“I think with a combination of good public health measures, a degree of global herd immunity and a good vaccine — which I do hope and feel cautiously optimistic that we will get. I think when you put all three of those together, I think we will get very good control of this,” -Dr. Anthony Fauci, webcast hosted by the TB Alliance, July 22, 2020.
It is likely that a “one size fits all” approach to epidemic intervention is inferior to a stratified approach that optimizes for those across the risk continuum (low, medium, and high risk for a severe case) as well as those who have recovered and developed a level of immunity. A multi-faceted stratified approach is likely to result in superior epidemic intervention planning. Just as shoe sizes vary; and just as the adaptive immune system develops unique antibodies that target varied pathogens from streptococci to Influenza, so is the need for multi-faceted, stratified plans that best fit each of the varied segments of society.
Protecting people at medium and higher risk for a severe case by shielding them from exposure; coupled with voluntary exercise of scientifically designed exposure risk guidelines for those at low-risk for a severe case could result in intelligent, situationally specific behavior that preserves economic, civic, social, and mental health and minimizes physiological health risks.
It is possible, given modern scientific understandings of viral loads, human challenge studies, fluid mechanics, and other areas of scientific discipline, to establish guidelines such that effective exposure viral loads are below thresholds that are likely to result in a mild case of COVID-19. It is possible to find viral load thresholds that are likely to result in no illness or minor illness that maximize harmony with “as normal as possible” living for the vast population majority that are at low risk for a severe case. In fact, a side-effect of such viral load threshold management offers some probability of being an extremely low risk variolation technique that could provide some degree of immunity with no symptoms of illness. When the threshold approach errors low, no illness occurs and when it errors high, since those using it are at low risk for severe case, they experience a mild case and the resulting stronger seroconversion / immunity. Since those at higher risk for a severe case have been much more strongly protected / shielded, the overall result is a relatively small number of moderate / severe cases. Case “exposure diary information” for moderate / severe case scenarios can be fed-back into the exposure viral load model as part of a continuous improvement process. It is possible to apply engineering skill sets to epidemiologic challenges that result in technological breakthroughs in medicine.
As Fauci appears to state in the quote above, an optimized approach involves well designed guidelines for those at low risk for a severe case and shielding those at higher risk until a rapidly developed vaccine becomes available to those at higher risk and those who desire it. Individuals at low risk may help to create a degree of herd-immunity as they continue a mostly-normal life with well-engineered personally tuned risk tolerance adapted exposure constraints.
The following epidemic intervention response is extensively supported via the hyperlinked discussion below. It is IMPORTANT to follow the hyperlinked content that provides scientific and logical support for these recommendations.
The correct response to COVID-19, based on science elucidated in the hyperlinked discussion below, could be as follows:
- Education and provision of safety information
- Improved running totals data at local, state, and federal levels to include breakdown by risk
- Protect people at high-risk for a serious case
- Rapidly develop a vaccine for those who are high-risk or want it.
- Ensure availability of health care resources
- Rapidly develop immunity of people at low-risk for a serious case
- Improve treatment options and preventative measures
- Optimize immune system function across the population
Safety information should include greater depth than “keep 6 feet of distance”, “wash your hands”, and “wear face coverings”. It should explain fundamental infection mechanisms and other helpful information such as the benefits of improved indoor ventilation and provide scientific references that help guide individual behavior so that optimal intelligent, situationally specific solutions can be utilized at individual, social group, community, business, and at-large levels, respecting freedom to adjust response as appropriate based on risk tolerance. Providing helpful and valid information (and avoiding compulsory enforcement) tends to improve intrigue and decision-making of those who would otherwise rebel and reject authoritarian processes; especially when those “one size fits all” processes have no method of creating intelligent, situationally specific, solutions. Education and clear scientific evidence tend to engender optimal responses. Obfuscation, political agendas, and edicts often do not result in optimal responses. Please see Safety Protocols, and Staying Healthy, and Immunology.
Improved running totals data
Running totals of Hospital Admission, ICU Admission, Recovery, and Death should be provided at federal, state, and local levels and be broken down by severe case risk factors and be made accessible to the general public. This allows individuals and entities at every level to rapidly assess what health factors create higher risk for a severe case. This running totals data also helps to create intelligent, situationally specific, real-time, solutions.
Studies have shown that higher risk factors can include: Skilled Nursing Facility (SNF) residents, elderly with health issues, obesity, cardiac health conditions, etc. Improving running totals data can help best identify and shield people who are at high-risk for a serious case. In the case of COVID-19, the CDC didn’t begin providing significant co-morbidity information until late August 2020 and that data still lacks necessary precision. This created a large window of time in which it was not known what populations to strongly shield, resulting in more severe cases than may have otherwise occurred.
Minimizing the period of time that infection is spreading can reduce the probability that people at high-risk for severe case would become exposed. Attempting to “slow the spread” and “flatten the curve” LENGTHENS the period in which infection spreads. It does NOT stop infection progression. When protocols used to slow the spread are discontinued, the infection rate typically increases again. This has the effect of creating a NET INCREASE in severe cases because a new set of high risk older population has matriculated into the “high risk” category. In epidemics where there is a low fatality rate for people at low-risk for a severe case, it is often better to NOT “slow the spread”, but rather manage infection rates so that the population becomes immune with minimal illness and the virus spread halts, having no access to isolated higher-risk people.
A higher rate of infection reduces the period needed to keep the high-risk for severe case population isolated but does create a higher probability of infection for everyone not isolated. There is an optimum balance between “safety protocols”, “period of spread”, “case severity”, and “number of people infected”. An additional issue is that “safety protocols” tend to get tedious and cumbersome as the “period of spread” increases to many months or years, resulting in fatigue that creates holes in shielding efforts when people become weary of using “safety protocols” over long periods of time. Slowing the spread excessively can increase the chance of infecting those at high-risk for a severe case.
People at high-risk of serious cases should be protected / shielded with great care. Co-habitants and care-givers should take extra precautions and use more stringent safety protocols. General population use of masks in essential shared indoor areas such as grocery stores and other businesses helps to keep that indoor air / environments pristine and free of viruses so that care-givers are less likely to bring the virus into areas where they are present with those at high risk for a severe case. Better protocols at Skilled Nursing Facilities should include improved staff screening by locating PCR viral presence test equipment at every large SNF, training SNF staff to use it, and enabling small SNF staff to provide samples for test to dedicated SNF test facilities. Other improved protocols and information should be developed and shared among all SNF facilities through a hierarchical protocol management team that enables great ideas to ripple up and be posted to a daily blog monitored by all SNF facilities. Explicit daily secure moderated blog sharing by SNF’s would help rapidly share best-practices and localized incoming threats.
Rapidly develop a vaccine
This is one area where present efforts appear to be quite good. More information can be found here. The vaccine should be trialed more rapidly in areas of high-risk and be available for those who have a strong wish to enjoin a trial on a lottery basis. Vaccines can be particularly helpful for those at high-risk for a severe case. Those who do not wish to use a vaccine, as always, are subject to their own personal constitutionally granted freedoms. Dosing intervals and strategy should be optimized based on the epidemiological scenario, risk of various sub-populations such as elderly and others at high-risk, the sub-population having already recovered from natural infection, first dose efficacy against serious cases, etc.
Ensure availability of health care resources
Provide surge capacity via hospital ships and RV-based surge centers as was done in early stages of the outbreak. Running totals data can enable local authorities to notify the public of recommended local safety protocols, with the understanding that 100% compliance is not required. Every individual is better equipped to make appropriate personal decisions knowing things such as their general health status and risk for severe case level, whether they already recovered, and their personal approach to optimizing their health and the health of others around them. Improved running totals data helps inform those decisions.
An optimal solution would be attaining vaccine like immunity without significant symptoms when no vaccine is available. Studies have demonstrated that low viral load exposures caused people to develop increased immunity levels without becoming significantly sick – they “seroconverted while having minimal clinical illness and no shedding“. One natural method of potentially encountering small amounts of exposure is avoiding areas with high viral load exposure potential and frequenting areas of low viral load exposure potential. It has been shown that there are ways to control exposure level by controlling time spent in areas that may contain infected people such that one may control the risk of having an exposure that results in either no illness, minor illness, mild illness. and avoiding potentially severe illness while gaining commensurate potential immunity. Those at low-risk for a severe case may choose an approach that best fits their physiology. It is even possible to achieve graduated inoculation that results in strong sterilizing immunity with no illness.
It has been shown worldwide that COVID-19 cannot be halted by isolation measures even when drastic measures were taken that deeply damaged economic, social, and mental health. Based on antibody serology data and corrected information from various media sources, it has been shown that the vast majority of infections result in mild, flu-like, sicknesses or even almost imperceptible symptoms.
During the COVID-19 outbreak, personal liberty to determine situationally specific choices have been undermined with authoritarian edicts. These attempts to “slow the spread” can actually increase the probability of infection to individuals at high-risk of severe cases by LENGTHENING the period of the outbreak by slowing it. Attempting to isolate those who have already been infected and recovered can diminish their ability to serve as protective to “the herd” – isolating those who have recovered can reduce the strength and length of their immune response. Respecting people’s freedom to choose a personalized approach to infection control, particularly those at low-risk for severe-cases has many positive effects that also include reduced social conflict, improved physical, social, mental, and economic health, reduced crime, violence, and suicide rates, and improved overall outcome.
Improve treatment options and preventative measures
As immunity is being developed, it is best to use protocols that can minimize development of severe cases. Since it’s clear that exposure to high viral loads dramatically increase probability of a serious case, use of Safety Protocols in potential high viral load areas such as indoor settings can dramatically reduce the probability of severe cases. Use of improved early treatments that tend to minimize development of severe cases is also helpful. Better methods of capturing and sharing high value treatment information is highly important and can be integrated into improved running totals data.
Optimize immune system function across the population
Threats such as an epidemic can provide motivation to improve individual health, thus improving individual immune response. One or more of the health risks that increases the likelihood of a COVID-19 severe case is controllable through attention to personal health. This is a good time to do everything possible to improve personal health and well-being.
Also see Questions And Answers (FAQ).
It may also be valuable to observe the work of another group that has independently arrived at similar conclusions though at-present, the epidemiologic intervention described herein appears to be described in greater detail and with specific, executable, actions that seek to minimize clinical illness. While the approach herein may result in a degree of herd-immunity as Fauci opines is helpful, the focus herein is on minimizing clinical illness and symptoms while gaining immunity through vaccine or [near] asymptomatic variolation threshold level exposure.