This post does not deny the effectiveness of social distancing or quarantine for COVID-19.
I am not encouraging people to suspend these practices before official determinations have been made public.
This post is to help physicians, thought leaders, and public officials understand and weigh the risks and benefits of extended lockdowns versus more measured and earlier return to work measures.
1. We have already flattened the curve
We have gone from predictions of millions of deaths, to hundreds of thousands and now we are predicting about 60 thousand deaths. This is with the likely over reporting of death. Dr. Birx admitted the attribution of death to COVID-19 has been liberal (her word). If the death count were limited to deaths directly caused by COVID-19, it would likely be even lower than this.
The most effective time for social distancing is early in a pandemic. Lockdowns also slow the development of herd immunity, which helps a society move past the virus.
We can still practice good hand hygiene, wear masks in public, and continue social distancing for the elderly and high risk, while we develop protective herd immunity for those most at risk. By the time the lockdowns began, COVID-19 had already been seeded in the US for months, limiting the effectiveness of the lockdowns in the first place as the virus was already widespread.
2. Economic collapse and unemployment are destroying families
Each day the shutdown continues, we are losing approximately one million jobs, as evidenced by 16.5 million initial weekly jobless claims in three weeks (since March 26). Many of these lost jobs will never return. If the lockdowns continue through April (essentially, a best-case scenario), we’ll be lucky if job losses are limited to 25 million. Many people see 6.6 million people as just a number , as Len Kieffer put it, it is the size of the state of Missouri. Twenty five million is almost the size of the state of Texas!
The 16.5 million jobs lost thus far are only counting people who have filed jobless claims that were processed through April 8, 2020; it’s likely that the real number is quite a bit higher than this. In addition, there are millions of people not-technically-unemployed who have seen their incomes plummet. One example would be so-called gig workers, such as Uber and Lyft drivers. It’s almost certain that realtors are suffering the same fate.
3. We have not saturated the health care system.
In New York We came close.
Although, the ER and ICU capacity has increased in many locations, overall healthcare system capacity has decreased dramatically, as all non-COVID and non-emergent care is being neglected. This has led to layoffs of healthcare workers and delays in care for countless patients, which will result in a range of negative consequences. Assuming the need for healthcare services has remained constant while availability of such services has plummeted, countless patients are not receiving the care they need in a timely manner. In medicine, timing is of the essence, so even receiving the same exact in the future comes at a price. Many important services are being delayed: blood donations, organ donations, screening colonoscopies, and many other elective procedures. It is very important to note that elective medical care is not useless medical care; rather, it’s simply meaningful and necessary medical care that is scheduled in advance and not performed on an emergency basis.
4. Suicide may kill almost as many people as COVID-19 this year.
In 2018, there were 48,344 recorded suicides. Economic ruin results in a wide range of health problems, suicide, mental health issues, loss of health insurance, reluctance to visit doctors in light of financial hardship, and increases in substance abuse. This is on top of the delay in non-COVID care.
5. The mortality was likely overestimated
The early reports of 3–4% case fatality rate (CFR) are likely misleading. The numbers miss those who are asymptomatic or recovered at home without seeking testing. What we really need to know is the infection mortality rate (IFR). Fortunately we have some good clues. Looking at the data from the Diamond Princess cruise ship, the infection fatality rate on the cruise ship was 1%. However, the average age of people on the cruise ship was much higher than the age of the average American. When you adjust for the differences in age between the cruise ship and America, you see that the IFR should be about 0.1%. There was a recent study out of Germany in the city of Gangelt where they tested 80% of the population, the IFR there was about 0.37%. The way we are testing now, we cannot know how many people have been infected with COVID-19 since we are missing those who had the disease and recovered. Antibody testing is needed to know the true number of people who have been infected. There is a good chance this number is well above 10 million, which drives the IFR down even further.
6. Children are at almost no risk from this disease.
The CDC estimates 37 to 187 children die every year, not from Covid-19, from the flu. This year we have lost 105 children from the flu. Yet, we have closed every school in America. Education is vitally important and a whole generation will miss a fourth of this school year. Closing schools also goes a long way towards limiting the development of herd immunity.
7. PPE was limited but is now becoming more available
This article is not meant to diminish the pain and horror this disease can bring to those who get it. I am a physician in one of the highest risk specialties for contracting the disease in the hospital. The lack of personal protective equipment (PPE) facing US healthcare workers is unfair and wrong. Yet, as the curve has flattened, it seems more hospitals have found adequate PPE. The CDC estimates a possible second wave would be at least 150 days from the end of the lockdown, possibly this fall. Ending the lockdowns would have no effect on the PPE for the current crisis.
We would have plenty of time to prepare for a possible second wave.
8. Authorities should show clear evidence regarding the benefits of indefinite lockdown
Those who want to continue the lockdown indefinitely should show clear evidence regarding the benefits of indefinite lockdown. There needs to be a clear reliable model that shows how many additional lives will be saved considering we have already flattened the curve and there is essentially no further risk of overwhelming the health care system. The previous models were wrong. The consequences of indefinite lockdown are quite staggering, to the tune of one million jobs lost per day.
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Jonathan Geach, M.D.
Ankur J Patel, M.D.
Jason Friday, M.D.
Lacy Windham, M.D.
Ashkan Attaran, M.D.
Jennifer Andjelich, D.N.P.