Why draconian measures may not work

Two experts say we should prioritize those at risk from COVID-19 than to try to contain the uncontainable

Testing and tracking down contacts is ultimately futile for this virus, as it devotes enormous resources to finding cases that are largely mild and spontaneously resolving

By Dr. Neil Rau and Dr. Susan Richardson, NATIONAL POST  March 15, 2020


A near empty United States check-in area at Toronto Pearson Airport’s Terminal 1 during concerns the Covid 19 virus, Friday March 13, 2020.

The early days of the COVID-19 were ominously reminiscent of SARS. We had a “mystery illness” originating in China with an animal market link caused by a virus with a genetic similarity to the SARS coronavirus. Not surprisingly, the WHO and the Chinese deployed the strategy that worked with SARS: find the cases with alacrity, isolate them, and monitor their immediate contacts for the development of disease.

Isolate the contacts if they get sick. The strategy worked: SARS was contained and it never returned. SARS, though it killed 10 percent of its victims, was not contagious enough to cause significant sustained community disease.But can COVID-19 really be contained? COVID-19 stopped following the SARS script weeks ago and appears similar to many respiratory viruses. COVID-19 along with the four “common cold” coronaviruses spread easily from person to person with mild disease, and sometimes from people before they develop symptoms. It is practically impossible to contain a virus that readily spreads early in the course of infection and circulates in the community.

The highest concentration and therefore transmissibility of COVID-19 in nasal secretions peaks in the first few days of infection. SARS was different: it was transmitted most efficiently late in infection. Therefore, using the SARS model to identify patients with the symptoms of COVID-19 is bound to fail. Moreover, it’s hard to pick out COVID-19 cases from those caused by other respiratory viruses also seen at this time of year. Testing and tracking down contacts is ultimately futile for this virus, as it devotes enormous resources to finding cases that are largely mild and spontaneously resolving.

COVID-19 stopped following the SARS script weeks ago and appears similar to many respiratory viruses

Now quarantine in its various forms, is being deployed as an ever-expanding strategy, from “self-isolation” to broad travel restrictions and school closures. This sledgehammer approach will affect mainly able-bodied workers, children and students, for whom a COVID-19 infection will be nothing more than a cold. It will put a huge segment of the workplace out of commission, including health care workers, at a time when we need them most.

The WHO containment ideal requires a huge societal sacrifice from those at low risk to prevent spread to those at high risk. Sacrifices include the avoidance of foreign travel (strangely this continues even after the disease is locally present) in addition to the cancellation of large events such as concerts, cultural events, sporting events and conferences. Tourism and service industries suffer. The stock market plummets. School closures are disruptive and costly to the parents who really cannot work from home. Higher education closures affect students’ abilities to complete or pay for their education if their exams don’t finish on time. Disinfecting surfaces at random in public places is resource intensive, costly and promotes a false sense of security.

We should instead be targeting significant resources toward the protection of those at highest risk (the elderly, those with underlying chronic disease, and those with immune compromising conditions) and maintaining a healthy, robust, responsive health care system that can handle a potential surge. The economic and social costs of pursuing quarantine are staggering and actually counter-productive.

COVID-19 shows no signs of slowing down yet and has finally been declared a pandemic by the WHO. While China’s outbreak wanes, multiple outbreaks are emerging around the globe. These outbreaks follow a similar pattern, i.e. initial cases are linked to travel or travel-related cases from known geographic areas of involvement, followed by rapid spread into the community without travel links. Cruise ship, nursing home and university campus outbreaks abound – SARS never did any of this. The WHO goal of stopping a respiratory virus which generates two to three new cases from each case has been compared with trying to stop the wind. The genie is out of the bottle.

Having failed to stop the virus completely, the WHO has revised the containment strategy to a novel one: to “flatten the outbreak curve.” This new strategy is being used to invoke severe restrictions to movement and liberty at an early phase of the pandemic in North America, although the effectiveness of this approach is unproven. Even China’s valiant efforts with unprecedented mass quarantine were only partly successful, and required a huge sacrifice of individual liberties. Great Britain is taking a more nuanced approach to containment, waiting to consider school closures and self-isolation of the elderly and other at-risk people, until the epidemic is on the upswing. They recognize that the goal of complete containment is not possible and that “containment fatigue” will result in failure to adhere to policies, if those measures are instituted too early and applied too broadly. We propose that WHO should abandon the containment ideal and urge countries to focus on how to best identify, prevent and treat infection in the population at risk of severe disease, in addition to protecting staff and patients in hospitals and the broader health care community. Once community disease is present locally, the vulnerable should avoid mass gatherings, and limit contact with visitors/family members who may unwittingly expose them to the virus. Nursing homes and hospital should limit, if not screen, visitors as well.

The head of the UN World Food Program now warns of absolute devastation as the COVID-19 effects ripple through Africa and the Middle East. Is this a direct consequence of the disease, or from the economic consequences of the WHO determination to contain it?

Dr. Neil Rau is an infectious diseases specialist and medical microbiologist in private practice in Oakville, Ont. He is also an assistant professor at the University of Toronto. Dr. Susan Richardson is a retired infectious diseases specialist and medical microbiologist. She headed the Ontario Laboratory Working Group for the Rapid Diagnosis of Emerging Infections during the 2003 SARS outbreak. She is a professor emerita at the University of Toronto.

March 16, 2020 | 7 Comments » | 506 views

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7 Comments / 7 Comments

  1. The huge foreign population living in Italy and its more or less even distribution throughout the country accounts for the huge number of coronavirus cases in Italy. New immigrants, particularly those from impoverished and war-torn countries, bring their infections with them wherever they go.

    “Immigration to Italy

    Foreign residents as a percentage of the regional population, 2011
    As of 1 January 2017, there were 5,047,028 foreign nationals resident in Italy. This amounted to 8.2% of the country’s population and represented an increase of 92,352 over the previous year. These figures include children born in Italy to foreign nationals (who were 75,067 in 2014; 14.9% of total births in Italy), but exclude foreign nationals who have subsequently acquired Italian nationality; this applied to 129,887 people in 2014. Around 6,200,000 people residing in Italy have an immigration background (around the 10% of the total Italian population).[1][2] They also exclude illegal immigrants whose numbers are difficult to determine. In May 2008, The Boston Globe quoted an estimate of 670,000 for this group.[3] The distribution of foreign born population is largely uneven in Italy: 59.5% of immigrants live in the northern part of the country (the most economically developed area), 25.4% in the central one, while only 15.1% live in the southern regions. The children born in Italy to foreign mothers were 102,000 in 2012, 99,000 in 2013 and 97,000 in 2014.[4]

    Since the expansion of the European Union, the most recent wave of migration has been from surrounding European states, particularly Eastern Europe, and increasingly Asia,[5] replacing North Africa as the major immigration area. Close to one million Romanians, about 60,000 of whom are Romani (also known as Gypsies),[6] are officially registered as living in Italy as of 2008. As of 2013, the foreign born population origin was subdivided as follows: Africa (22.1%), Asia (18.8%), America (8.3%), and Oceania (0.1%).[7]

    Statistics

    Total foreign resident population on 1 January[note 1]
    Year Population
    2002 1,341,209[8]
    2003 1,464,663[8]
    2004 1,854,748[8]
    2005 2,210,478[8]
    2006 2,419,483[8]
    2007 2,592,950[8]
    2008 3,023,317[8]
    2009 3,402,435[8]
    2010 3,648,128[8]
    2011 3,879,224[8]
    2012 4,052,081[9]
    2013 4,387,721[10]
    2014 4,922,085[11]
    2015 5,014,437[1]
    2016 5,026,153 [12]
    2017 5,047,028 (8.34%)[13]
    2018 5,144,440 (8.52%)[14]” (Wikipedia).

  2. DO they actually bring it or is it just your assumption?
    Do immigrants officially constitute a disproportionate share of those infected with coronavirus in Italy?
    You posted elsewhere that Italy actually lumps all the cases of respiratory infection together until further diagnosis.

  3. Stock market suffered biggest crash today ever. Dow lost nearly 3,000 points. Nasdaq and S&Ps also way down. All sectors hard hit.

  4. US Government to lose billions in tax revenue as Las Vegas and New York close up – US & Canada
    US Government to Lose Billions of Tax Revenue as Las Vegas and New York Close Up

    The US government is expected to lose billions over the closure of popular entertainment and tourist venues, as the nation prepares to limit the risk of coronavirus spreading.

    President Trump called for the closure of all non-essential outlets including bars, restaurants, hotels, casinos and any commercial places of gathering – with sport events already postponed a week prior.

    The duration is a two-week lockdown, designed to keep people indoors and stop the risk of the outbreak, which has already claimed over 100,000 lives.

    New York City has reported that it will lose around $3.2 billion in tax revenue during this time. Meanwhile, Las Vegas has closed all hotels and casinos on the strip including the Bellagio, MGM and Wynn Resorts – where lost revenues are not confirmed, but likely to be significant.

    This is likely to have a further impact on neighbouring shops, restaurants and also conventions, including the Recon convention in Vegas which attracts thousands each year.

    A guest at a convention at MGM’s Mirage was tested positive for coronavirus last week, and the company confirmed that several of its employees had come down with the virus days later.

    This news will come as come as a blow to holidaymakers, travel companies, employers and investors. Staff members may still be expected to get non-statutory pay, which will be a further blow to business managers and owners.” From today’d Arutz Sheva.

  5. Even Las Vegas is closing down. According to Arutz Sheva, a huge loss of revenues for the Federal government. Large numbers of restaurants ruined. Large numbers of workers have been layed off. Even the casinos are closing.

  6. “A whopping 86% of infections were mild enough that people didn’t seek medical care or confirmation of their symptoms. These milder cases were only about half as contagious as the recognized infections, but because there were so many more of these undocumented cases than the documented ones, the unrecognized cases were the ones fanning the flames of the outbreak”

    This is from an article in today’s WebMD. The author thinks this is a reason to do more testing and put more people in isolation. Hmmmmm.

  7. @ adamdalgliesh:
    I think they will keep trying to “contain the uncontainable” and fanning the flames of the panic until there is a vaccine in a few months, and then coronavirus vaccinations will be made MANDATORY with the “refusers” treated as the enemies of the people.
    The “servants of the people” will, of course, take all the credit for the containment.
    The side effects of the vaccine (some of which can be very bad) will be, of course, completely ignored. In fact, the whole world will become a gigantic testing field for this vaccine which is completely unprecedented, to the best of my knowledge.
    I really hope my prediction will not come to pass.

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