been discovered in China sometime around mid-February. Initially it sounded like yet another ‘failed pandemic’ that would turn out to be nothing.
The developing situation in Italy at the start of March came as a surprise. Suddenly, new cases and deaths were reported at a growing pace and it started to look like this time the pandemic could be true.
The figures were alarming, in March 8 the number of daily deaths jumped to over 100 and were doubling every few days. The next country was my own, Spain, and more specifically the city I live in, Madrid. It looked like it was following the Italian pattern with a lag of around ten days.
It was known at the time that the Chinese authorities had established severe restrictions to the population to try to cope with the disease. Since China had been the epicenter of the epidemic and therefore they had the most experience, could it be assumed that government enforced social distancing was the only way to fight the virus?
Unfortunately, the Italian government established a national lockdown of the entire country in March 9. In Spain, a ‘State of alarm’ was declared on March 13, followed by a national lockdown on March 28, which is still in effect.
Most countries in the Western hemisphere followed in various degrees the example, resulting in the collapse of the World economy due to the irrational behavior and unprecedented abuse of power by the governments of the most advanced countries of the world.
On the other hand, some Asian countries such as South Korea, Singapore handled the medical crisis in a totally different way. Due to having established adequate protocols after suffering the SARS epidemic in 2003 they were able to identify the initial cases, trace the people infected and isolate them to prevent the spread of the disease.
Unfortunately, this option was not available to most Western countries because their healthcare systems were not prepared.
Did the situation warrant the measures adopted in the West?
The short answer is, no.
When these extreme measures were adopted there was too much uncertainty about the actual threat posed by the new strain of a familiar family of viruses, the coronaviruses, that constitutes one of the ingredients of the seasonal flu that have plagued humanity forever.
Even with the uncertainty existing at the time these measures were adopted, there was some data that suggested that the threat could be lower than the initial estimates, while the initial sanitary response was being inadequate:
- Most people experienced none or very mild symptoms. This suggested that the actual number of contagions could be severely underestimated and that the assumed mortality rate could be overestimated to the same degree.
- Even for patients experiencing symptoms, the severity of the disease was extremely biased; almost all of the deaths and the severe cases were either very old people or people with underlying diseases. Therefore the profile of the population that was at risk was very clear and limited to a very specific part of the society.
- Meanwhile, hospitals and care homes were important focus of infection, because infectious people were admitted as patients without an adequate protection of the other patients and the healthcare personnel. Furthermore, the initial procedure used, ventilators, was very doubtful, both in terms of its medical efficacy and the resources required.
Given the situation described above, the proper procedure should have been to focus in protecting the population at risk and eliminating the risk of infections in healthcare facilities.
It is important to note that reducing the infection rate on the population at risk would have been the best way to prevent the collapse of the healthcare system and, what is more important, the total number of deaths. What would have been a good response?
I cannot stress this point enough. The policy decisions adopted, not only made little sense to handle their alleged intentions, prevent a sanitary collapse, but more importantly, would cause more direct deaths. Even before considering other indirect deaths that could have been easily predicted as a consequence of the economic collapse and the panic induced on the general population.
The reason why protecting the population at risk is much more effective, both in terms of severe cases that require hospitalization and fatalities is a direct consequence of the highly asymmetric nature of this particular disease.
Even with the preliminary data available in Europe and the US at the start of March, it was evident that overwhelmingly people requiring intensive care, and finally dying, were people with existing severe medical conditions including and old people, but only because old people are more likely to have worse health conditions.
It can be argued that limiting or postponing the spread of the disease in the general population, which is not at risk, could have had some minor indirect advantages initially, because it could have helped to achieve the main objective, protecting the population at risk, in the first stages of the epidemic. If the proportion of infected people is small, it is easier to ensure the protection of the elder and the sick, at least until the logistics of establishing the safety measures have been refined.
But this approach, slowing the spread of the disease on the general population, possesses important sanitary problems:
- First, they obscure the real focus of the mitigation measures that have to be adopted, confusing people (and authorities).
- Second, to achieve results, ensuring that the isolation measures are effective, they require costly enforcement measures that would be more useful if employed in protecting the population with real risk.
- Third, they increase the time requiring protecting the population at risk, increasing the risk of contagions and increasing the total death toll.
A better alternative is to proceed following three very simple steps:
- Protect the population at risk: prevent infections in hospitals and care homes, establish measures to prevent infecting other sick or old people by their family or caretakers.
- Monitor the evolution of the epidemic and, as soon as the data demonstrates that the first objective has been achieved, let the epidemic burn itself, as quickly as possible, by encouraging the spread of the disease.
- Return to normal life.
Not so difficult. Is it?