Note: The CDC has recently taken the position that asymptomatic people do not need to get tested. For the record, I’m not 100% sure I agree with this. But I don’t think it’s nearly as bad an idea as most people seem to. So here are some of my thoughts about the situation. There is a least a bit of Devil’s Advocating here and several points I could be convinced I’m wrong about.
For some reason, people still have this idea that we can “beat” Covid. That ship sailed, probably in February. It’s so far over the horizon, it’s a distant memory. Based on experience in most countries, the virus passes so quickly that by the time any country or region realizes there’s a problem, it’s already too late to stop it.
A vaccine might save us, but you need a critical mass of people taking it for it to work. I’m afraid that subject (like the subject of HCQ) is so hopelessly politicized that the vaccine won’t be adopted by enough people to be effective.
The vaccine is a big “if”, and the virus has spread way too far and wide to stop it at this point. The only real solution left is to let the epidemic burn itself out. People get sick, they develop some degree of immunity[1], and eventually the virus runs out of new hosts to infect. This is more or less what happened to Spanish Influenza, and why that doesn’t exist any more, even though we never made a vaccine for it.
This is also what seems to have happened with Covid in Europe. Population density is much higher there, so it spread a lot more quickly. It was a dumpster fire in the spring while the flyover states had near-empty ICUs. But now the number of fatalities there has dropped to near zero, while the US is still catching up.
With that being the situation, someone getting sick is potentially bad for that person (depends on how severe the case is), but it’s good for the public health, because each person who recovers brings us closer to the end of the pandemic[2].
Here we enter the realm of tradeoffs.
The lockdown has been very hard on most people mentally and emotionally. (If you’re one of the lucky ones who didn’t much mind the lockdown, please go ask a parent with kids in school how they’re doing.)
The lockdown did several good things. It allowed medical practitioners to figure out which treatments work and which don’t. Things like “skip the ventilator and just roll the patient on his back”. You’re going to get a better outcome if you get sick in September than if you had gotten sick in March.
But we have probably learned most of what we’re going to learn. It doesn’t seem likely there’s a new treatment on the horizon that won’t also become hopelessly politicized.
There was also the part about making sure the ICUs don’t get overloaded. That has happened once in one place at one time (NYC in the spring). Right now every place should have plans and capacity to deal with any substantial outbreak.
So whatever benefit we got from a blanket lockdown on everyone, regardless of circumstances, the situation is different now than it was in March.
Then there is the potential cost of contracting Covid.
When we first got word of this, nobody knew how bad it was to get. Was it like ebola, which kills 50% of the people who get it?
Well, we now know that if you’re under the age of 40, there a 99.99% chance you will survive. Even if you’re over 65, you still have about a 95% chance of surviving. If you’re under ten years old, you’re considerably more likely to die in a car crash than to die of Covid (although last I checked we haven’t (yet) made it illegal to let kids ride in cars).
Furthermore, apparently some people who have T-cells from fighting off different coronaviruses, which provide some level of immunity to Covid. Thus you might already immune to COVID-19 because of that cold you got a few years ago[2].
Some people are more at risk than others. Some people have complications after they recover, although for obvious reasons we don’t have any studies about how people are doing a year later. The effects may linger the rest of your life, or they may go away after six months. Nobody knows.
But then, nobody knows the long-term effects of the lockdown and prolonged social isolation.
Right now, we have a situation that has extremely high costs on everyone, with some benefit for some people and extremely negligible benefit for other people. These policies collectively slow the spread, without stopping it. We are ripping the bandaid off slowly, rather than quickly.
I know March seems like a long time ago, but remember that when the lockdowns were proposed way back when, it was never sold as a way to defeat Covid or make sure nobody gets sick. It was just supposed to buy us time. It seems to have done that. (And even if it was sold as a way to beat the virus, well, clearly that didn’t happen.)
Now, instead locking down everyone regardless of circumstances, and inflicting suffering on everyone equally, we might consider looking at individuals. We might consider how they can balance the harm caused by a lockdown with the harm caused by the virus.
Consider someone who just got a job and is now doing her part to rebuild the economy and earn a paycheck for her family. If this person tests positive, per the policies we have, she will effectively be quarantined, effectively put under house arrest for the next two weeks. This means a return to the trauma of social isolation. In the meantime, her employer might find someone else from among the millions of unemployed people to take her job. (Maybe not “fair” but it happens.)
If this person is asymptomatic and doesn’t know she has the virus, she can continue working, avoid quarantine, and keep helping the process of returning things to normal.
She might spread the virus to more people. We know it’s possible to be infectious without having symptoms, but we don’t know how much less infectious an asymptomatic person might be. Maybe it makes a difference why someone is asymptomatic. Is she asymptomatic because the virus is incubating, but she’ll be sick in a few days? Or does she have the aforementioned T-cells that are killing off the virus, but haven’t finished the job yet?
It’s entirely possible she is so mildly infectious that she won’t infect anyone else. There aren’t any good studies on this.
But even if she does infect other people, remember that the only way the covid situation will really end is if enough people develop immunities. Which means people either getting a vaccine or people getting sick. This is just accelerating how quickly the bandaid is being ripped off.
But what if she tested positive and doesn’t actually have the virus, due to a testing error? Then she bears all the costs of actually having the virus — the quarantine, the stress, possibly the job loss — for no reason at all. And if she actually does get sick at a later date, she might attribute it to something else, because “I’ve already had Covid.”
You might recall that women under 40 were advised not to get a mammogram unless they have a family history of breast cancer. This is a similar situation. If a woman gets a positive result on a mammogram, she ends up getting unnecessary treatment until they figure out she was negative the whole time. The costs don’t outweigh the benefits.
There are no easy options that don’t involve people suffering. But given what we know, the huge majority of people who are exposed to the virus will be fine, and most probably won’t even notice they have it [3].
Meanwhile, the human toll of the lockdown and attendant social distancing is huge and continues rising. We are doing just enough to slow down the spread of the virus, without doing enough to actually stop it (assuming it isn’t several months too late for that, which again I highly doubt).
But don’t immediately dismiss some idea because “if we do that people are going to get sick”. It’s definitely too late for that.
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[1] You might be thinking, “Well, we don’t know how much immunity you get from getting it! Didn’t I just read about a guy in Hong Kong who was reinfected?” First off, we do know you get at least some immunity [citation needed; I can’t find the thing I was reading about this, but I assure you it’s true]. Second, there have been three known cases of reinfection out of millions of people who have gotten this. Doesn’t seem like the odds are likely. But let’s assume you get zero immunity from getting the virus. Then guess what? There’s not going to be a vaccine either! Vaccines work by getting your immune system to recognize and fight off a disease. If the immune system is hopeless on this task, COVID-19 is going to be with us forever. The only thing that will get rid of it is if everyone hides in their houses until humanity dies out.
[2] This is how the smallpox vaccine worked. People were given a dose of cowpox, which is much less deadly. People built up T-cells for fighting cowpox, and those same T-cells were also effective against smallpox.
[3] This goes double if you’re in St. Louis and allergic to everything. Like me. I can’t tell you how many times this year I’ve wondered, “Is that tree pollen or am I dying?” Maybe one of those times it actually wasn’t tree pollen.
