I received a video on March 22 featuring an Israeli minister making an argument supporting “mitigation” as a strategy for combating COVID-19.
He explained that since mortality rates are lower than 1% for the young, society just needs to isolate those older than 70, and allow the infection to spread through the rest of the population so that — after about 80% of the population have recovered from being infected by COVID-19 — herd immunity in the population will protect the older members from getting infected.
There are many misconceptions underpinning this line of argument.
We now know from the experience of Wuhan and Italy that approximately 10 to 15% of COVID-19-infected patients develop respiratory difficulty and suffer a drop in their blood oxygen levels.
Many of them can be managed with oxygen. However, 5% of all COVID-19 patients deteriorate even with oxygen therapy, and require intubation and ventilation in an Intensive Care Unit (ICU) setting. Only when you can provide this level of care to all patients who need it, can you achieve mortality rates of about 1%.
In both Wuhan and Italy, the number of COVID-19 cases requiring ICU care outstripped the capacity of the healthcare system to provide ventilator support to all who need it. Bear in mind that ventilator support is not for a day or two only. On average, 5% of the most ill patients need prolonged ventilation for two, three or more weeks, tying up many ventilators in the process. That is why the mortality rate for Wuhan was about 3.4% and for Italy seems to be around 5% and rising.
So, blithely arguing that mortality is low for the young is a very dangerous misconception. Even the quoted 1% mortality rate is about 10 times higher than for influenza.
Those still advocating the mitigation strategy have now changed tack a bit and are advocating “flattening the curve”. By this they mean that the country should practice social distancing, so as to allow the infection to spread through the population, but at a rate that the health system can handle. Meanwhile, the elderly should be shielded. This is another ill-conceived idea.
Britain has a population of about 67 million. If you intended 80% of the population to get the infection naturally so that the population develops herd immunity, you are talking about allowing 53 million people to acquire the infection, with the caveat that the curve should be “flattened” so that it does not swamp the health care system’s capacity to give ICU care to those who need it.
We know that with only 40,000 cases, Italy’s health services have been swamped many times over and that the situation there is quite grim. Assuming that the British system is more robust and can provide optimum care to 50,000 new COVID-19 patients a month, it would take Britain 89 years to develop herd immunity.
Makes much better sense to wait for the vaccine doesn’t it? Hopefully we should have one before the end of the year. That would confer us “herd” immunity much more painlessly than exposing 80% of the population to natural infection.
Luckily, Malaysia is following the other strategy of COVID-19 management — suppression of the outbreak by isolating all active cases and tracing and quarantining all contacts, thus breaking transmission. This is the strategy being followed in Wuhan, South Korea, Hong Kong and Singapore. To me this seems to be the most sane and humane way of handling this epidemic.
Wuhan has demonstrated that it can work — they managed to stop the epidemic there with only 70,000 cases out of a total population of 60 million (for Hubei province). The downside to this approach is that is does not create herd immunity.
In Hubei, only 0.12% of the total population was infected, far short of the 80% required to give herd immunity. Imported cases can restart the epidemic quite easily if vigilant surveillance and quick action in damping down any recurrence of the disease is not implemented religiously.
This strategy of “suppression” is quite different from the tactic of “flattening the curve” and we should not confuse the two (as some people in Malaysia are doing). Suppression means we aim to bring the transmission of COVID-19 down to zero if we can. Flattening the curve means that the epidemic is permitted to spread through the population, but at a “controlled” rate.
The latter approach is a dangerous route to follow. Britain and the United States seem to be particularly enamoured with the mitigation strategy, and they are going to find it is not easy to maintain a controlled spread of the COVID-19 epidemic through the population. It is like talking about a controlled wildfire.
It is sad that many thousands of citizens in these two countries will pay the price for this deeply flawed policy.
[Jeyakumar Devaraj is a medical doctor and chairperson of the Malaysian Socialist Party (PSM).]