Some Perspectives on the Epidemic’s Potential Course

An organization at the University of Minnesota called the Center for Infectious Disease Research and Policy, run by noted infectious disease expert Michael Osterholm.  He must have turned very gloomy in his old age, because this is a depressing perspective, which is also dated in some of its assumptions.  Osterholm is getting paid big bucks for consulting with the state, so he of course toes the official line on how dangerous everything is and how much we all have to hunker down forever.   (UM Report)   They point to influenza pandemics as the most analogous situation, but as far as I can tell, we didn’t shut the country down for any of those.

They list some similarities and differences between the flu and this coronavirus, and then discuss scenarios.  They think the virus spreads more easily than flu, but that really hasn’t been proven in any meaningful way and it is pretty irrelevant.  What matters more is how much serious illness it might cause.  They think the outbreak will last 18 to 24 months and that 60% to 70% of people need to be immune before it in essence stops.  Well, how long it lasts depends on how hard you try to suppress it.  If you keep enforcing these extreme lockdowns, it will take forever to get there, longer than 18 to 24 months.  And the evidence is pretty clear now that a large percent of people don’t get infected, so population immunity may be achieved at much lower levels, despite high transmissibility.

They lay out 3 scenarios of waves of infection.  They assume, however that only 25% of infections are asymptomatic, which grossly understates the true fraction, which looks closer to 90%.  That renders the whole wave notion absurd, as long as we don’t put too extreme lockdowns in place.  They assume asymptomatic and presymptomatic people can transmit infection, and that seems like a reasonable assumption.  Their discussion of waves seems to assume either very strict lockdowns that limit early development of population immunity and/or some seasonality to the virus.  Their scenarios and strategies are basically more of the same disastrous responses that have destroyed the economy. We simply can’t even consider continuing that for 18 to 24 months.  I think the reality today is that every Governor realizes that their state won’t survive if they don’t get the economy moving.

The paper has no discussion of the extremely wide divergence in impact of the disease by age; a divergence that is unlike any influenza epidemic.  So those are poor models for devising policy.  And Osterholm, of all people, should recognize that given that divergence, we could devise a strategy that is safe for the general population in developing the population immunity that is the best protection for the at-risk elderly.

The next paper on exit strategies is by Avik Roy, a journalist and supposed policy expert, and a group of associates.   (Roy Paper)   Mr. Roy is concerned about what we are doing to the economy.  He challenges what at the time the paper was written just a short time ago was the consensus, that we just had to keep schools and businesses shut and people at home for months.  I think that consensus, if it ever existed, is gone now.  He does recognize that the epidemic is really only a serious health threat to the elderly and some with pre-existing conditions, so that a more tailored strategy can be adopted.  He also properly notes undue optimism about testing, treatments and a vaccine.  He worries that antibodies may not be strong enough to provide immunity, but recent research would seem to put that concern to rest.  His specific recommendations include opening the schools, lifting stay-at-home orders for non-elderly people who are healthy, reopening non-essential businesses that can operate “safely” (okay, I am tired of that BS, if the risk is so low to the general population and you are still isolating the at-risk elderly, how is any business not safe?), continuing to prohibit large groups (see the parenthetical above), do testing and contact tracing (contact tracing of millions of people–not gonna happen), re-open travel again as long as it is “safe”, minimize non-essential inpatient admissions (I thought we had dispensed with the fraudulent concern of overwhelming the health system), and several other points.  A more thoughtful approach than most.

And here is a piece of what is being referred to as “pandemic porn” or “panic porn”.  This article is by an writer I generally trust, but unfortunately in this one, she just went full negative scary.   (Stat Article)   The article talks about three possible futures for the epidemic, but completely ignores the possibility of attempting to achieve population immunity.  She basically describes having either a series of small waves after this one ends, having an even worse wave, or enduring a series of waves that are relatively large for the next couple of years.  None of these scenarios seems particularly likely, although our current extreme suppression efforts make the possibility of ongoing waves far more likely.  And then once again, there is Sweden.  About a really much better scenario, get your population to immunity and it becomes more like the flu, or even less of an issue if the virus doesn’t mutate much.

Now, one disturbing possibility, not talked about much, is that our suppression efforts put so much pressure on the virus that it becomes more likely to develop mutations that actually enhance its virulence.  Just one more reason to attempt to encourage a moderate spread that gets us to population immunity.