A “Modest Proposal” for Flattening the Curve

It seems clear(?1) that the pandemic will proceed in each community until about 70% of the population has acquired immunity by having survived the infection. The question is just how many will not survive.

The good news is that the proportion of young and healthy people who will die is very(?) small. But the potential cull of their parents is much higher. For those over 70 the death rate appears to be around 10%, with the actual rate being strongly dependent on the availability of suitable intensive care.- especially mechanical ventilators which, not being so much needed in the normal scheme of things, will be in short supply when the peak infection rate hits.

Since there is as yet no way of reducing the actual number of people who eventually get the disease, the key to minimizing the losses is to lower the peak infection rate so that all those for whom the disease is critical have access to the best possible treatment.

This means that old people (and young ones who are not too desperate for a quick inheritance) may benefit from any behaviour which slows down the progress of the disease, and, by spreading the demand over a longer time interval, makes it less likely for people to die due to not having access to optimal treatment. (See this Washington Post Article for a good explanation of how “social distancing” works to keep down the peak number of active cases – and also this Medium article for more detail on some of the actual history of the pandemic – and this report form a team at Imperial College in London which apparently was istrumental in persuading the UK and US governments to adopt strong measures of social distancing.)

I must admit that my first reaction on hearing of the disease was (despite being over 70, and so in a relatively high risk population myself) to say “well let’s just get it over with and take our chances – like dealing with the pain of pulling off a band aid”. But on realizing the significant life-saving potential of high tech medical equipment, and seeing the numbers in need of that equipment quickly overwhelm the capacity of a relatively modern medical system in Italy, I have changed my tune and now favour as much social distancing as we can stand for as long as we can stand it.

However I do have a novel suggestion to add for dealing with this novel Coronavirus.

Perhaps, given the very low risk of serious harm to an identifiable sub-population, it might be helpful to ask for volunteers to undergo early infection and quarantine – after which they would be free (nay, even encouraged) to get out and mix with others as much as possible.

The main reason for bothering to slow it down (as opposed to taking the “rip off the bandaid” approach) is the fact that if all the infections happen quickly then the small percentage who get critically ill will still overwhelm our intensive care capacity and so suffer losses which would otherwise have been avoidable. But if we could increase the immune population by selectively infecting and isolating people at low risk for complications, then the peak IC burden might be lessened. Does it make sense therefore, to use the now empty cruise ships, hotels, and holiday camps to offer free luxury accommodation (and guaranteed access to whatever critical care might be needed) to groups of healthy young people who can expect to spend part of their holiday under the weather but who will be free to mingle among themselves throughout both their brief (usually mild) illness and also a substantially longer period of normal health?

For my own part it might have made sense to get it early if I could have been sure of getting in there with access to the best available care before the big rush made it likely for me to end up gasping without a ventilator. But sadly, I think it may be already too late for that.

(?1)NB (added March19) The success of China in suppressing transmission sufficiently to bring a halt to new internal cases leaves a large unexposed population still vulnerable to potential infection unless at least the borders continue to be very closely monitored with mandatory quarantine of every new arrival until fully confirmed with non-carrier status.

(?2)NB The claim that for the young and healthy this has a death rate that is “very” small may be understating the risk since a fatality rate of 0.5% per year would be about the same as that of US troops deployed to combat in Iraq in the early 2000s. (But perhaps the “modest proposal” of asking people to expose themselves to that probably inevitable risk just earlier rather than later, and for the purpose of reducing the risk for others, is at least no more callous than asking them to do so in order to achieve a political goal which may have been mainly just to maintain control of a massive oil supply.)

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One Response to A “Modest Proposal” for Flattening the Curve

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