General LeMay, or Ho Chi Minh? Saturation bombing or guerrilla war?

The Art of War

Selective battle against the flu vs. all-out war. From the NYT, but no cash wall. Worth reading in its entirety, in my opinion, but here’s a small bit of it:

Is Our Fight Against Coronavirus Worse Than the Disease?

There may be more targeted ways to beat the pandemic.

By David L. Katz

Dr. Katz is the founding director of the Yale-Griffin Prevention Research Center.

….

The data from South Korea, where tracking the coronavirus has been by far the best to date, indicate that as much as 99 percent of active cases in the general population are “mild” and do not require specific medical treatment. The small percentage of cases that do require such services are highly concentrated among those age 60 and older, and further so the older people are. Other things being equal, those over age 70 appear at three times the mortality risk as those age 60 to 69, and those over age 80 at nearly twice the mortality risk of those age 70 to 79.

These conclusions are corroborated by the data from Wuhan, China, which show a higher death rate, but an almost identical distribution. The higher death rate in China may be real, but is perhaps a result of less widespread testing. South Korea promptly, and uniquely, started testing the apparently healthy population at large, finding the mild and asymptomatic cases of Covid-19 other countries are overlooking. The experience of the Diamond Princess cruise ship, which houses a contained, older population, proves the point. The death rate among that insular and uniformly exposed population is roughly 1 percent.

We have, to date, fewer than 200 deaths from the coronavirus in the United States — a small data set from which to draw big conclusions. Still, it is entirely aligned with the data from other countries. The deaths have been mainly clustered among the elderly, those with significant chronic illnesses such as diabetes and heart disease, and those in both groups.

This is not true of infectious scourges such as influenza. The flu hits the elderly and chronically ill hard, too, but it also kills children. Trying to create herd immunity among those most likely to recover from infection while also isolating the young and the old is daunting, to say the least. How does one allow exposure and immunity to develop in parents, without exposing their young children?

The clustering of complications and death from Covid-19 among the elderly and chronically ill, but not children (there have been only very rare deaths in children), suggests that we could achieve the crucial goals of social distancing — saving lives and not overwhelming our medical system — by preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure.

Why does this matter?

I am deeply concerned that the social, economic and public health consequences of this near total meltdown of normal life — schools and businesses closed, gatherings banned — will be long lasting and calamitous, possibly graver than the direct toll of the virus itself. The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order.

Worse, I fear our efforts will do little to contain the virus, because we have a resource-constrained, fragmented, perennially underfunded public health system. Distributing such limited resources so widely, so shallowly and so haphazardly is a formula for failure. How certain are you of the best ways to protect your most vulnerable loved ones? How readily can you get tested?

We have already failed to respond as decisively as China or South Korea, and lack the means to respond like Singapore. We are following in Italy’s wake, at risk of seeing our medical system overwhelmed twice: First when people rush to get tested for the coronavirus, and again when the especially vulnerable succumb to severe infection and require hospital beds.

Yes, in more and more places we are limiting gatherings uniformly, a tactic I call “horizontal interdiction” — when containment policies are applied to the entire population without consideration of their risk for severe infection.

But as the work force is laid off en masse (our family has one adult child home for that reason already), and colleges close (we have another two young adults back home for this reason), young people of indeterminate infectious status are being sent home to huddle with their families nationwide. And because we lack widespread testing, they may be carrying the virus and transmitting it to their 50-something parents, and 70- or 80-something grandparents. If there are any clear guidelines for behavior within families — what I call “vertical interdiction” — I have not seen them.