Some COVID-19 Questions Need to Be Answered as We Move to Reopen

Today more than a dozen states are easing their lockdown restrictions, increasing the number emerging from the COVID-19 economic shutdown. It almost seems as if the decision whether or not to go outside has become political, but increasingly it seems states are moving to the model Sweden has used all along. Their herd immunity approach has been mocked and criticized. However, as John Fund and Joel Hay point out in National Review, it has actually worked fairly well. The highlights:

Sweden’s case-per-million rate is lower than the United States, the U.K., Italy, Spain, France and a number of other European countries.

• They expect to reach herd immunity in Stockholm in early May, decreasing the chance of a second wave.
• Sweden’s death rate is only slightly higher than the U.S., which is at least partially explained by their higher life expectancy.
• On an age-adjusted basis, they have actually had lower cases per million and deaths per million than the United States.

This is encouraging news for states and locales that have started to lift restrictions. However, there are still some questions that our public health officials and medical community need to answer. The answers to these questions will impact a broad range of public policy and have an effect on treatment of those who do fall ill.

First, why are we seeing such wide disparities in the asymptomatic rate in contained outbreaks? Studies are showing that prison populations in Ohio and other states are having asymptomatic rates above 90%. Outbreaks centered around meat processing plants also do not seem to be having a significant severe case rate. This differs from the data coming out of New York and California. It is also much higher than the experience on the USS Roosevelt, where the population is generally healthier than in the prison system.

I can only think of two answers to the question these studies pose. Either the asymptomatic case rate is wildly higher than even antibody testing is detecting, or the virus itself has become less virulent through mutation. Either of these may explain why one Israeli researcher found a four- to eight-week eruption cycle.  It is a pattern similar to that noted by Nobel laureate and Stanford professor Michael Levitt.

There could certainly be other factors at play, but understanding what is going on here is critical to forming appropriate public policy. Less virulent forms of the virus would allow a faster lifting of restrictions. It would also become necessary for sentinel testing to identify the different strains, like it does today with influenza.

The next question is whether or not ventilators are an appropriate treatment for those suffering from severe symptoms. A high percentage of those placed on a ventilator do not survive, leading many doctors to question their use. Pulmonologist Dr. Thomas Yadegar has proposed a completely different treatment regimen that has seen some success at Providence Cedars-Sinai. To provide effective treatment we need to understand very clearly what this virus does to the body systems. Right now, there is significant noise with new symptoms being reported frequently. Practitioners like Dr. Yadegar seem to be advancing theories that make sense, yet they aren’t getting much exposure.

Ventilators became a political football. The administration took harsh criticism for the lack of them in strategic stores and took drastic action to increase supply. The politics of it all matter very little to the patients and families confronting the medical realities. We needed to rebuild the strategic stores and that has been accomplished. Now let’s get the medical community and the public the right answer on the most effective way to treat the most severe outcomes.

Finally, what the heck is up with kids? Studies are showing children under 10 are far less likely to become infected and do not play a significant role in spreading the virus. According to a Swedish study, this is because they do not have the receptors used by the virus to enter their cells. The implications here are obvious for parents returning to the workforce and school districts nationwide.

Current phased opening guidelines say schools and daycares should remain closed. In Georgia, they are contemplating pushing the start of the school year past Labor Day in September. Some states aren’t sure school will open at all come fall. Neither of these actions is required, at least in the younger grades, if children do not add to the spread of the virus. This would be a relief to parents who need to return to work and educators concerned with more intensive needs for reteaching concepts due to an extended break from formal education.

As I have said before, the world is building the plane while we are flying it in response to COVID-19. Research for effective therapeutics and a vaccine will be ongoing. However, data critical to forming appropriate public policy and treatment of current patients also needs to be relentlessly pursued. It may be too much to hope that the current pandemic will just burn itself out, but there seems to be mounting evidence that it not as dangerous as previously thought for reasons that are not very clear.