As of the first week of May, more than 66,000 Americans have died from the COVID-19 pandemic. [Almost 90,000 as of May 16 – Ed] Given that three to four weeks typically elapse before death, thousands more who are already infected will also succumb to the virus. That said, the direct toll from the infection has markedly declined throughout the United States, including the epicenter of New York. The curves have been flattened – the stated goal of the isolation has been accomplished – for both hospitalizations per day and deaths per day.
We now have an even greater urgency, due to the severe and single-minded policies already implemented. Treating COVID-19 “at all costs” is severely restricting other medical care and instilling fear in the public, creating a massive health disaster, separate from a potential world poverty crisis with almost incalculable consequences. Half of neurosurgery patients still refuse to come in for treatment of diseases that if left untreated risk brain hemorrhage, paralysis and death, even when their doctors directly reassure them. That’s just one subset of the latest reports of skipping two-thirds to three-fourths of cancer screenings, most childhood vaccinations and treatment for new strokes and known cancer.
There are two critical aspects of this urgently needed re-entry plan. First, policymakers must apply logic and critical thinking to the massive amount of evidence we have acquired and combine that with decades of established medical science. Second, we must demonstrate and fully convey the logic underlying the plan to reassure a public that has become almost paralyzed with panic and fear.
The basis of reassuring the public about re-entry is repeating the facts about the threat and who it targets. By now, studies from Europe and the U.S. all suggest that the overall fatality rate is far lower than early estimates. And we know who to protect, because this disease – by the evidence – is not equally dangerous across the population. In Michigan’s Oakland County, 75 percent of deaths were in those over 70 years old; 91 percent were in people over 60, similar to what was noted in New York. And younger, healthier people have virtually zero risk of death and little risk of serious disease; as I have noted before, under one percent of New York City’s hospitalizations have been patients under 18 years of age, and less than one percent of deaths at any age are in the absence of underlying conditions.
Here are specific and logical steps to end the lockdown and safely restore normal life:
First, let’s finally focus on protection for the most vulnerable — that means nursing home patients, who are already living under controlled access. This would include strictly regulating all who enter and care for nursing home members by requiring testing and protective masks for all who interact with these highly vulnerable people. Specifically, nursing home workers should be tested for COVID-19 antibodies, and if negative, for virus to exclude infection, to ensure safety of senior residents. No COVID-19-positive patient can resume residence until definitively cleared by testing.
We should continue to inform the public about what they have already successfully learned regarding the at-risk group. That means issuing rational guidelines advising the highest standards of hygiene and appropriate social distancing while interacting with elderly friends and family members at risk, including those with diabetes, obesity and other chronic conditions.
Second, those with mild symptoms of the illness should strictly self-isolate for two weeks. It’s not urgent to test them — simply assume they have the infection. That includes confinement at home, having the highest concern for sanitization and wearing protective masks when others in their homes enter the same room.
Third, open all K-12 schools. Children have nearly no risk of serious illness from COVID-19. Exceptions exist, as they do with virtually every other clinically encountered infection, but that should not outweigh the overwhelming evidence to the contrary. Again, standards for consciously protecting elderly and other at-risk family members or friends would still be employed.
Fourth, open businesses, including restaurants and offices, but require new standards for hygiene, disinfection and sanitization via enforceable, more stringent regulations than in the past. It is reasonable to post warnings for customers who are older or in other ways vulnerable. Avoid unnecessary requirements for spacing of customers, though — it is not logical that otherwise healthy adults, especially younger age groups, should be isolated or maintain a six-foot spacing from each other. If infection is still prevalent, socializing among these low-risk groups represents the opportunity for developing widespread immunity and eradicating the threat.
Fifth, public transportation, the lifeblood of much of the workforce in cities, should resume. In addition to new standards of cleanliness and hygiene that passengers would welcome, regional authorities could require barrier masks for passengers. Given the state of our fearful public, it seems highly likely that most people will choose to wear them.
Sixth, parks and beaches should open. The closure policy was aiming to prevent social mingling. There is no scientific reason to insist that people remain indoors. Given now that we know whom to protect and how to protect them, even inside our homes, outdoor sports activities can resume.
Finally, implement prioritized testing for three groups: Nursing home workers, health care workers and first responders, and patients in hospitals with respiratory symptoms or fever. Widespread testing is not a predicate for reopening as above. And contact tracing is not valuable after a disease is already widespread, even though it would be an important part of the overall preparation for potential future outbreaks.
Total isolation must now end to limit the enormous harms accumulating from sacrificing vital health care and imposing economic lockdown. Smart re-entry cannot be delayed by fear or hypothetical projections, because we have direct data on risk and experience with managing it. Targeted protection for the known vulnerable, standards and commonsense recommendations for individuals and businesses, with prioritized testing form the basis of an urgently needed re-entry plan. Science and logic must prevail over fear and worst-case scenarios.
Scott W. Atlas, MD, is the David and Joan Traitel Senior Fellow at Stanford University’s Hoover Institution and the former chief of neuroradiology at Stanford University Medical Center.