Report: Ohio's policies may save lives, but a coronavirus vaccine is what's really needed
How would you feel about doing two months of self-isolation and social distancing followed by one month of normal life before repeating the cycle? Experts say that's one way we could get through the coronavirus pandemic until a vaccine is available.
The idea is outlined in a recent report from the Imperial College in London. It's been dubbed the report that made the White House change its course on the novel coronavirus. The Enquirer compared the policies discussed by the researchers to what's already being done in Ohio.
The college's report, released Monday, was an apparent wake-up call to President Donald Trump's administration. It said that without any changes, the novel coronavirus could infect 81% of the American population and kill 2.2 million people.
The report prompted Trump to promote social distancing by limiting gatherings to no more than 10 people. The Centers for Disease Control and Prevention recommended avoiding eating at restaurants and bars, public schooling and discretionary travel.
The good news: Ohio Gov. Mike DeWine's administration had already ordered many of those changes. Before the report was released, DeWine had closed schools for at least three weeks, banned visitors to nursing homes, limited large gatherings and closed restaurants and bars except for carryout, delivery and drive-thru orders.
“You need to know what you are doing is really making a difference," state health director Dr. Amy Acton said Tuesday. "If we did nothing, we would see that more scary sharp climb that we saw in Wuhan (the Chinese city where the virus first appeared)."
The bad news: These changes might be here to stay for a while. If suddenly lifted, even after five months, COVID-19 cases will surge again, the report states.
The researches say the measures will need to stay in place, or at least be periodically reinstituted, until a vaccine becomes available.
A vaccine likely will take 12 to 18 months to develop, approve and ship, federal experts such as the government's top infectious disease doctor have estimated.
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Without changes: 2.2 million deaths
The British research team estimated that without any interventions, such as social distancing and closures, COVID-19 could infect 81% of the American population and kill 2.2 million citizens in just a few months.
They reached this conclusion using World Health Organization infectious disease modeling along with recent data from China and South Korea.
The 2.2 million estimate is nearly a million people more than the Americans killed in all U.S. wars dating back to the revolution. It's more than three times the number of Americans killed in the Spanish flu pandemic of 1918-19.
And this staggering number of forecasted deaths does not factor in "potential negative effects of health systems being overwhelmed," the report states. A health system filled with COVID-19 patients may not be able to properly care for those suffering from other problems.
Assuming the deaths would be distributed evenly across the population, that would mean about 82,500 deaths in Ohio and about 2,100 deaths in Cincinnati alone with thousands more becoming sick. Put another way, one of roughly 150 Ohioans would die.
But the scenario calculated in the report appears unlikely since many states, including Ohio, are taking aggressive measures to stop the spread of the virus.
“There’s no scenario now by which we won’t have a surge, but if we did nothing the estimates were that 2.2 million Americans would die," said Acton, referencing the London report Tuesday. But Ohio and U.S. leaders did make changes.
"If we do these measures in the absolute way they’re intended," Acton said, "we can cut the hospital surge, by these authors' examples, by two-thirds."
Four ways to tackle the pandemic
The research team suggested four types of intervention:
- Voluntary home quarantine: People with COVID-19 and everyone in their household stays home for two weeks.
- Social distancing of those over 70 years old: People in this age group reduce contacts in workplace-like environments by 50%.
- Social distancing of the entire population: People reduce contact outside the household (except school) by 75%.
- Closure of schools and universities: All schools and 75% of universities are closed.
The study also assumed a certain amount of non-compliance with these directives or people not doing what they're told.
The researchers found that only by implementing all of these measures will the number of sick patients stay below the number of available intensive care unit beds.
In Ohio, home quarantine, case isolation and school closures are already in place. What remains unclear is how much social distancing – as defined by the researchers – is taking place.
Ohio's leaders have taken steps to ban visitors at nursing homes, close schools, close restaurants and bars – except for carryout, delivery and drive-thrus, close hair salons and tattoo parlors and might soon limit day cares. They also closed polls on what would have been Ohio's primary date on Tuesday.
The state hasn't taken the dramatic step of requiring residents to stay home or "shelter in place" as San Francisco and some Illinois communities have. But DeWine is pleading with most Ohioans to do so anyway.
“Just to put it very bluntly – stay home,” DeWine said Thursday. “Please stay home if you can.”
The report says that if all the four measures above are taken, lifted after months and then put back in place whenever ICU beds start to fill up again, deaths could be reduced dramatically.
Without a vaccine, using this cycled strategy, the research suggests that deaths over the next two years could be reduced nationwide from 2.2 million to between 22,400 and 192,000 depending on exactly how contagious the new coronavirus is.
However, the report says if these measures are kept in place for five months and then all lifted in September, cases of COVID-19 will surge again.
Until there's a vaccine, there's intervention
The cycled option explored in the report is called "adaptive triggering."
Here's how it would work: Those older than 70 and sick patients would remain quarantined, but the remaining people would return to school and their regular lives.
Then, if novel coronavirus cases spiked or available ICU beds reached a certain point, that would "trigger" more restrictions and a return to social distancing.
The researchers modeled this tactic for Great Britain, which has about a fifth of the population of the U.S., using 100 ICU cases across that nation as a trigger point to return social distancing and school closures. Those restrictions would be lifted when the number of ICU cases dropped below 50.
Using this method, the report shows that the population could go to work and school normally for about one month before restrictions on school and work kicked in again for two months.
This one month of work and school followed by two months of restrictions could maintain what the report calls a reasonable hospital population through the end of 2021.
However, the researchers admit they are only examining a small number of variables in a very large problem. Every change individuals make to stop the spread of coronavirus makes a difference.
Self-directed changes people make – like hygiene practices, the 6-feet rule and changes in gathering practices – could also have a big impact if enough people join in.
The report also completely, and admittedly, ignores the economic and social impacts these policies could have.
"No public health intervention with such disruptive effects on society has been previously attempted for such a long duration of time," the report states. "How populations and societies will respond remains unclear."