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The Red Line

One Size Does Not Fit the Virus

The attempt to protect everyone left the most vulnerable nakedly exposed

The nation and Connecticut are reopening fitfully and unevenly from a shutdown that many think should not have happened – many including Pulitzer-Prize-winning columnist Thomas Friedman of the left-leaning New York Times and Dr. David L. Katz, a Connecticut MD and an expert with a public health degree from Yale.

Our “one-size-fits-all” shutdown policy is strange in the face of a virus which afflicts different population segments in such wildly different ways. For those over age 65, who comprise only 16 percent of the country’s population, the virus has been devastating. This age group has sustained about 80 percent of nationwide deaths – 94 percent of Connecticut fatalities have hit people over 60.

Additionally, it is just plain common sense that people with serious prior conditions would be at greater risk, and that transmission would be greatest in densely populated urban areas and in communal residential settings for seniors. An estimated one-third of national fatalities occurred in nursing homes, and almost 70 percent of Connecticut deaths occurred in nursing homes and assisted living communities.

To have imposed a uniform stay-home-shutdown policy was like a shoe store selling only size-8 shoes.

Before the U.S. shutdown began, data out of China and Italy were unambiguous that the virus attacked the elderly and spared those younger. Moreover, the first U.S. outbreak occurred at a nursing home in Washington State.

Tragically, the attempt to protect everyone left the most vulnerable nakedly exposed. A central precept of medicine in the context of scarce resources is triage. God knows, we had scarce resources as the pandemic broke out. When everyone can’t be saved, triage means focusing policy, effort and resources in a manner designed to maximize survivors – in the case of this virus, that means protecting those most clearly vulnerable.

Instead, nursing homes were overlooked at best, and, even worse, in New York and some states, governors forced them to admit infected seniors. Will these governors be held to account?

From the start, many saw a targeted approach without a total economic shutdown as a better approach. Unfortunately, partisanship has developed, with most Democrats supporting the universal stay-home-shutdown policy and many Republicans the targeted alternative. So, looking at the targeted alternative through the eyes of Thomas Friedman may help.

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