A Proposed Framework for Risk-Based Interdiction of Coronavirus

David L. Katz, MD, MPH, FACPM, FACP, FACLM
LinkedIn
2 charts showing age of patients vs days days to COVID infection

As referenced in this New York Times column by Thomas L. Friedman.

A risk-stratified, rather than population-wide, approach to COVID19 interdiction is supported by separate computer models from scientists at MIT and at University of Pittsburgh/Carnegie Mellon.

Operationally, the approach would likely involve a sequence of phases, roughly mapped out here:

Vertical Interdiction (i.e., risk-stratified) Coronavirus Response – Tactical Sequence

  •   Phase 1; IMMEDIATE /URGENT:

o  Reaffirm value of social distancing/sheltering in place

o  Announce plans for plans in phases

o  Continue all forms of social distancing

o  Minimize spread

o  Address medical system resource shortages

o  Care for those in urgent need

o  Resource optimization for medical care delivery during the early surge

  • Phase 2; NOW:

o  Deploy widespread testing; ideally to include drive-through at pharmacies and mobile testing

o  Active case ascertainment and containment

o  Teams focused on data analysis and risk stratification (state and federal authorities, multidisciplinary working groups of experts; CDC, NIH, NAM, etc.)

o  On-going care for those most in need of special services

o  Public announcement of this multi-phasic plan so the public knows that the current shut-down is not indefinite

  • Phase 3; NEXT:

o  Public announcements regarding results of data analysis

o  If U.S. data conform to global data, a very high percentage of all cases will be relatively mild, and only a tiny portion of the general population will be deemed at ‘heightened risk’ of severe infection

o  If the above proves true, move to vertical (risk-based) interdiction strategies, and de-isolate much of the population

  • Phase 4; TO FOLLOW:

o  On-going monitoring/case ascertainment/containment

o  Concentrated allocation of services/support measures to high-risk population still in isolation

o  Work on treatments/vaccines

o  On-going data analysis to refine risk criteria

  • Phase 5; CLOSURE:

o  Verify near-zero spread in the population

o  Confirm herd immunity

o  De-isolation of the high-risk population

o  Global dissemination of advances, best practices: treatments, vaccine

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