“We must be the great arsenal of democracy. For us this is an emergency as serious as war itself. We must apply ourselves to our task with the same resolution, the same sense of urgency, the same spirit of patriotism and sacrifice as we would show were we at war.”

Franklin D. Roosevelt, 12/29/1940 Fireside Chat

COVID-19 Mitigation: Big, bold, but… For how long? 

Lockdowns, shutdowns, and quarantines… These are the buzzwords to describe our current attempts to mitigate the spread of COVID-19.  They are considered necessary at this time, mostly due to our lack of preparation.  We had a 2-month runway to prepare for landing this plane. We missed that opportunity. We will perform a post-mortem on this process soon enough. We have bigger problems right now. 

The current mitigation measures are heavy-handed and all-encompassing. The entire country could be on lockdown soon.  California just ordered people to shelter-in-place. New York just ordered all non-essential workers to stay home. These broad mitigation measures are necessary to allow the US to catch up.  These measures will slow the spread. But at what cost? And for how long? Mitigation is not an effective, or workable long-term strategy for a novel virus in an immunologically naive population.   

Let’s not forget… 

“EVERYTHING WE DO BEFORE A PANDEMIC WILL SEEM ALARMIST. EVERYTHING WE DO AFTER WILL SEEM INADEQUATE”

Michael Leavitt

It’s the economy, stupid. 

Even though listening to financial pundits speak to how long this could go on is virtually comical, one common thread remains clear.  A 25 Trillion dollar a year economy is at risk. Significant risk. They talk about the risk of recession. There will be a recession.  The larger issue is the looming risk of depression; and the financial, emotional and social upheaval that would result.  

The UK has said that they will 80% of the wages of those who are unemployed.  A huge step in the right direction. The US just announced that it is moving back the April 15th deadline to file your taxes.  Time-shifting a major financial obligation is a big move… but the US will need to do much more.  

We cannot remain in full lockdown for more than a few more weeks.  Mathematically speaking, for a virus that is doubling every 3-5 days and has an R0 of 2-3 we will need to remain sequestered in our homes for the next 3-4 weeks.   But what do we do after that?  

Will the COVID-19 virus be gone in 4 weeks? 

No.. the virus will be with us for a very long time.  As we discussed in our initial article on COVID-19, this is a novel virus.  No one has immunity to it. COVID-19 will continue to spread until there is herd immunity, a vaccine, or a very safe antiviral medication.  None of those options will likely occur within a year. So the question remains, how do we protect our workforce so that we are potentially able to return to work after the next month?

We need a massive COVID-19 testing and surveillance infrastructure built overnight 

That sounds unrealistic… right?!?  And it is. The point is, we need to be designing the implementation of an incredibly bold and broad system that will be capable of identifying everyone who is infected, and then be able to isolate and treat them outside their tight social circle.  

This will be a massive undertaking.  This will require immediate and swift action. Attention will need to be rapidly focused on funding, oversight, logistics, staffing, infrastructure, test equipment, supply chains and so much more.  This will require a champion within the administration. That part worries me a bit.  

We can do this.  We must do this. We do not have a choice. This is the only viable option moving forward that leaves us with a functioning economy and a reasonable chance at recovery from the financial and societal carnage that is taking place.  

COVID-19 and our Charles Perrow moment

  “… multiple and unexpected failures are built into society’s complex and tightly coupled systems. Such accidents are unavoidable and cannot be designed around.”  

Charles Perrow

In other words, these supply chain issues were entirely predictable in the setting of a pandemic.  We discussed that in an earlier post reflecting on why we are so short on needed ventilators and other healthcare-related supply chain items.  

This is why the current lack of personal protective equipment (PPE), COVID-19 screening capacity, viral swabs, and other supply chain issues is such a worrisome issue today.  If we can’t get the supplies that hospitals and frontline healthcare employees need now, you can imagine how difficult it will be to ramp up a nationwide massive COVID-19 surveillance system.  

It can be done. The US has been in this situation before.  This is our Pearl Harbor moment. Our current strategy of strict, definitive social isolation is the most effective tool we currently have available to us. Strict social isolation is not an appropriate long-term solution.   The issues that will arise after a prolonged quarantine might be worse than the pandemic itself, therefore other alternatives must be explored. 

As far as I see it, the only alternative that presents itself as a reasonable option is the immediate deployment of a nationwide, strict all-encompassing COVID-19 surveillance project. We need to look no further than the South Korea model. It is not perfect. Pockets of infections are still occurring. But they are manageable and they allow many activities to continue.  

Not only will a nationwide initiative employ tens of thousands of workers, but it will also allow the rest of us to get back to a far more normal existence than we are currently experiencing. 

True normal, however, will take a very long time to achieve.  

 

Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.

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About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

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