By the last of April, I was hoping there would be better news.  After close to 6 weeks of stay-at-home orders in the United States, 20 of the 53 states (including Maryland) and US Territories have increasing numbers of cases over the last 1-2 weeks.  An additional 20 have plateaued and the remaining 13 show improvement.  Part of the increase in cases is due to increases in testing, but hospitalizations, which are an indicator of active disease have not declined substantially nor have deaths due to the virus.  The need for hospital beds, however, has proven to be drastically lower than was predicted several weeks ago.

Sussex County Delaware, with low population density, has exploded as an unexpected Covid hotspot because of a high infection rate among workers in the chicken processing industry.  Interruptions in the supply of beef, pork, and chicken have become more likely due to infections of workers in many of the processing plants across the country.  

This is turning out to be one nasty virus, and not because it is particularly deadly.  It is very dangerous for the elderly population as evidenced by high mortality rates in nursing homes and adult communities. An overwhelming proportion of young people, however, will either not be affected or will have mild illness. But just enough of the young healthy population can develop a deadly form of the disease to make everyone in this age category feel a bit vulnerable. And if they don’t feel vulnerable, they may at least feel guilty that they could give it to Grandpappy.  It is also exquisitely contagious. Recent data has shown that the 14-day quarantine idea may be a myth, as viral shedding in asymptomatic carriers may occur for weeks, and they remain able to transmit the virus to others.  This has created a perfect storm of universal dread, leading to high unemployment, closed businesses, increased Netflix use, and little human productivity. 

Alternatives to long term sheltering in place have emerged, the most interesting (and promising) is the Swedish model.  This model has also been promoted by Dr. David Katz, an epidemiologist from Yale (no relation)

The basic premise of this model is as follows. 

• The vulnerable population must continue to isolate and stay home.  This includes the population over 70, those with chronic illnesses such as diabetes, emphysema, heart disease or asthma.  Nursing home patients are strictly guarded with frequent testing of staff for the virus to avoid inoculating this population.  (This is where over half of Covid deaths occur)
• Younger people without chronic health conditions go out into the world.  They can work and go to restaurants, the car wash, and the dry cleaners.  Social distancing will remain in place for these activities, but economic activity will be started up.
• There will be strict limits on crowd size.  This will remain in place until there is a vaccine, or the population becomes immune by some other means.
• Children 14 and under will return to school.  High school and college students will take classes online until immunity in the population emerges.
• The circulation of the young healthy population in society will transmit the virus among them leading to higher and higher rates of immunity in the population, much like a vaccine would accomplish.  
• It is known that when the immunity in the population reaches 60-70% the virus dies out, as it can’t transmit its genetic material efficiently enough to stay viable.  This is called herd immunity.  

If everything goes well with this model, economic activity resumes quickly, though it does not get up to pre-pandemic levels until herd immunity is apparent.  Some healthy young people will get sick and succumb to the illness.  But chances are this would have happened eventually anyway over time. 

Though this seems like a plausible idea, it is worth noting that Sweden has 3 times the number of cases and 10 times the number of deaths of its closest neighbors, Norway, and Finland.  But in the long term, they might see their numbers plummet as immunity increases, while the population of Norway and Finland hide in their homes drinking Glogg and waiting for the world to end. 

In any case, we are in for a longer ordeal than I originally anticipated.  We will have a clearer idea of the best way out of this as results from ongoing studies are released over the next few weeks and months. 

For now, stay safe, it’s a tough world out there.  We remain in the office for urgent visits or contact us by phone or email.