The solution we suggest, based on scientific studies and common sense, is:
Selective confinement of selected risk groups!In home if a single person or more people all of risk. If not, then in the empty Airbnb, Hotels and other spaces (paid by the government). Also leave the large majority of people, proven not at risk, to move free, work and have a normal life. This will save people lives, enormous government expenditures as well as the economy.
During this unprecedented coronavirus crisis blocking the world, there are two main camps. The one is for a forced confinement of everybody. The other one is for the free movement of everybody. People from one camp think this coronavirus (SarsCov2) causing Covid19 (SARS2) is super dangerous. The other people do not think… they neglect the danger! Well, both sides are right and wrong. Right to some point and wrong to some point.
Let’s repeat it in another way. If you are for the free movement of people, you are right. If you are for the forced isolation you are right too. How come?
THE KEY IS THAT A NUMBER OF SCIENTIFIC STUDIES ALREADY PROVED THIS VIRUS ATTACKS SEVERELY ONLY SELECTED RISK GROUPS!
For all the other people it is as mild as a seasonal flu in terms of hospitalizations and death rates. Yes Covid19 is not a flu, but you can still make valid comparisons of risk rates (if you have solid data, knowledge and clear brain). Covid and Influenza are both contagious respiratory diseases. You can compare both as you can compare relative risks of cars and airplanes accidents and deaths – both are modes of transport.
To sum up, the people with relatively high risk of hospitalization and death are people of certain age and certain health conditions.
Let’s focus on the well proven age factor. Different age groups have different risk levels to come to a need of hospital beds, especially in intensive care units, as well as death beds.
See a quote of a new report (out of more than 70 000 cases studied), published March 30, of The Lancet Infectious Diseases medical journal. Study co-author Azra Gahni mentions in a news release, source (usnews.com/news/health-news/articles/2020-03-30/odds-of-hospitalization-death-with-covid-19-rise-steadily-with-age-study):
“Our analysis very clearly shows that at age 50 and over, hospitalization is much more likely (than in those under 50) and a greater proportion of cases are likely to be fatal,”
“Our estimates can be applied to any country to inform decisions around the best containment policies for COVID-19,”
From the same source:
“By decade, the risk of hospitalization from infection with the new coronavirus is: (Practically) Zero for kids under 10; 0.1% for kids 10 to 19; 1% for people aged 20 to 29; 3.4% for people aged 30 to 39; 4.3% for people in their 40s; 8.2% for those in their 50s; 11.8% for people aged 60 to 69; 16.6% for those in their 70s; and 18.4% for those in their 80s or above.
As for the death rate, the risk was near zero for people under 40; crept up to 0.2% for people 40 to 49; to 0.6% for 50-somethings; just under 2% for people in their 60s; 4.3% for those in their 70s; and 7.8% for those in their 80s, the findings showed.”
See the age numbers in the table3 via the link below. There are a few columns. For simplicity, what matters is on the left the age range, on the right observed deaths:
Attention the said studies are for ALREADY PASSED outbreaks, thus the death rates are reliable. Remember DURING an outbreak it is extremely difficult to give valid estimations of death rates. I do not want to write too long with too many technical details. But in the media there is so much chaos causing panic with different numbers of mortality… So it is essential for you to know a bit about it!
The reason there are so large ranges of mortality percentages is that there are TOO MANY UNKNOWN VARIABLES DURING AN OUTBREAK. Too many different methodologies. Too many different outputs to measure. Too many different contexts. Too many different terms of deaths rates, etc.
Mortality for example can be in terms of:
- Case Fatality Ratio (aka Case Fatality Risk or Case Fatality Rate). This is the ratio of cases of deaths out of total infected cases (but only the cases tested positive or even only the hospitalized cases by symptoms). This usually gives false high death rates, especially during the outbreak! As usually the first diagnosed and or tested are ill people of highly risk groups. But even after the outbreak it can be misleading as you don’t know the true number of infected persons in given area or country. Which leads us to a more important number below.
- Infection Fatality ratio: the deaths vs the true total infected cases in a population. You know the positive tests are just a small part of the true total infected persons in your country!. This ratio would give you an accurate number only if you had the true number of the infected people. This is tricky to estimate, especially during the outbreak. The first rule of thumb is: the more tests you do, the closer you get to the true number of infected people and the true fatalities percentage. The second rule is: count the dead and live chickens at the end. The third rule: the more epidemic time passes – the more the death rate slows down. But for those that can’t wait the time there is the…
- Crude case fatality rate: The most misleading rate usually. You obtain it by dividing the ongoing number of deaths vs number of infected people. This is the most unreliable estimation! This rate paradoxically gives you very high false numbers or very low false number! Which logically shows you practically always a wrong death number. Mainly because of the time lag between the moment one case is diagnosed and the end point (recovery or fatality). In Covid case the cases stay crude for very long time. The usual recovery is up to a couple of weeks. But in rare severe cases one may need to wait for several weeks to end death or alive.
Now you know something about epidemiology deaths that even some journalists may not know. Unfortunately most media just throw numbers in the air. It leads to chaos and panic. Even the WHO World Health Organisation Director General gave such a misleading number on 3rd of March during an official speech to media: “Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected”. As he mentioned: “There is now a total of 90,893 reported cases of COVID-19 globally, and 3110 deaths”. See the link to the official source (who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—3-march-2020).
As you already have the three main fatalities ratio above… can you guess which death percentage the WHO chief used?
That’s right he referred to the crude case fatality rate… the most misleading one!
Let’s not jump to false conclusions or to false accusations of the leader for bad intentions. I understand it was just a speech and the WHO Director General wanted to emphasize the overall gravity of the situation. So that the people to take the danger seriously. This urged actions and saved lives.
The question is does the general public understand the death percentage are inaccurate? As we can see obviously even majority of journalists do not understand it’s misleading! I’ll explain to you about this in another article.
For now just to prove the golden rule in epidemiology… You count the gold at the end. Let me give you the example of another giant mass hysteria that is a dwarf compared to the current hysteria. It is about the swine flu that attacked the people in the last Pandemics, in 2009. You can see according to the study below:
The death risk was miscalculated DURING the outbreak up to 500 times higher than the real risk of only 0.02% proved later! Case fatality risk of influenza A(H1N1pdm09): a systematic reviewFrankly it is co
Here below is the most important quote to remember from this study:
The estimates based on confirmed cases were up to 500 times higher than those based on symptomatic cases or infections (Figure 3). The consequent uncertainty about the case fatality risk — and hence about the severity of H1N1pdm09 — was problematic for risk assessment and risk communication during the period when many decisions about control and mitigation measures were being made.
Now you see me? I mean my point. You can have accurate fatalities rates only after the epidemics is over. Not in advance, not during the outbreak. Sometimes not even after.
To cut the long story short. About the government confinement measures up to now. I think considering the unknown dangers of this novel coronavirus the leaders were right in general… up to now. They have been taking necessary steps. They did slow down the spread of death. They saved lives. Of course ideally the world leaders should have prevented the spread much earlier from the very beginning. A great example is South Korea, but that’s another story.
Anyway we do not live in an ideal world. The devil is out of the bottle. He may be dangerous to some people… but inoffensive to the large majority. So we must adapt smartly to the evolving epidemics situation.
Yes. Now, having all the confirmed data about the danger to the risk groups vs. the banal risk to the big majority of the population… It is the time to adapt our approach. Especially the governments!
This virus is selective. Our approach must be smart, nuanced and selective too.
Specifically, we must protect and isolate only the vulnerable groups in the country. In plus, to let the overall healthy population work and live the normal life. This will save peoples lives and the economy. The world must go on.
Now, if you ask me. Ok, but where to isolate the groups of risk? That would be a trillion dollar question. Indeed a question saving trillions of dollars!
Here is our answer. Considering the proven facts:
- All people of all age groups may spread the coronavirus infection
- The majority of the infected people, especially those in good health in the young and middle age groups, do not have any extra risk compared to flu and common cold (large portion of these groups don’t even have any symptoms).
- From the above majority of people (of point 2) only a minimal fraction may need hospitalization (thus they are not an overburden of the health system).
- Elderly people are groups of risk (especially those with other chronic health problems). Small minority of the risk groups may develop severe COVID19 or SARS2 (Severe Acute Respiratory Syndrome) which would lead to many hospitalizations, overload of the health system and increase of death rates.
OK sounds good selective confinement, but do we have the capacities for such selective confinement?
Yes. Currently there is an enormous amount of empty Airbnb and Hotels places as well as potential friends roommates!
The government can simply pay the relocation expenses of temporary selective confinement to the persons of risk! Or in some cases the relocation of the family members of the persons of risk. The re-location expenses would be a very small fraction of the current astronomic government expenditures keeping the overall population confined. Especially that in Canada a large portion of the people in the risk groups live alone or in special residency complexes.
Every country leaders must evaluate their specific situation. For the moment I ask you to follow the established governments confinement and protection measures. Let’s give the political leaders the time to analyse the evolving situation and to adapt accordingly. Just let them know that there may be better solutions than the current ones. Now.
If we do not adapt, we may need to stay all of us confined months and months till the Covid Wave passes. What about the next wave after?… We can’t stay confined for a year or so till we find a reliable vaccine. We can’t wait for all the population to be tested (with current rates it would take years; even if you are tested negative today, you can’t know if you are not infected tomorrow… you can’t test everyday). The only guarantee would be to test everybody once for anti-bodies (when you recover from the infection you get anti-bodies and acquired natural immunity forever (or at least for some good time). But currently we can’t proceed with such anti-bodies tests.We can’t wait to develop them being in total confinement. We must adapt now with the selective confinement. This will lead in a controlled way to the acquisition of natural immunity of the population. After this the spread of the virus will stop (or if it evolves it would become most probably a banal virus).
That’s it for the moment. We’ll continue further on this topic very soon. What do you think? Please send us your questions or suggestions. Also if you send this article to your friends or political leaders, we would sooner solve this historic crisis. We all will go back to normal life sooner.
Jordan
