What are your worst fears: Lockdown or open the economy?

What are your worst fears: Lockdown or open the economy?
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The nation is now facing a devastating COVID-19 pandemic toll that leads the world. Current policy is focused on balancing illness and deaths; and from easing the lockdown with the benefits of restarting our economic engine to provide jobs, commerce, and the start of restoring our social fabric. 

In this environment of generalized fear and anxiety about family survival and the unremitting drumbeat of alarming news, politicians and scientists debate whether the U.S. response can be better.

It can if we deploy our best science-based realism. This requires a paradigm shift in how we think about coronavirus. This is a Darwinian “war” that we can win by attacking virus behavior on its terms, not ours. 

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We are now attempting to impose our political, cultural, best-guess scientific and aspirational baggage on the virus. Much of it is destined to not work. We have devised reactive mitigation and suppression strategies to buy time. We have recommended unproven wonder-drugs. We have offered fuzzy solutions based on hope and fear. Now we’re facing graphically stark death versus economic survival decision.

How does this fit with the virus’s behavior? It’s a useful thought experiment to look at the pandemic from the perspective of the perpetrator. Through the lens of evolutionary biology, how did this virus get here and what is it trying to accomplish? 

The virus “spilled over” to humans from another animal species, reportedly by from a bat to a pangolin to humans in China perhaps five months ago. It was armed with an array of characteristics destined to successfully sweep the globe and potentially infect nearly every human being on the planet. The virus inflicted itself on a susceptible population with a formidable selective-advantage toolkit: respiratory community spread, asymptomatic transmission, high contagion, and relatively low case-fatality rate, assuring an ever-growing human reservoir. This deadly cocktail was geared for evolutionary success. 

Now that an aggressive global response has been marshaled, what are the virus’s fears? What front-lines is the virus defending and trying to penetrate? How will the virus‘s opportunistic foray into human despoliation end?

There are at least six exit scenarios that the virus is facing. Three are mostly in human control or influence and three are owned by the virus.

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The cards that we hold:

  1. New and successful vaccine(s)
  2. New highly effective treatments
  3. Proactive strategies of population acquisition of natural herd immunity 

The cards that the virus holds:

  1. Weakening or burnout of the virus through sequential mutations or environmental factors 
  2. Acquisition of reactive or “default” population herd immunity (our current passive strategy)
  3. Becoming embedded in the human respiratory virus ecosystem as another endemic similar to the seasonal flu.

What are the implications of this “attack the virus in its own paradigm” for current U.S. policy?

It is to maximize our focus on the three controllable virus exit-strategies and as importantly, to minimize any actions that play to the virus’s advantage.

The U.S. in collaboration with much of the world has unleashed the fastest and most sophisticated science and technology response to a pathogen in history. This unprecedented effort will bear important fruit over time. But while we wait, we must give the acquisition of population herd immunity a much closer look. Our current indiscriminate mitigation and suppression strategy, while obligatory, if maintained indefinitely, is in direct conflict with the achievement of natural herd immunity. No country can afford an indefinite precautionary principle-based on the strategy of avoidance of all risks. The economic, social and psychological consequences are too destructive and dire. 

While as a society we debate whether and how to deploy these evolutionary biology-targeted strategies, we must get the critical policy decisions right. The current choice between deaths and jobs is not binary. With careful planning and close monitoring, selective “tap and release” reopening of the economy while allowing a gradual buildup of levels of acquired immunity (with unavoidable collateral illness and deaths) is the best mid-term U.S. strategy. A central pillar of this approach is rigorous measures to protect both the high-risk vulnerable populations and front-line health care providers from infection. They cannot be sacrificed in the “deaths vs. jobs” equation.

Acquired herd immunity within a functional society must be the virus’ worst survivalist fear. An effective vaccine is a close second, but that’s not predictable in timing or success. 

Our current early-pandemic flatten-the-curve game plan will buy critical time. If we can now take on the virus in its own court, the endgame becomes winnable and insight.

Steven Phillips. M.D., MPH is a medical epidemiologist and pandemic preparedness practitioner formerly with the Centers for Disease Control and Prevention.