NOTeD: Can We Prevent a Second Coronavirus Lockdown?

Tom Rifai, MD, FACP

IN TODAY’S MEDICAL NEWS: Can We Prevent a Second Coronavirus Lockdown?

British Columbia’s Provincial Health Officer and top doctor, Dr. Bonnie Henry, recently said, “we’ve never had a pandemic in recorded history that has not had a second wave.” But whether it is a second wave, or a continued first tidal wave with multiple ripples (or however SARS-CoV2 sticks around), COVID-19 is here to stay and spread rapidly until – one way or the other – we reach herd immunity. The question then becomes: how can we get back to at least semi-normal as safely and quickly as possible (without the benefit of a safe, effective and widely available vaccine, which we simply cannot bank on based on history alone) while we prevent a second Coronavirus lockdown?

In How to Avoid Another Lockdown, Max Nisen notes that the hasty, sometimes indiscriminate re-opening of some social events and indoor businesses (e.g., bars) has led to a resurgence in COVID-19 cases– not at all an unreasonable observation. He then writes, “reopening only works if people feel safe.” Not much is closer to the truth than that. A question begged, of course, is what are ways we might get to people feeling reasonably safe?

Reducing Transmission Risk Versus Safe Viral Spread

Because of the way the outbreak was initially handled in the U.S., many still believe the key to safety is continued aggressive suppression of viral spread through extended quarantine. I would argue that this is virtually impossible. This virus is now deeply entrenched in the United States. Experts have believed and the CDC now officially states that the penetrance is ten times (or more) the number tested and confirmed to have it. This is largely due to many in the population handling the infection (with asymptomatic or exceedingly mild infections) fairly well, especially those in our “herd” that are under 45 years old (notably, I’ll be 52 next month). Trying to suppress SARS-CoV2 and the often mild disease it causes will only delay the inevitable. Nisen’s suggestion of “cracking down on businesses that don’t require distancing, closing those like nightclubs that never should have been opened, boosting contact-tracing and isolation efforts and enforcing broad mask use” in order to “significantly reduce transmission risk” is one important prong of the effort to address the spread, but a problem occurs when this type of sensible effort is combined with a more draconian approach. Where shut-down orders are as indiscriminate and overrated as the aforementioned indiscriminate re-openings, problems occur. For instance, why are we opening bars before gyms in some areas? In both, people are in closed environments but in one instance engaging in immune strengthening behavior (gym), versus immunocompromising behavior (imbibing alcohol)? Whether we like it or not, until herd immunity is established — whether by the safest possible transmission, vaccine, or both — the virus is going to spread. At best, we can only delay it, though to try to do so with harsh measures that have major societal ramifications on health and well-being in other ways in the hopes a vaccine will soon be available ignores both history and public-health experts well versed in the social determinants of health.

The only likely path we have to the ultimate “all clear” is the safest viral spread to herd immunity that we can muster. In fact, it seems our only reliable path. I am not as confident as Dr. Fauci seems to be that there will be a vaccine anytime soon.  Why not? There has never been a successful Coronavirus vaccine in the past, and the notion we will have a highly effective, low risk vaccine available quickly to millions who are willing to utilize it, is wishful (if laudable) thinking. It defies history in terms of vaccine development, acceptance (especially one whose development has been fast-tracked) and challenges of fair distribution to believe we’ll have a “perfect” vaccine anytime soon. While I pray Dr. Fauci is correct, the idea of putting all our eggs in the vaccine basket, or a therapeutic of widespread applicability with high benefit to low risk ratio, would be unwise. Even if we do develop a vaccine with reasonable efficacy, the odds are high that it will not have the best possible benefit to risk ratio that only time and refinement would provide.

BOTTOM LINE: A To-Do List is Needed to Prevent a Second Coronavirus Lockdown

Could we develop a national “to-do list” of steps, a handbook, of sorts, that would allow the virus to spread through the healthy low risk first as much as possible, in a reasonably controlled manner? Such a list would avoid the “invite some really sick people with COVID-19 over to an apartment and stuff 50 young, intoxicated but otherwise healthy, people in a circle around them while they cough in everyone’s face” approach (obviously an extreme example, but to be clear, I am using it to make a point). Please remember: the virus will continue to spread one way or the other. Let’s pray for a safe, effective, widely distributable vaccine, absolutely. But as praying and wishing in and of themselves are not plans, I posit that we need to have an actionable plan in the meantime. This type of plan will engender the safest path to herd immunity and save us from harsh lockdowns with their inevitable self-inflicting damage – damage that is increasingly linked not just to decreased quality of life, but to death itself.

Cases are up, yes. But death trends are down. And we could quite possibly keep that relationship (i.e., cases up, death trends down) going if we find a path to continue, and possibly improve upon that trend. For that to happen, we will almost assuredly need a detailed national vertical interdiction plan. Maybe it’s time for a national handbook to herd immunity with maximum safety that helps us thread the needle between “all or nothing” we so desperately need.