When Donald Rumsfeld, then Secretary for Defense, introduced the idea of “known unknowns” when appearing before a Senate committee in 2002, he was referring to weapons of mass destruction. WMD proved to be largely fictitious.
In 2020 COVID-19 has been described as an aimless weapon of mass destruction in a worldwide war where the enemy is a mindless virus. Unlike the WMD of 2002, the power of COVID-19 in 2020 is not a fiction, it is a FACT.
Since COVID-19 was first detected in the US on January 20th it has spread to nearly 870,000 people in the USA. Of these, over 50,000 are reported to have died as a result of viral infection (April 25th). The global equivalents are over 2.5 million infections and 180,000-200,000 fatalities.
The spread of COVID-19 has been slowed by various measures, of which the most impactful is ‘staying home’. This is closely followed by (six feet) ‘social distancing’. It follows that relaxing these constraints would allow the unhindered spread of the virus.
Before we consider the possible consequences of a change in strategy, let us look more deeply into what Rumsfeld was saying about forming opinions, making judgments, and implementing decisions.
He went on to explain that there are some things we know, proven facts, and some things we know that we don’t know, the known unknowns. His third category was reserved for the possibilities we haven’t even considered, the unknown unknowns.
Most of the research into the COVID-19 pandemic is conducted in cross-disciplinary teams. The real strength of such groups is the opportunity to share ideas and knowledge, in other words, to minimize the number of unknown knowns. It reduces the energy wasted in trying to solve problems to which some, but not all, already know the answer!
Covid-19, which has claimed more than 2 million lives across the world, affects the lungs and airways.
COVID-19 Symptoms can be flu-like, including fever, coughing and sore throat, while some people may not experience symptoms but still have the transmissible virus.
In the worst cases, the virus causes pneumonia that can ultimately lead to death.
It is thought that the virus is spread primarily through respiratory droplets produced when an infected person coughs or sneezes.
Scientists around the world are trying to understand exactly how the virus spreads, to help prevent transmission and develop a vaccine.
The disease is extremely infectious, more so than common flu but in most cases (up to 80%) there are only mild symptoms.
We can test to find out if someone is infected (at the time of the test). These tests increasingly indicate that the rate of infection is higher than previously reported. It sounds like bad news BUT it suggests that the fatality rate (the percentage of deaths compared with the number of infections) is lower than the rate on which epidemiologists have based their lockdown recommendations. More of this later!
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The above are some of the known knowns
Some of the unknowns of COVID-19 are:
Not knowing why some people are affected more than others, especially seniors and/or those who suffer from underlying conditions. How can we protect our seniors AND free our younger earners to re-enter the economy?
We do not know whether those who have recovered from a COVID-19 infection are immune nor if they are, for how long. We cannot reliably test that an ostensibly recovered patient has actually had the infection.
We do not know of a vaccine that will protect us from infection nor can we reliably predict when one will be available. The same applies to a COVID-19 specific anti-viral drug.
In common with almost every other nation (in varying degrees) the USA has introduced lockdown measures to slow or limit the spread of COVID-19 within its borders. A further consideration is that we do not know how many lives have been saved as a result of the measures the Administration has taken.
It is true that thus far the medical and epidemiological forecasts have erred in favor of caution but as the volume of data grows, so does the reliability and quality of the evidence offered to our politicians (and the ability to justify the needs of minorities groups).
As we gain more knowledge of how the virus works, we are realizing that many of our assumptions were wrong or their implications exaggerated. For instance, data from New York suggest that less than 0.5% of the total number of people dying from COVID-19 are under the age of 44. Similar figures are reported from ITALY. Together they suggest that the effect on the working population as a whole is minuscule.
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Early assumptions, on which most of the current ‘defense strategy’ is based, were that the pandemic was more deadly and less common than later studies (including random anti-body tests) are showing to be true.
In fact, reports from Stanford, LA, Boston (Mass.), and New York indicate that the prevalence of the disease is at least 10x and possibly 30+x greater than predicted. The majority of cases detected are ‘asymptomatic’ – that is, the infected individual neither experiences nor displays any symptoms. In other words, the disease is more widely spread than anticipated but IS less deadly.
It is time to reconsider the regulations, the ‘lockdown’, which currently governs our domestic, social, and commercial activities. The Administration has delegated (conceded?) the right of individual states or regions to determine the level and timing of their relaxation to meet their local needs. Clearly the President acknowledges that the needs of Maine are not the needs of Washington, the population of California does not have the same demographic profile as New Mexico.
Purely on a statistical basis New York is the most significantly affected state and has one of the most diverse populations.
“No plan survives the first contact with the enemy” (Dwight D Eisenhower, et al).to which Tim Harford, English writer and economist, adds “what matters is how quickly the leader[s] is[are] able to adapt”.
The initial COVID-19 defense strategy, based on the evidence then available, was to slow the rate of spread so that there would be sufficient trained staff and facilities to manage any peaks in demand from infected individuals for critical care. This so-called ‘flattening of the curve’ was based on the assumption that, within reasonable limits, the population at large would be equally susceptible to the COVID-19 virus. Consequently, all age groups were treated in the same way. Additionally, the number of infections was under-estimated (see before).
Changes in our understanding of the impact of the pandemic suggest the original strategy should be changed based on our greater knowledge of how the virus behaves.
“This virus is an enemy that the entire country underestimated from day one and we have paid the price dearly”. (Andrew Cuomo)
In the words of Donald Rumsfeld, we have increased the known knowns and reduced the known unknowns.
The growing weight of evidence is that the virus is infective in the way that seasonal ‘flu is infective but has little effect on the vast majority of younger people (under 45) and those under 60 with no underlying conditions. Only a very small percentage of individuals in these categories are likely to require hospitalization. The capacity and resources that have been built up will be available for those who really need them, the elderly and those needing elective and emergency care for cancer, heart conditions and other respiratory conditions.
The current lockdown regulations prohibit from working those whose job is not classified as essential. The result is that at the end of April there are almost 30 million people registering as unemployed. It should be clear that this impacts individuals and the nation: individuals through the loss of income and increasingly from loss of job satisfaction; the nation from loss of productive output and the drain on government resources through benefit payments.
We should expect State Governors to create a regulatory framework in which young people can go back to work and allow the virus to circulate among them. We must accept that a small percentage will require hospitalization but the vast majority will need only self-isolation and restrained contact with seniors and other vulnerable individuals. Apart from the obvious contribution to the economy, these individuals will acquire a level of immunity which will create natural barriers to the uninhibited spread of the pandemic. This is known as creating ‘herd immunity’ for the country. A word of warning: it is not clear how long acquired immunity will last.
Herd immunity is the natural way to contain the spread of both infectious and contagious diseases but it places a special responsibility on the community to protect and care for those who do not have the benefit of natural immunity, for example, the elderly, particularly those in care, and individuals with suppressed immune systems.
For the foreseeable future, we should recognize that the greatest contribution we can make to containing the pandemic is to: –
- Observe social distancing (six feet)
- Maintain high standards of hygiene (esp. handwashing)
- Isolate if symptomatic
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A ‘one size fits all’ lockdown approach has put 30 million people on unemployment benefits. State governors have the opportunity to introduce regulations which give younger Americans the freedom to contribute to a national economy which can support the needs of the less fortunate few.