Until we have a meaningful alternative, blocking is the only thing we can do to prevent further catastrophic spread of the virus, says Edward R. Melnick. But John PA Ioannidis argues that any benefit of the blockade depends on its effectiveness and the load of the covid-19, and that the damages are multiple.
Yes, Edward R. Melnick.
There is still a lot we don’t understand about covid-19. Since the first case in the US was confirmed. USA Just over three months ago, we have seen cases overwhelming the health care infrastructure in endemic areas, 1 while discovering that asymptomatic and presymptomatic transmission can be rapid and widespread.2 Although reassuring, preliminary evaluations of covid- 19 Prevalence and undervaluation rates should be interpreted with caution, considering sample selection bias and high variability in local rates of infection, transmission, and testing.3 Indeed, preliminary estimates of the death rate are likely to be overestimated , although they are still likely to be more than 10 times greater than that of seasonal influenza.4
Regardless, high transmission in a naive population to covid-19 has contributed to more than 250,000 deaths worldwide and has substantially taxed health care resources and capacity. Even the most conservative predictions show that covid-19 deaths can outnumber any other infectious disease in our lives.5 And, as of this writing, the majority of the world’s population is likely still susceptible to covid-19.
In the absence of a safe and effective vaccine, treatment or prophylaxis, non-pharmaceutical interventions are the only options available to delay the spread of the virus. These include physical detachment, hygiene, masks, isolation of infected people and their contacts, and closings, such as school and business closings and bans on public gatherings and travel. The best strategy to reduce transmission of such an infectious disease is aggressive and early detection, with isolation of infected people to minimize transmission before the disease can become locally endemic.6
This strategy was particularly difficult with covid-19, probably due to the delay between infection and the manifestation of severe symptoms and the lack of available evidence. As a result, strategies have shifted from containment to mitigation, giving way to blockages on an unprecedented scale in modern collective consciousness.
A powerful but necessary tool
Blockages are, comparatively, the most draconian non-pharmaceutical intervention. When implemented successfully, they decrease disease transmission by limiting human contact to scale. Historical analysis of archives from 43 cities in the 1918-19 influenza pandemic shows a strong association between blockages and delayed or reduced peak mortality rates, as well as reduced cumulative deaths.7 Earlier implementation and more lengths were also associated with reduced total mortality.
Locks are not without cost, risk or damage. The economic, social and emotional cost resulting from covid-19 blocks has been catastrophic and vast.8 And the medical consequences of the blocks are beginning to emerge, with a paradoxical increase in preventable deaths due to avoidance in the search for Necessary medical attention, resulting in excess morbidity and mortality from non-greedy conditions.9
But restrictions cannot be safely lifted without the ability to carry out mass testing, contact tracing, and adequate protection for high-risk populations. Otherwise, the spread of covid-19 could be accelerated in communities that have not yet experienced its maximum case incidence rate, and the second waves could be more lethal in communities that have reopened after successful blockages.7 Of course It is not known if a second wave will occur — or how serious it can be. If one occurs, preparation is essential. Hopefully, less forceful non-pharmaceutical interventions (such as masks, testing and tracing, and social distancing) will be adequate to contain a second wave.
But hope is not a strategy. Free aggressive community screening without a doctor’s referral, along with targeted testing in high-risk settings (nursing homes, prisons, homeless shelters) and random populations, may obviate the need for confinements.10 However, In the United States, we have not prioritized building the capacity necessary for mass testing; there is also no public will to use such a strategy. Until then, or until an alternative strategy emerges, blockades will continue to be essential to mitigate this growing pandemic.
No, John PA Ioannidis
The block was initially justified, when the announcements declared a new contagious virus with a mortality rate of 3.4% and no asymptomatic infections. The possibility of 50 million deaths coincided with that of the 1918 flu pandemic. However, we know that undetected infections are the vast majority. Infected people outnumber those confirmed by polymerase chain reaction tests, from five times (Gangelt, Germany) to more than 500 times (Kobe, Japan).
The death rate from infection is therefore much lower than the documented case fatality rates. Furthermore, most covid-19 deaths affect people with limited life expectancies, 11 while the average age of death in the 1918 flu pandemic was 28. The expected loss of quality-adjusted life years Even without aggressive closure measures, it is 100 to 1000 times lower than in 1918, perhaps comparable to (if not less) than typical seasonal flu, which kills 34,800 children (95% confidence interval 13,200 to 97 200) every year with acute lower respiratory tract infections, 12 in contrast to covid-19, which overwhelmingly forgives children.
Even if covid-19 is much smoother than previously feared, it can still be devastating in specific environments. Massacres in hospitals overflowing with contaminated personnel13 and in nursing homes14 account for the majority of deaths. Hospital preparation, universal detection of personnel, draconian infection control and social distancing in these places are essential.
However, the blind closure of entire populations has questionable additional benefits. Locking up healthy and safe people and transferring covid-19 patients to nursing homes was absurd. Proponents of the “curve-flattening lockout” must recognize that this saves time for hospital readiness, but that most, if not all, covid-19 deaths will still occur when measures are relaxed, unless treatments and / or effective vaccines. Furthermore, the rationale for blocking to flatten the curve ignores seasonality and advocates 100-year observational data from a 1918 pandemic with an infection death rate 100 times greater than covid-19.