As national statistics of confirmed COVID-19 infections rise and no clear path to resolving the pandemic has emerged, a challenge has been raised by Neil Howe, head of the demography sector at Stamford-based Hedgeye Risk Management, for the federal government to aggressively pursue either a policy of mitigation or suppression of the virus.
Speaking in a webcast on the pandemic’s economic disruptions, Howe noted that both options come with serious pluses and acute minuses.
“You can go for a mitigation and that flattens the curve while allowing more infections sooner,” Rowe observed, citing the recent “herd immunity” comments by U.K. government’s chief science adviser Sir Patrick Vallance. “In a sense, that is the only time when an epidemic stops. That is to say, when enough people are immune that the Ro (net reproductive rate) basically goes below one because there’s so many people you are in contact with who”™ve already gotten it.”
Howe noted the strength of this approach was that it “minimizes the duration of the epidemic with much less economic damage.” On the other hand, Howe added, the weakness of this strategy is that “it overwhelms the health care system” and multiples the death rate. Howe noted that the governments in the U.K., the Netherlands and Sweden were beginning to take this approach but have since backed away.
The other option, Howe continued, is to go for suppression that will “flatten the curve all the way down.” Unlike mitigation, fatality rates and cases of new infections are minimized and “you allow the health system to care fully for everyone who is sick.” Yet this approach also carries major flaws.
“The weakness is it maximizes the duration (and creates) much more economic damage,” Howe said. “In fact, it sort of defers any solution indefinitely. This would be a great idea if we could bring up effective antivirals or bring up the date of the introduction of an effective vaccine ”“ then that would really make sense. Right now, though, I think best estimates, we’re still talking about at least a year away for a vaccine, and who knows about the antivirals?”
Howe pointed out that a solution could exist in hybrid approaches, including “smart mitigation” that would “allow for more infections, but directly sequester the older, sicker population.” This strategy would take the herd immunity approach with the goal of gradually returning the older and less healthy demographics back into the general population.
A second option, Howe continued, was “smart suppression,” which he defined as “suppression with minimal hindrance to work activity, but that would require widespread testing, diligent contact tracking, compliance with universal social distancing (and) would require a very socially regimented and disciplined way of life for several months in a row ”“ perhaps sort of indefinitely until we get some of those pharmacological solutions.”
Howe noted that “smart suppression” was tried in an Italian town with a population of 3,300, where the infection rate was dropped to zero.
“They”™re basically testing everyone every 10 days, and anyone who is positive, they sequester them and track them all down,” he said.
Howe also stated this was being done in parts of Asia, but admitted “it’s going to be much harder for the west to do it.”
