Coronavirus War in Israel: What is a regular citizen to do? Lockdown and Risk Factors
It seems that in these days of social media and the wide and easy availability of reams and masses of information, many people feel free to declare themselves experts regarding the best government policy to fighting the Coronavirus. At least, from what I have seen, the conspiracy theories have subsided (for now?) and people now seem more concerned about how to get through this next year with our mental health and finances intact than in what started the pandemic in the first place.
The debate about lockdown and whether or not it is effective and worth the risk to the economy and school year (in other words, the collateral damage) rages passionately. I do not know the answer to this. I am still examining what I can find online about the Coronavirus and sitting on the fence on this one. I can see the merits in both sides of the issue. But for now, I wanted to bring you something I think may be helpful to know and to think about.
One of the options suggested widely is that the vulnerable members of the population be protected in isolation, leaving their homes only to shop for groceries, and the rest of the population can be set free from lockup to resume their lives normally. The idea is that these initially healthier people will not get seriously ill when infected with Covid-19 and that once we reach at least 40% infection rate, we will have herd immunity and the vulnerable individuals will then be released from isolation.
(I am including three tables of these vulnerability factors below my discussion. On your phone view them sideways to increase font size or click on them to go to the website on which they originally appear).
Vulnerability Factors and Decisionmaking
Where do we draw the line and who do we exclude from the selective lockdown? Only those with vulnerability factors showing the strongest level of evidence or do we include everyone with any of the factors listed above? Who decides? And will there be a mechanism for individual appeals?
What about those who have cancer or other medical vulnerabilities but have not yet been diagnosed because their symptoms have not yet brought them to medical attention?
And what do you do in the case of multiple-generation families? What if parents can go to work only because a grandparent lives with them and looks after the kids? Is the state going to provide domestic childcare when grandparents are taken from the home into isolation in some hotel? What about cases in which a parent carries a risk factor? Or a child? Will children be removed from the home like they were in London during the Blitz?
I would like to see my Facebook friends who support this solution grapple with these questions rather than just put up glib posts about how the vulnerable should be protected while everyone else gets to get on with life freely.
In addition, examination of the table reveals one curious thing that I, with my limited knowledge, can see. In the mixed-evidence table we see that taking corticosteroids (such as dexamethasone) can increase risk, presumably because it acts in part as an immunosuppressant, yet dexa was given to President Trump as part of his treatment against covid-19 and it is being used experimentally with seriously ill Coronavirus patients in the UK. Many cancer patients receive dexa as part of their medical regime because it improves response to cancer meds and I wondered if dexa paradoxically provides some partial protection for some of them. An oncologist told me that dexa acts as an immunosuppressant only after longterm use.
This shows the complexities of the issues and provides one reason why those of us who are not trained should not try to second-guess the experts.
Even the experts do not agree with one another. And the only ones who can assess the relative merits of one expert’s opinion over another’s are the experts themselves. They read each others’ studies, hear each others’ presentations at medical conferences. We can work toward achieving a level of understanding that would allow us to evaluate what we are reading and hearing, but that would involve a huge investment of time and work in reading the studies.
The Case of Sweden’s Approach to Coronavirus
If we want to use Sweden, that did not have lockdown at all, as a model, we need to understand that the government did recommend restrictions and a huge proportion of the population voluntarily complied. Yet, contrary to expectations/hope the country only reached a 6.1% infection rate as measured in late May and that is far from herd immunity of 40% minimum. A sobering fact for those who claim that we should not really fear Covid-19 is that Sweden’s death rate so far this year is 10% higher than the average over the previous five years. Of course, a large proportion of the deaths were because they did not know in the beginning how to sufficiently protect the homes for the elderly. But are we sure we know enough now about protecting all the vulnerable among us? Furthermore, given that their approach did not prevent a second wave, Sweden is considering applying stronger restrictions now. In fact, Sweden’s state epidemiologist, Anders Tegnell, says they should have been stricter from the start.
So now, what do you think Israel should be doing about the Coronavirus epidemic?
Coronavirus Risk Factors with the Strongest Level of Empirical Suppport
Risk Factors for Coronavirus having Mixed Support
Risk Factors having Limited Empirical Support
Where does age fit into this? What of those over say 70, 80 and 90 with none of these conditions?
I do not remember where I saw this but I saw an article that was clear that after age 60, the chances of getting hit by the disease harder increased substantially.
I’ve thought about this all day. I think about it all the time. I’m 77 years old and live in India in an orphanage I founded with 15 children, some with severe disabilities. We have been in severe lockdown for over six months. I worry all the time. I’ve also been a doctor for 51 years so I have another perspective and I remember the tail end of polio epidemic in the US and diptheria in the South. I would not have done a lock down for COVID. I would have followed the model of Sweden. One of the reasons is the effect of increasing government control of our lives. Another is the economic destruction of people’s lives, people who will not recover economically. Then there are the children who have missed a year of education, for some the critical early years of language and number development, and their lag behind their peers with computers and other economic means. People become afraid of each other, afraid of getting sick, even more afraid of infecting others. We all become like walking bioweapons, afraid, afraid of sickness, afraid of blame.
And then there is the economic factor, the profit motive, so that inexpensive treatments, no longer under patent are considered dangerous suddenly, while billions goes to expensive treatments and vaccinations.
In my opinion the people running the show are scared and like us, afraid of blame, afraid to let up, to accept that our lives are always at risk. But COVID isn’t Ebola. It’s not even TB.
At the end of the day, I say to give us back control of our lives. Government control does not have a good history.
I agree with the socioeconomic dangers of lockdown you talk about and also do not relish government control of our lives. In this case, however, it is not clear what is really going on. We will only know in retrospect in a few years. I sure would be overwhelmed by the responsibility if I had to make decisions for my country at this time. I think this may be a case of “damned if you do and damned if you don’t”.
I can only speak for myself and those I know — I do not see it as being afraid of other people, but being afraid of getting the virus from someone who may have it and be contagious and not yet know that. Or someone who deliberately goes out and about in spite of having tested positive. Wearing condoms does not imply being afraid of other people — it is mutual protection re STDs when you do not know if that other person has been careful about who they have been with recently (as well as protection against unwanted pregnancy). From what I have been reading, Sweden does not necessarily agree with what it did at the start of the pandemic.