Stop COVID-19 NOW!

We attended a fund raiser for the local theater that was suffering from the closure.  It seemed safe enough. Only a dozen couples had been invited. Apparently one couple had felt lethargic a couple of days ago, so got tested, but felt better that night and decided to go to the function, even though they had not heard the results. The next morning they found out and called the organizer, who then informed us. Everyone was wearing masks. We’re probably okay, but all of us are elderly.  This might be bad for some.

The new theater manager had been excited that they would soon be opening, with half the rows closed off and at least three empty seats between each household. Cases in our city are rising. They might have to postpone the reopening. Bars and restaurants might have to be shut down again.  The economic devastation was already wreaking havoc on the finances of most businesses, even the hospital.

“But as soon as there is a vaccine, we can open this theater up and fill all 750 seats,” the Board Chair had announced. As soon as there is a vaccine we can fill the restaurants to capacity. As soon as there is a vaccine the University and its championship basketball team can fill the arena. As soon as there is a vaccine people will start shopping and the economy will recover.  As soon as there is a vaccine we can have parades again, large block parties, bowling tournaments, our club can have a picnic, kids can play in the city pool, we can…

Anthony Fauci says there will likely be a vaccine developed before the end of the year! The vaccine will let us all go back to normal and the risk of death, illness and disability from COVID-19 will vanish. The world seems focused on a miracle vaccine. 

I’m a scientist. Vaccines are difficult to develop. Vaccines require extensive testing to determine safety and efficacy. Studies so far have not been able to determine if a vaccine will even provide immunity and even if it does, for how long? I remember attempts in the 1960’s that tried to and develop a vaccine against coronaviruses. When SARS emerged and later MERS, worldwide research was done to try and produce a vaccine. New techniques are available, but a vaccine against any coronavirus will not be easily developed.

Then a vaccine requires testing for safety and even longer testing for effectiveness. Then a vaccine has to be manufactured in huge quantities and then distributed throughout the world. Finally, at least 70% of the population of each country must agree to be vaccinated. People in China and other autocratic countries probably will not have a choice. Most people in Northern Europe trust science and if the safety studies are good, they will mostly accept it, but what about the USA? Skepticism is rampant here and also in many other Democracies.  What about developing countries, what about Syria and Yemen? What about Afghanistan and remote regions of Pakistan? Both of those countries still have polio spreading.

How effective will even the best vaccine be? Some vaccine induce lifetime immunity, but others not. Tetanus is recommended every 10 years, but flu has to be repeated annually. Current studies show that immunity to COVID-19 in previously infected individuals disappears in 2-3 months. So if a vaccine were ever able to be developed, everyone would need to be reinoculated every 5-8 weeks!

A vaccine solution is going to take years. Economic recovery is not going to instantly occur with the discovery of a vaccine.

We need to eradicate COVID-19. We have not done well at adapting our behavior to living with the virus.  It continues to spread exponentially. We are social beings and desire to interact with each other. Commerce, travel and many businesses are not fully functional even with mild restrictions, but the virus spreads rapidly when restrictions are not severe.

Stopping COVID-19 is possible

So let’s just do it:

COVID-19 may be the most deadly enemy that humanity has every faced.  Worse than death, though is that many individuals get ill and then take months to recover. Some may never recover. Those hit the hardest are elderly, but many young healthy individuals have spent weeks in the hospital and months recovering.

“I can’t breathe.” This is the call at all the protests. Inequality is another problem and being made more obvious by COVID-19. People of Color are most severely affected. We must also consider not just the fatality rate (less than 2%), but the morbidity rate (15-20%). That is those who get sick, but have lungs that remain damaged. If you get COVID-19 and recover, you could be saying, “I can’t breathe,” for months or even years.

I needed to buy groceries and ran into one of my former students just coming off work. She is an intensivist at the hospital and took care of five patients last night with COVID, all struggling to breath. Three were under sixty and would not be going back to work for months. A couple of days ago I did a phone interview along with one of my former colleagues on a local radio station. I presented the results of large studies and she presented the statistics of what is happening locally. Before the interview, she told me that her 30 year old daughter had contracted COVID six weeks ago in NYC. She was previously healthy and athletic. Now, even after six weeks, she cannot climb a single flight of stairs, and she was never sick enough with COVID to require hospitalization.

The SARS-CoV-2 virus is insidious. On average, we spread the virus for 3-4 days before we get any symptoms. Some people have been shown to be spreading the virus for over 14 days and still have no symptoms of significance. However other studies show that even the asymptomatic carriers have visible damage to their lungs on CT scan. Other coronaviruses do not spread before symptoms appear. Other coronaviruses do not cause the body’s own immune system to go crazy and damage nearly every organ in the body, even the brain. Other coronaviruses do not continue to stimulate the immune system to destroy cells long after the virus is gone.

No medication seems to have much effect on this virus. A vaccine is unlikely to wipe the virus off the face of the earth. As long as there is a risk of getting the virus, consumers will be hesitant to go out and many industries will fail. Businesses and individuals will go bankrupt. Tighter contact tracing, more testing and isolation of infected individuals will slow the spread of the virus, but COVID-19 will still smolder and flare up in different communities at different times. No one will be safe, so the world’s economy will dwindle—unless we do something drastic:

Why not just get rid of the virus? Wipe it off the entire planet!

It is doable, but it won’t be cheap or easy. It may take months, or even a year; but that is better than what we are doing now – waiting for a vaccine that may never appear, or will not be accepted. We could wait for herd immunity, but studies do not indicate that that is even possible. Once you have been infected, you will have antibodies for a while, but it may only last a few months. There is some evidence already that certain individuals have been infected twice. If 70% of the world were to be infected and a kind of “herd immunity” were to develop, that would be 5.5 Billion people. If only 2% die, that is 110 million (probably 2-3 times that) and close to 1 Billion with long-term disability. So we don’t want to go there (although it looks like we are heading in that direction in the USA).

A plan that can do it

 

Fighting WWII, the US attacked a visible enemy and did everything in its power to defeat the enemy. Bonds were issued, factories were converted, supply chains were realigned and prices were controlled, as rationing was necessary. We did not know how long it would take us to win the war, but the entire country and our allies put everything we had into the effort. There was no unemployment, but many worked jobs that would not exist after the war. The national debt skyrocketed to over $5 Trillion in today’s dollars.

If we could make that effort for 3 years to protect us from an enemy that could overwhelm our allies and then attack us, then we should be more than willing to put even more effort over the next year to 18 months to eradicate an enemy that is right in our midst.

We will need to work together and cooperate.

We might even have to temporarily give up some of our privacy and live with the inconvenience of wearing a mask when outside the home, (or if we test positive, even inside our own home). Contact tracing will have to be fast and accurate, so everyone would need to use an app such as currently being used voluntarily in Germany.

Most challenging is that we would have to give up our political squabbling and work together at the local level, state level, national level and ideally at an international level. Social media will be important for communication and interaction, but a very assertive campaign will be needed to eliminate false information spread by social media. Leadership will need to be like that of Angela Merkel or Jacinda Ardern, who can unite people to the cause.

We need a strong leader.  The President of the United States must ask Congress to “Declare War.”

Yes, declare war on SARS-CoV-2. Both houses of Congress must work together, just like WWII. Industries must be mobilized. Funding must be provided to keep those industries solvent, but also to keep State and local governments and schools funded.

Every potential lab in the country must set up to rapidly process COVID-19 tests. The current PCR test is good, but a more rapid and more reliable test is needed.  This needs the funding of a Manhattan Project. The needed supplies for testing must be produced and adequate high quality personal protective equipment needs to be manufactured and distributed. Quality masks that are not uncomfortable and do not inhibit breathing need to be made available free to everyone over the age of two.

The food chain needs to be realigned so all grocery stores are adequately stocked all the time. Clean water and soap must be available to every American. Hand sanitizer should be easily obtained at store entrances, bathroom entrances and any place else where you might need to touch something.

We will need to create “social bubbles.” Groups need to form that allow social interaction and especially the opportunity for children, teens and adults to interact. Highly vulnerable individuals may need to form social bubbles of only 2-4 individuals, but two or three families could form a group that might include up to twenty individuals. An isolated village could form a larger group, as long as the village did not interact outside of the village. In more urban environments, the social bubble might include a single apartment building, or parts of it. Two or three social bubbles might of necessity be linked because coworkers in an essential industry are unable to socially distance while doing their work.

Each social bubble would need to work in conjunction with local government and NGO’s to develop supplies for a 60 day period of isolation at some point in the next few months. Food, water, soap, sanitizing and hygiene supplies and other essentials would need to be warehoused or stored in or near each social bubble. Adequate energy would be needed as well as essential medical supplies and supplies for first aid and basic emergencies.

Factories would need to be converted to manufacture testing supplies for the entire world, as well as large amounts of personal protective equipment, especially masks, sanitary supplies and food supplies would have to be reengineered to get needed food to each bubble. There has to be cooperation so that there is no competition between governments to obtain essential supplies.

It may not be necessary to institute a draft, but a huge number of individuals all over the world would need to be recruited to work as public health technicians and laboratory technicians as well as logistics experts and even workers to load, unload and drive supply vehicles. In the US the National Health Service Corps (NHSC) could be hugely expanded to have a large reserve force of officers and create enlisted to fulfill all of these special jobs needed to seriously identify all cases of COVID-19, trace all contacts and support infected and potential carriers during their isolation.

A very accurate and rapid test kit needs to be developed and widely disseminated. This has not yet been developed. The test kit needs extremely high sensitivity and specificity when used in the field (not just a controlled environment) and under extremes of temperature, humidity, rain and dust, etc.

Because the disease spreads silently through presymptomatic and asymptomatic carriers, very aggressive and repeat testing is essential. Every case needs to be tracked down and isolated. That means there has to be a safe place to isolate people. Some individuals may be able to isolate in their own home for 14 days with volunteers or NHSC workers to bring them food and assure they have needed medication. Trained personnel must be available to immediately come to the aid of someone who is developing worsening symptoms. Some individuals will need to be isolated in a special facility such as a hospital or a converted hotel with trained personnel.

With widespread testing, contact tracing and isolation, the virus can be brought under control in the US. Smaller countries such as Iceland and New Zealand have done this, but even countries with lots of travel and trade and dense populations such as Hong Kong, S. Korea and Taiwan have gotten the number of new cases very low and have trained public health workers to rapidly respond to any new outbreak.

Once the developed countries of the world have gotten COVID-19 in check, they must assist other countries. Places like India that have dense urban populations may have to move many people into villages.  This will create an economic hardship. The goal is to get India to be able to ramp up testing, contact tracing and isolation now to stem the flow of COVID-19 through India and on into Pakistan, Bangladesh, Nepal, Myanmar, etc. Countries like India will need financial help now and help rebuilding their economy once the threat of COVID-19 is gone.  It is worth it to the thirty wealthiest countries to assist less well-off countries to control the virus, or it will just come back to the wealthy countries.

All of this will require increasing the National Debt. We did it during WWII, as the need was obvious.  The need is even more obvious now. It took until 1962 to pay down the national debt, but during most of that time the economy and the stock market were booming. It will be easier this time, as interest rates are much lower. Of course low interest rates are good for home buyers, but a problem for retirees. If we bring the pandemic under control, there will be a lot of retirees in financial straits. If we don’t, lots of retirees will die and no longer have financial needs.

Currently the USA is the financial leader of the world. The dollar is the default international currency.  Therefore, for this dire emergency, Congress can safely increase the national debt. The USA must regain its role in world leadership, or the dollar will cease to be the World’s Reserve Currency. Then the National Debt will be a problem and the Federal Reserve would have to turn to other countries to borrow, just as major western democracies are currently borrowing from the US Treasury.

First prepare as quickly as possible,

then totally eradicate COVID-19

 

Once all preparations are in place, then have everyone isolate into their bubble. Some businesses will be able to still function, but most will close. Ideally, it would be best if the entire world were to coordinate a simultaneous shutdown, but even if just the US and Canada did, the virus could be eliminated from this part of the world.

For sixty days everyone stays in their bubble. Everyone will know the start date and the end date, so there is no uncertainty as there is with the current chaos. Aggressive testing will have found and isolated most cases, but now everyone in every bubble will be tested. If any test comes back positive, that person is taken to isolation and after the incubation period (five days), everyone in the bubble is retested. Everyone in isolation must remain there until they have had two negative tests five days apart.

At the end of the sixty days, ideally there will be no cases of COVID-19 left in the world.  If there are still cases, they will be isolated in special hospital units.

With COVID-19 gone, the economy can return to where it was in 2019. COVID-19 and its disastrous effects on the economy is over for good. And, we are prepared for the next pandemic to end it before it can even spread.

Of course things will be different. Higher taxes may be needed to pay down the national debt and to keep the NHSC funded to be prepared for the next pandemic. However, most of the NHSC will be a reserve corps like the military.

Countries, who have temporarily ceased hostilities for the sixty day bubble lockdown, may have found ways to resolve some conflicts. Countries that out of necessity have needed to have liberal, temporary trade agreements may after the sixty days, develop long-term agreements that are better for both. The environment and climate change would have improved during those sixty days, so measure may take hold that will keep some of those improvements permanent. Mask wearing may become acceptable in all cultures and influenza, RSV and other respiratory infections will be less ubiquitous.

Most importantly, people will be able to meet again without fear. Gatherings will not have to be limited. Celebrations can be attended by all safely. Grandparents will again be able to put their grandchildren in their lap and read them a story.

 

I’m calling to tell you, that you have been exposed to someone who tested positive to COVID-19

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