Thoughts of a Mathematician
This article assumes that federal, state, county, and city governments, having jurisdiction over a particular location, act in coordination and agreement. This agreement is referred to here as the government’s decision. Any such decision would likely comprise actions by the government and reasonable and easy to follow recommendations to public.
“If you can’t measure it, you can’t manage it” is applicable here. To control COVID-19, we need to measure the percentage of infected, immune, and naïve individuals in each location and age group. The most popular metrics – the number of tested positively and the number of deaths – are not very useful.
The best way to measure the spread of COVID-19 is to perform random testing of the population. 500 random tests in a location with the population of 1-10 million would provide a sufficiently accurate picture, while only using a small fraction of available test kits. Such testing can be performed daily using a small fraction of available test kits.
The local government can accomplish that by offering free COVID-19 tests to randomly chosen drivers on the roads, students on campuses, children in schools, passengers in airports and other public transportation. Like in surveys, the raw results should be normalized to reflect the whole population.
2. Lifting Restrictions: Go-Stop-Go
A good technique for re-opening the country (state, city, or county) is to temporarily lift most restrictions for a three-day-period – from the nearest Monday to Wednesday. People will enjoy a short week, after a long period of forced idleness. More importantly, this would allow the government to closely observe the situation for the rest of the week. The median incubation period of COVID-19 is 5 days, so about half of the symptomatic cases, exposed in the Monday-Wednesday period will appear before the next Monday. The number of cases that would appear later can be calculated. Unless there is an unexpected rise in hospitalizations or new patterns of symptoms, the same restrictions are lifted permanently, per location. The “location” means a county, a city, a metro, or a small New England state. Large states, like California, Washington, and even New York comprise multiple locations with different conditions.
This Go-Stop-Go approach to lifting restrictions is preferable to their gradual relaxation, in which case we would always be a few days behind the actual developments.
Obviously, there are differences between locations depending on the infection levels, population density, transportation modes etc. The most heavily infected areas might benefit from continued stay-at-home recommendations.
The COVID-19 death rates sharply vary depending on age. Only a small percentage of deaths occur in people below 50 (see CDC data on COVID-19 statistics page on April 15), Most of those individuals had known pre-existing conditions, mostly hypertension and diabetes. See the New York’s dashboard.
It seems that in most areas, people below 50 and without the described pre-existing conditions, can return to their ordinary lives, except for some high-risk activities.
On the other hand, additional caution and help can be recommended for those who are 65+. They might even need isolation from family members who go to work. Measures to actively protect the elderly and vulnerable might include:
- Delivery of groceries & other necessities to their homes, rather than requiring them to go out in public.
- Encouraging their employers to provide them paid vacations.
- Giving free lodging, if anybody in their household is symptomatic or has tested positive for COVID-19.
The CDC should stop using the phrase ‘community spread’. COVID-19 transmission cannot be traced, which is the definition of community spread. However, COVID-19 is not a plague, as is the implied connotation and sense of panic when using the term “community spread”.
4. Immediate Priorities
In my opinion, when the country goes back to work, the priority should be to ramp up preparedness for any dangerous mutations of CoV2. This would also be a useful step in preparing for future pandemics. For example, we need to quickly increase the surge capacity of the health care system, rather than to try bending the curve to meet its limits. The surge capacity might be free of most regulations and even be of lower grade than the regular capacity.
I saw an interview with an experienced US doctor on epidemics in the Third World. They set up field hospitals for epidemic patients so that ordinary hospitals can continue without getting infected. Domestically, US did exact opposite. Allowed epidemic patients to disrupt [the whole health care system]. Worse than the Third World.
The government has some emergency powers for use in emergencies. However, the current COVID-19 situation falls far from the emergency, possibly except for the New York metro area. Thus, state governments, with possible exception of the New York and New Jersey, don’t have emergency powers. No level of government has the constitutional right to decide what we, the people, do. Whether we go out, stay at home, work or don’t work, these are OUR decisions. They cannot order us to stay home to save statistical lives, even if those statistics are correct – which isn’t usually the case, when a government tries to overstep its authority.