Sunday, March 22, 2020

COVID-19: Cocoon the vulnerable, save the economy?

1. Define a high-risk (age 65+, pre-existing condition) and low-risk population. Perhaps 15% in the first category, 85% in the latter.

2. Let the low-risk people go back to work. Start the economy up again.

3. Issue a "shelter in place" order for ALL high-risk people. Low-risk individuals who co-habit with high-risk people (e.g., family members) have a choice: self-isolate as well, or move into government provided accommodation.

4. The isolated people receive regular food deliveries and medical care (virus tests). Existing platforms for food delivery (Lyft, Uber) can be used almost immediately for this purpose.

This seems to be a good solution in that:

a. it minimizes damage to the economy,
b. reduces deaths significantly (if executed efficiently), and
c. matches the sacrifices (inconveniences) to the people who benefit most.

Would it work? When I first heard about herd immunity and cocooning the vulnerable, I was skeptical. But now that whole countries have experienced lockdown, and financial markets have descended into chaos, I suspect that the solution above would be widely acceptable as an alternative.

Previous discussion
of this idea:
I've yet to see any detailed calculations for an alternative plan which tries to isolate the most vulnerable while allowing the economy to continue to function. Could it work?

1. Define the vulnerable population: e.g., people over 65 or with pre-existing conditions. Let's say this is 15% of the total population.

2. Try to isolate these people as much as possible. Give them free accommodation in the now empty hotels and college dormitories, on military bases and in makeshift shelters. Guarantee them free food delivery and regular medical checkups in these new locations. Within these locations practice very good internal isolation, as on the Princess cruise ship: isolate each person in their room, require the wearing of (inexpensive; not N95) masks when they emerge for activities, etc. Use the National Guard and military to execute the strategy.

Alternatively, we could leave the vulnerable population in place where they are now and move out any younger people (e.g., family members) they live with into temporary housing, or even confine the younger people in place if they consent to isolation in order to help their elders. The shelter in place order only applies to 65+ instead of the whole population!

It seems that this could be less expensive than the lockdown currently in place.

Uber and Lyft drivers wearing gloves and masks, spraying down their cars periodically, could be used as people movers or for food delivery. Instead of shutting down restaurants, the government could employ them to produce the meals for the sequestered people... The government just has to pay Uber and Lyft through their existing platform. Beats mailing checks to the entire population!

Diamond Princess data: "3,711 passengers and crew members onboard. Passengers were initially to be held in quarantine for 14 days. However, those that had intense exposure to the confirmed case-patient, such as sharing a cabin, were held in quarantine beyond the initial 14-day window [3]. By 20th February, there were 634 confirmed cases onboard (17%), with 328 of these asymptomatic (asymptomatic cases were either self-assessed or tested positive before symptom onset) [3]. Overall 3,063 PCR tests were performed among passengers and crew members." Among the infected were many younger passengers and crew members, but the 7 individuals who died were all 70+. AFAIK 10-20 more individuals were in critical condition and we don't know their ultimate fate, but clearly the worst outcomes are highly concentrated among older people. This is reflected in the data from Italy, PRC, and S. Korea as well.

Note: as of March 24 the number of deaths has reached 10, but I don't know the age distribution. In recent NYC data it looks like ~80% are over 60 and the rest a bit younger.

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