It’s just about half a year since we recognized that the coronavirus had taken residence in the US and just about everywhere else. We took a while to realize that the bug was going to stay longer than The Man Who Came to Dinner. Though epidemics have been a feature of human existence ever since we forswore hunter-gathering for civilized life, they always take us by surprise.
With a half a year’s experience some observations can be made with at least a hint of confidence. First, when you hear a politician declaim that he intends to follow the science you can be certain that he is either confused, cynical, or both. What science does he intend to pursue? That of the virologist, or the epidemiologist, or the infectious disease specialist, or the immunologist, or the primary care physician, or the psychologist, or the psychiatrist, or the economist, or the sociologist, or the political scientist; the list has barely begun. Epidemics are complicated and their effects go beyond the domain of any scientist or that of anyone one who thinks he’s an expert on anything. Obviously, a large scale epidemic will become politicized. The current one coming during a presidential election year was certain to drive journalists and office seekers madder than a rabid polecat.
The initial response to the virus, generated by fear and and panic rather than serious deliberation, was to close down much of human activity. Of course, complete closure is impossible as we’d soon starve, die of thirst, lose power, and generally collapse. Remember that complete cessation of all activity is precluded by the third law of thermodynamics which the courts have yet to invalidate. So we partially closed down. Doing so only extends an epidemic as there are still many people trying to prevent the world from collapsing and who thus expose themselves to the pathogen. When we reopen the epidemic flares and there is a new spike in cases. Epidemics always end, but only when a majority of the population develops immunity to the causal agent or when an effective vaccine is developed. We’re not close to the former. The prospects of an effective vaccine are uncertain.
We now have a good idea of the lethality of the novel coronavirus. It increases with age. The very young, 20 and below, are very low risk of dying, likely less than the death rate of the flu. But older people are at increasing risk as they go from 20 to 80 and beyond. Why? There isn’t a definitive answer to the question, but a pretty good explanation is clearly at hand and probably is correct.
Aging alone is likely not the enabler of the deadly effects of the virus. I think it’s the association with comorbidity that is directly proportional to age that is the culprit. People 80 years old or more have a mortality rate from COVID-19 that is somewhere around 30%. The mortality rate in an octogenarian who has no comorbidity is not known. Consider old people who are not hypertensive, do not have cardiovascular disease, have a normal immune system, do not have any inflammatory diseases, are not diabetic, are not overweight, and have normal pulmonary function – in other words, no disease of any sort beyond a creaky joint. Are there such persons? Yes, they’re called future centenarians. Admittedly, there are not battalions of them, but they do exist. My suspicion is that they would survive an encounter with the coronavirus much the same as a 20 year old.
So how should we have proceeded and regardless of any previous errors how should we move on now? First and most important, don’t shut anything down. Inform people about the disease and the risk factors that place them at greater or lesser likelihood of dying from it. Masks are probably helpful, but I wouldn’t make their use mandatory. Recognize that relying solely on doctors to make decisions that go far beyond the limit of their competence is a mistake. The opinion of an economist should carry as much weight as that of an epidemiologist. Allow people to chart their own course after giving them as much information as they desire. Above all, pay no attention to politicians and journalists who give medical advice. Which is what I just recommended about doctors who give advice on the organization of society. Think for yourself.
All of us have responded to this epidemic poorly. We’ve overestimated it’s death rate, by about a factor of 10, and made a serious health problem into a global catastrophe. As acting irrationally didn’t work, we could try reflection and analysis based on all the evidence available and see if this approach has a better outcome. Fear and panic should be replaced by a targeted response as described above. The virus will be with us for a while longer and some people will die from it. These death will mostly be in people whose health status was not good to begin with. Killing society will not protect them.
