Saturday, March 14, 2020

Three options

Sometimes when natural scientists write about social science, it is difficult not to smile at their enthusiasm at “discovering” what is already well-established (or, more often, long-abandoned) theories. I guess the same is true for me when writing about epidemiology and public health. But the covid-19 situation has had me thinking, and talking with friends, there seems to be basically three options:

1) “Big Bang” – get everyone infected in the hope of creating herd immunity; maybe isolate the most vulnerable until a vaccine becomes available; a painful option with high mortality but short duration of the epidemic and more managable economic consequences

2) “Flatten the curve” – slow the flow of new cases through social distancing; long duration of the epidemic with far-reaching economic consequences but less mortality

3) "Containment" – widespread testing and tracking down of every new case using cell phone location data and other invasive technologies combined with extreme social distancing; very high upfront costs but potentially short duration and low mortality

So far, China, Korea and Taiwan have been going for the third option but, without global cooperation, it will not be effective unless they also remain isolated from the rest of the world for the duration of the pandemic. Sweden started off with the third option but has now shifted to mitigation and a “flattening of the curve” (which may not be possible). Boris Johnson has floated the first option which, even if very risky, may ultimately be the most effective way to permanently address the issue, in particular if a vaccine fails to materialize. However, beyond the high human cost, it may also seriously damage social trust as the health care system becomes overwhelmed.

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