Trying to protect everyone, we exposed the most vulnerable to the virus

In the Senate hearing last week on the country’s response to the coronavirus pandemic, Sen. Rand Paul (R-Tenn.) challenged the preternatural influence of Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), saying: “You are not the end-all.”

Paul was rude, but right. The nation has become transfixed by Fauci and the current approach to the coronavirus pandemic, which Paul described as a “one-size-fits-all” policy. Almost the entire nation was ordered to stay home and socially distance, almost the entire economy shut down. You can’t get more one-size-fits-all than that.

It is a marvel that the nation followed such a uniform policy with a virus that afflicts different population segments in such wildly different ways. Over three-quarters of all serious cases and deaths have befallen people over age 65, who comprise only about 16 percent of the population. And it is just plain common sense that people with serious prior conditions would be at greater risk, and that transmission would be greatest in densely populated urban areas and residential settings. To offer a uniform policy is like a shoe store selling only size-8 shoes.

The dramatic imbalance was clear before the U.S. shutdown began. Data out of China and Italy were unambiguous that the virus attacked the elderly and spared those younger. Moreover, our first reported outbreak occurred at a nursing home in Washington state, among seniors in a dense residential setting.

Tragically, the U.S. has failed to protect precisely those population segments whose high risk was obvious from the start. While the damage sustained — in terms of both lives and livelihoods — cannot be undone, it need not be compounded. From the start, many people saw a targeted approach without a total economic shutdown as a better approach, and they still do.

Since an unfortunate partisan flavor has crept into the debate over the best policy, with Democrats supporting Fauci and many Republicans supporting the targeted alternative, let’s look at the targeted alternative — not as presented by a Republican or a conservative but, rather, by Thomas Friedman, renowned opinion columnist for the New York Times, a generally left-leaning newspaper.

Shortly after the U.S. shutdown began, Freidman wrote a column entitled “A Plan to Get America Back to Work,” articulating the same grave concern about the total shutdown of the economy as expressed by The Wall Street Journal, this columnist and many others at that time and since. Friedman even framed his concern in the same words that became so controversial when uttered by President Trump: “Is the cure — even for a short while — worse than the disease?”

Friedman worried about “groupthink.” He worried that the exclusive focus upon the virus would crowd out treatment of other serious illnesses and conditions, e.g., someone in cardiac distress might hesitate to go to the hospital or be unable to summon an ambulance. He pointed out that, in the long term, a prolonged shutdown would make us all significantly poorer with consequently poorer general health, quite simply because a poorer society cannot afford the best health care.

Then, Friedman turned to a discussion of “another way” advocated by Dr. David L. Katz, founding director of the Yale-Griffin Prevention Research Center. Katz is an MD with a graduate degree in public health from Yale, who had penned an op-ed in the Times two days before. Friedman said Katz advocated a pivot from the “horizontal interdiction” strategy — restricting the movement and commerce of an entire population — to a more “surgical” or “vertical interdiction strategy” that would focus on protecting and sequestering those most likely to be killed or suffer long-term damage.

Katz said everyone should stay home for two weeks, rather than indefinitely. Those who develop symptoms within the virus’s usual two-week incubation period should then self-isolate; those not symptomatic, if in the low-risk population, should be allowed to return to work or school.

With more than nine weeks having passed — far more than the two-week period Katz considered sufficient — we should go back to work and school, according to his strategy.

If this alternate strategy is not compelling in its own right, consider what our current strategy has failed to prevent: the highest infection and death rate in the world, concentrated in exactly the high-risk groups, areas and settings which were clearly identifiable at the start.

Not only has this strategy largely failed, but it is almost certain to make things worse in the future. Had younger people not stayed home and socially distanced, they would have become infected — with only a rare incidence of serious cases — and herd immunity would have developed, vastly reducing transmission and spread in a dreaded second wave.

What leaps to mind is that, in trying to protect everyone, we left the highly vulnerable few tragically exposed. A central precept of medicine in the context of scarce resources is triage. God knows, we had scarce resources as the pandemic broke out. When everyone can’t be saved, triage means focusing policy, effort and resources in a manner designed to maximize survivors — in the case of this virus, to protect those most clearly vulnerable.

The economic fallout of the shutdown has been catastrophic: more than 36 million people have filed for unemployment benefits. The unemployment rate has hit 14.7 percent, and is expected to exceed 20 percent. GDP has collapsed, falling by 4.6 percent in the first quarter, which included only two weeks of the shutdown; economists project a 30 percent GDP drop in the second quarter. We have added $3 trillion to our national debt just in the fiscal “stimulus” already dispensed. The Federal Reserve Bank has extended about $2.3 trillion in monetary support, even before launching several planned new programs. Income tax revenues will evaporate as businesses sustain losses and many individuals suffer massive declines in income.

In contrast, a targeted approach would not have required such a costly economic shutdown, quite simply because it would have focused almost exclusively upon people of retirement age.

There’s a pernicious canard circulating that focusing on the economy is “putting money before lives.” Does anyone seriously believe that these apocalyptic numbers do not spell extreme pain and decreased life expectancy for the vast majority of Americans?

What now? We have flattened the curve, our original objective. While we are reopening the economy, we are reopening painfully slowly, with many state governors imposing myriad rules and regulations that effectively extend the shutdown and continue to scare the public. The likely result will be an anemic recovery. We need to reopen aggressively to survive the economic apocalypse we have put ourselves through, and we need to focus almost exclusively on comprehensive protection for the obviously vulnerable until a vaccine is deployed or, at least, until effective therapeutic treatments are widely available.

The targeted approach presented here is largely that of Thomas Friedman, a journalist at a generally liberal newspaper, and it is based upon conversation with a public health expert. The fact that many Republicans and conservatives share this view should not prevent reasonable people of all political and ideological persuasions from considering the targeted approach.

Red Jahncke is president of Townsend Group International, a business consultancy headquartered in Connecticut. Follow him on Twitter @RedJahncke.