By: Mark Glennon*
We wrote earlier this week on why Illinois’ COVID-19 policy should be to obsess about the elderly and infirm. Data clearly show that only the elderly and those with certain comorbidities (who are mostly elderly) face serious risk and it’s they, in overwhelming numbers, who are dying. Eighty-eight percent of Illinois deaths from the virus are age 60 or older, and fatality rates for younger people are infinitesimal. Accordingly, Illinois’ policy of general lockdowns and school closures is upside down, failing those who are actually at risk.
What are those alternative measures to better protect high risk groups?
In this article, we will present a few.
For background, a debate on COVID policy now rages between two camps of medical experts.
One group has signed what’s called the Great Barrington Declaration. Because the risk of death is more than a thousand-fold higher in the old and infirm than the young, it says a more compassionate approach is to allow those who are at minimal risk of death to live their lives normally while better protecting those who are at highest risk. They call it “focused protection.”
The other group says focused protection isn’t realistic because uncontrolled transmission in younger people risks significant deaths across the whole population. Their statement says prolonged isolation of high-risk groups is practically impossible, unethical and not feasible.
It’s the focused protection approach that seems more sensible to us, but it also seems the two approaches are not binary alternatives. Whichever side you are on, shouldn’t the measures that follow become policy?
We make no claim that these measures are original ideas. Most have been made by others but ignored by health authorities that have focused instead on broader measures. Many are simple matters of adjusting the public communications by state and local health authorities:
- Aggressively communicate that the risk is limited to specific people.
Americans of all age groups are “blinded from science” when it comes to understanding how heavily mortality risk is concentrated in the elderly, said the authors of a credible opinion poll we reported on earlier. “These results are nothing short of stunning…. Six months into this pandemic, Americans still dramatically misunderstand the risk of dying from COVID-19,” they said. Both the elderly and younger people in contact with them simply need to understand through better messaging from health authorities.
- Warn against undue reliance on masks.
This is an interesting topic unto itself, coming under the label of what researchers call “risk compensation.” Do mask wearers become less cautious about distancing and other safeguards, thinking they are protected by masks? The answer isn’t certain but it would appear they do, and they should be warned.
What we know is that the primary communication health authorities bombard us with is masks, masks, masks. The head of the Center for Disease Control went so far as to say that masks are more effective than vaccines.
I can find nothing whatsoever to support such a strong claim. Studies on mask effectiveness have come to different conclusions. A credible one recently completed in Denmark found that masks are of no value protecting the to the user. However, they do reduce chances the user, if already infected, would spread it further.
Whatever the truth is on that, it’s easy to find evidence by yourself that many elderly apparently think it’s safe for them to loosen social distancing measures. The grocery store in my neighborhood, for example, is routinely full of eighty-ish shoppers with masks. That’s reckless for some, especially those with underlying causes, unless they’ve chosen to take an informed risk, but they probably haven’t been properly informed.
The reasonable policy in light of that uncertainty would seem to be that messaging on masks should include a warning that they are far from foolproof. As a scientist here put it, “It is important to reiterate the fact that face coverings need to be combined with other health behaviours such as frequent hand washing for maximum efficiency.”
- Assure that the elderly have free delivery options open for groceries, drugs and other options.
Some volunteer groups around the state have already stepped up to provide this service, but the state could easilly encourage their formation and put out the word that those services are available. That’s not being done.
- Aggressively encourage work-from-home accommodations for those at risk.
The private sector seems to have responded well, but it’s unclear whether all those who are at risk are genuinely offered the option to work from home. All reasonable pressure should be applied to encourage those accommodations.
- Fixate on making retirement facilities safe, where about half of the deaths occur.
The signers of the Great Barrington statement offered these suggestions:
Nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized…. When possible, they should meet family members outside rather than inside…. A comprehensive and detailed list of measures….can be implemented, and is well within the scope and capability of public health professionals.
Respecting use by nursing homes of “staff with acquired immunity, it should be noted that well over half Illinoisans could now be immune – based on official numbers – most of whom were infected but never tested and now carry antibodies. They should be identified with antibody testing and used as frequently as possible to staff retirement homes.
Some of the above measures for retirement homes are supposedly in place, but it’s fair to ask how seriously they are being enforced in light of the huge death toll in those homes – over 6,000. The Chicago Tribune covered the state’s failures in its in-depth report: Illinois nursing home complaints not investigated for more than three months amid pandemic that killed thousands of residents, and we wrote earlier about questions and problems in Illinois’ handling of retirement homes.
Most recently, the Lasalle Veterans Home lost 27 residents to the virus and another 104 residents and 94 employees at the home had tested positive. That resulted in part because some employees who had tested positive worked nevertheless.
With that kind of failure, it’s fair to ask what level of other, serious failures remain unaddressed in other retirement homes, and to put the needed resources on ensuring a fix.
The bottom line should be minimizing deaths, and that demands the “focused protection” on those most at risk of death – a strategy endorsed by more scientists every day. A vaccine is only months away, making broad-based policies like school closings less and less sensible.
Obsess about those at risk.
Keep them alive until the vaccine arrives.
*Mark Glennon is founder of Wirepoints.