I did not get to a big-picture situation update this weekend, but I will try to do so in the next day or so. I have been thinking about how this epidemic likely has proceeded to date and what may come next. So here is my current take, which obviously may evolve as more evidence becomes available.
The epidemic almost certainly started by November in China, perhaps earlier. The Chinese clearly suppressed information about what was occurring. By the time it became apparent that an epidemic of some severity was underway, thousands of people had traveled from areas where the virus was circulating to many countries across the globe. Those people infected others in the countries to which they traveled, and until international travel ceased, there likely was a pattern of travel of infected persons from one country to another. It is almost certain that the virus was in the United States by December. At least two deaths in early and mid-February in California are now attributed to coronavirus, which would suggest that infections must have been occurring well before the date of those deaths.
Although the Chinese probably realized this, it wasn’t apparent to other countries how differentially the virus affected people throughout the age spectrum. Now we now the difference is quite extreme. Given the typical social contact patterns of children, adults and the elderly, particularly the elderly in long-term care facilities and other group living settings, it would seem sensible to assume that the virus was infecting younger and working age people first and these people largely were asymptomatic or had mild illness that they believed was just a cold or the flu. So while there likely were many infections, there were few serious illnesses. Since dying from coronavirus usually involves pneumonia or other respiratory distress not dissimilar to flu, even deaths would not have appeared to medical personnel to have been due to a new agent, until there was awareness of the potential spread of the disease from China.
It would likely have taken a longer time for the virus to reach the elderly, and again, any initial illness might have been perceived as flu-linked. But when it began to reach the elderly, especially in long-term care settings, it spread rapidly due to their lower ability to prevent infection and serious illness. Bad data from China led to terrible modeling of possible consequences of the disease and off we went. Early results in the US, because the known cases were heavily weighted toward the frail elderly, appeared to support the notion that a high proportion of all cases would be serious illnesses and there would be a high rate of death. Instead of waiting for more clarity or considering other explanations, driven by public health experts who should have known better, governments began issuing stay-at-home and business shutdown orders. We all now know what the result of those has been.
It couldn’t be more obvious from the data at this point that children have essentially zero risk and working age adults have a very, very small risk. The frail elderly on the other hand, have a far, far higher risk. So left unchecked, this epidemic would have assumed an almost bifurcated shape. For the general population it would have been fairly similar to a bad flu year, almost all infected people would have no or mild disease. For the at-risk sub-groups, especially the frail elderly, especially those residing in a group setting, it would have proceeded very quickly and caused a large number of deaths.
Instead of the obvious strategy of focusing on protecting the at-risk groups, we chose to shut everything down. This has interfered with the development of population immunity, which would slow the virus’ transmission to all groups. These actions have actually created a longer and greater period of risk to the elderly. Now, instead of being able to continue to protect those groups, but not have to worry about any significant transmission in the general population, we have condemned ourselves to perpetual lockdowns, fearing “second waves”. This is unsustainable from an economic or a social perspective.
Sooner or later we should be working toward population immunity; it is faster and more likely than development of a universal vaccine. It would be far less damaging to the economy and to our health. We will see a large number of excess deaths from both the joblessness we have created and from the terrorization of the population which has led many people to avoid needed medical care. It is honestly hard to imagine a dumber response. And if we don’t reverse course now, we are multiplying all the pain we feel–from the virus, from joblessness, from loss of social contact.