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Friends have asked my thoughts about an op/ed in The Hill by Dr. Scott W. Atlas entitled, “The data is in – stop the panic and end the isolation” (and many articles like it). With more and more information coming out, the arguments on each side are becoming more and more sophisticated. 

Both camps, those who believe the safest option is to continue social distancing measures and those who feel that it is safe to open things up each point to more and more data to point to support their argument. I still lean towards the former camp, but I fully acknowledge that there are arguments for the latter. 

Many arguing to open things up base much of it on two things:

  1. those already infected and recovered are (most likely) immune
  2. most of the serious infections/deaths occurred among those with underlying conditions; therefore, those at lower risk (without the underlying conditions) are safe to return to work/normal lives.

First, how do we identify those who are immune? 

The answer, as many of us have been calling for, is widespread testing ability. We can’t rely on anyone who has been sick with a cold or influenza-like illness over the last two months, assuming that they had COVID-19 and are now immune. 

A majority of people with similar illnesses had one of the many less serious respiratory viral illnesses. We know this by the high proportion of people tested (because they met the criteria of being symptomatic) testing negative. So, we can’t assume we don’t need to re-test them. 

Despite being six weeks removed from promises of a Google map directing everyone to the nearest drive-through test site, those sites are few and far between. Limited testing supplies have so far limited widespread PCR testing, which identifies active disease. Immunologic testing, which tests for the presence of antibodies that indicates past infection, is just now starting to roll out. But again, supplies are nowhere near what would be required to do widespread testing to identify those who were infected and now are presumably immune. 

Further studies are needed to assess the accuracy of the tests, understanding the pattern of immunologic responses to this infection, and confirmation that all those previously infected are now immune. Each of those remains questionable, at least to a degree.

Getting ready to head into a room of a patient with suspected COVID-19 (test results pending).

Second, and I think most concerning, is the argument that only a small portion of the population is susceptible to severe illness/death. All we have to do is isolate and protect this small proportion of the population, and all of us “normal” people can get back to our lives. 

Proponents of this argument are quick to point out the overwhelming majority of those who die had an underlying illness. However, they fail to look at the fine print definition of underlying illness and what proportion of the population would meet that criteria. 

Those underlying conditions include…diabetes, lung disease, history of cancer, heart disease, high blood pressure, asthma, kidney disease, liver disease and obesity…in other words, at least half of the population. 

Look at your family…how many would be at risk due to one of these conditions? I can tell you from my family, both me and my wife, as well as one of our three kids. Sure, just having one probably only elevates your risk to a degree, having more of the underlying condition is probably worse than having only one. 

But you can’t have it both ways. You can’t brush off a guy who dies who was obese as “just someone who had an underlying condition” and, at the same time, say that most of us can get back to work because we feel we are low risk. And let’s say even if we let the approximately 1/3 of people who are in excellent health go back, you would have to double down on the isolation of the 2/3 with underlying conditions because now more people are free to spread it around.

There are no easy answers. There is data to support the argument that we can open things up, and there is data that supports keeping restrictions in place. Anyone who only presents one side, cherry-picking their data, and insisting they have the answer is naive. I don’t have the answers, and I don’t know for sure if keeping restrictions is best, I don’t know for sure if it is safe to open things up, but I do know that anyone who says they have the answer and knows for sure is naive. 

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