by James A. Bacon
We can all be thankful that Governor Ralph Northam has ended the ban on elective medical procedures. At least one sector of Virginia’s economy, healthcare, can start the struggle back to normalcy. Hopefully, hospitals will staunch losses that have ran up to $200 million or more, 30,000 furloughed and laid-off healthcare practitioners will get back to work, and thousands of Virginians will receive long-delayed medical treatment.
The question now: What next?
The restoration of normalcy will take months. President Trump, Governor Northam and governors of most other states have suggested that the process will unfold in phases as the COVID-19 epidemic recedes. But many details have yet to be worked out. In the days ahead I hope to explore the what-next question in a series of posts that articulate logical principles that should drive the Governor’s decision-making.
The first principle is this: Public action should focus on protecting the most medically vulnerable members of society while allowing the least medically vulnerable to return to normal life and work as quickly as possible.
While there is still much left to understand about the COVID-19 virus, there is broad consensus in one area: Mortality rates are highest among the elderly; and among those with medical risk conditions such as asthma, diabetes, and heart disease. While the disease can strike anyone of any age, the risk of dying for an otherwise healthy 21-year-old patient is orders of magnitude lower than the risk for an unhealthy 71-year-old patient.
It makes no sense whatsoever to apply the same blanket shutdown to people of all ages and health conditions equally. Such an approach is immensely destructive to the economy, with all the indirect health effects that entails, while contributing only marginally to the reduction of virus-related fatalities.
Virginia public policy should encourage healthy young people to go back to work. I will lay out a conceptual approach of one way to do this, fully cognizant of the administrative challenges that would need to be hammered out. The first step is to agree on the idea, then we can agonize over the details.
The core idea is to create COVID-19 risk classifications based on age, the existence of health conditions, and previous exposure to the virus. If you’re 21 years old and have no health-risk conditions, you fall into the Low Risk classification. If you’ve recovered from COVID-19 and tests indicate the presence of antibodies in your blood, you fall into the Low Risk classification. If you’re 90 years old and have emphysema, you fall into the High Risk classification. If you’re 55 years old and healthy, you might fall into the Medium Risk classification. If you’re 30 years old and have diabetes, you might fall into the Medium Risk classification. I’ll leave it up to the medical practitioners and actuaries how to set up a classification system.
If you’re classified as Low Risk, you should be free to undertake a wider variety of activities under the assumption that if you contract the disease, the chances of dying, while not zero, are very low. Indeed, we should consider it a good thing for young people to get infected and then recover. It is sound public policy goal to build up herd immunity in the least medically vulnerable segment of society. Once 60% or more of the population has developed resistance to the disease, the ability of the virus to propagate itself plummets.
As we allow greater freedom for Low Risk members of the population, however, we need to redouble our efforts to protect the High Risk members. COVID-19 is most likely to spread in intimate family environments. If three generations are living under the same roof, there is a risk that Junior could contract the virus at his barista job (despite the sanitary measures in place), bring it home, and infect grandma.
Perhaps a greater fear is that if more members of the general population are walking around asymptomatic with the disease, it will be easier for the virus to infiltrate a nursing home, where it can run wild. We have seen the disastrous consequences at Canterbury Rehabilitation in Henrico County, where nearly 50 people have died.
Under a demographic risk approach to fighting COVID-19, the state would focus its resources — temperature checks, testing of patients and employees, contact tracing, social distancing mandates, and restrictions on who can enter the facility — on nursing homes, assisted living facilities and other locations where the elderly are sequestered in close proximity. (A second priority would be to apply resources to jails and prisons, where the disease has the potential to run rampant, though, perhaps with less devastating consequences.)
Any program of this nature would have to be accompanied by a public education campaign aimed at healthy young people that says, “Hey, healthy young people, we’re giving you more freedom, but freedom is not license. Think of the vulnerable people around you. You still need to abide by sanitary and social-distancing practices.”
Such an approach entails risks. But every approach has risks, including the measures currently in place. But we can’t let an unremitting focus on COVID-19 mortality destroy the economy, ruin lives, and undermine the long-term ability of our healthcare system, dependent as it is upon revenues generated by a functioning economy, to save lives.
