There are numerous opinions about the best way to handle (or perhaps end) the COVID pandemic. They range from more strict lockdowns, to "let's open as quickly as possible" coupled with the hope to keep it in check. A pandemic expert picks the first way. It's very unpopular. Is it even a realistic choice?
There is a wide variety of opinions about the value of the use of lockdowns as a method of controlling the spread of COVID, ranging from "a complete waste of time that did more harm than good" to "they weren't done strictly enough." Those in the first camp are not going to like what they read in a Medscape Interview where John Whyte, MD, MPH, who has been writing about public health for two decades, interviews Yaneer Bar-Yam, Ph.D., an expert in the quantitative analysis of pandemics, in an article entitled "Here's the COVID Exit Door -- Will We Walk Through It?" Here are some of the highlights of the interview.
When asked what our strategy for eliminating the virus (and whether we've already been doing that) Bar-Yam says no. Rather than eliminating the virus most of the world has instead been employing a "live-with-a-virus strategy".
What we've been doing is the "live-with-a-virus" strategy, which is not working very well. What we end up doing is giving up our ability to do what we want to do, and we have the virus around that is causing all the disease, disability, and long-term consequences. The problem is that there is not an end to this that we see, even with the vaccination.
Yaneer Bar-Yam, Ph.D.
Part of (but not all of) the problem is that Bar-Yam estimates it will take 6-12 months to give vaccine shots to protect the population. It is during this time that new problems will arise, especially the emerging variants that will reduce the effectiveness of current vaccines. At that point, we may be forced to give booster shots or new vaccines with protection against multiple variants (multivalent vaccines) – the same strategy that is employed with flu vaccines, and with only modest success at best.
"The current situation is not an end game; it's just a way of perpetuating the harm that the virus is doing, both to our health and the economy."
So what to do? According to Bar-Yam, our actions are playing "nice" with the virus rather than trying to eliminate it. One is the inappropriate use of "green zones," areas without community transmission that are protected by quarantines or other temporary restrictions to keep the virus out of these areas. Bar-Yam argues that getting down to a few hundred cases and then saying "Hey, we're safe enough; let's open up" is counterproductive and that over this past summer in the US there were many places that could have been opened safely had they been protected for a few more weeks.
Control the Fire or Put it Out?
Bar-Yam likens the virus to a fire. He says, "We have a no-fire policy. Our no-fire policy means we don't let fires burn in houses; we don't let fires burn in the city and then put them down when they're big enough. We put them out [right away]."
This isn't going to be popular
When Whyte asked Bar-Yam what he would do if he were in charge, he replied, "We say, 'Look, we've been living with a virus. We do not want to live with the virus.' All the ideas of finding some way to live with it are not working. So, we're going to make this decision to get rid of it."
His plan, even if it is "guaranteed" to work is not going to go over well with people in the US and other countries who have already been cooped up too long (and ineffectively).
In order to get rid of it, we have to do the strong action over just 5 weeks. We're going to do all of the things we know: a stay-at-home order, drive-by pickup, or delivery. We're going to protect family members by making sure that if someone is sick, we quickly isolate so that we don't infect others. We're going to do all of that. And then in 5 weeks, there are going to be many parts of the country that are going to be virus-free. [emphasis added] (1)
Strict Measures vs. "A little of this and a little of that."
Bar-Yam maintains that attempts to make life a little "less bad" by making exceptions has actually worked against us. "[If you say] 'Well, I'll do a little bit of this, or I'll do a little bit of that' only serves to perpetuate the spread of the virus."
"But if you say, 'Look, we want to eliminate the virus. In my town, my neighborhood, I want to have the ability to meet with my family and friends, go to restaurants, and have everything open.' The way we get there is by making sure that we don't transmit at all. Now, of course, some cases are going to happen; we can't avoid everything. The more we limit ourselves during the first time, the less time it takes, and that's the most important thing."'
He may be right, but to a world that has already suffered from a year of restrictions and lockdowns, this is going to be a really tough sell, especially in the US where people don't like to be told what to do.
While Bar-Yam's five-week austerity period may theoretically be helpful in drastically cutting back infections my guess is that it won't be practical in most parts of the world because of human behavior. If people aren't willing to do something easy like wearing a mask asking them to remain inside for another five weeks isn't even remotely feasible.
In the absence of a very effective COVID therapy, something that isn't on any pharmacy shelf, we'd better hope that vaccine scientists can continue to work their magic for a while.
(1) Five weeks was chosen to cover a two-week incubation period, a two-week infection period, and a week for good measure.