Introducing The Proximity Solution: A Strategy to Win the COVID-19 War
A 3-Step Solution to Save Lives, Help Hospitals Cope, and Restart the Economy
- The COVID-19 pandemic is spreading rapidly and devastating people, healthcare systems, and economies across the globe.
- To slow the virus’ spread and enable health care systems to cope, governments around the world have issued Stay-At-Home orders.
- Stay-At-Home orders will slow the spread of the virus, but what happens when they are lifted? We will likely have subsequent flareups that necessitate further lockdowns.
- With everyone staying at home, the global economy has come to a grinding halt. The world has never experienced a global economic freeze of this magnitude.
- Staying at home is not a viable long-term solution, but it buys us time. We need to use this time wisely and put in place a viable solution for winning the war against COVID-19.
- This article introduces ’The Proximity Solution’ — a strategy designed to win the war against the virus by saving lives, helping hospitals cope, and restarting the economy.
Why Stay-At-Home is not a viable long-term solution?
The Immediate Health Care Crisis
With huge numbers of people infected and suffering from COVID-19, many hospitals lack the required capacity to treat the critically ill. All critically ill COVID-19 sufferers require hospitalization, with the most critical needing to be admitted to an ICU and some requiring ventilators. Hospital space, ICU space, and ventilators are in short supply in areas that have been badly ravaged by the pandemic. In the worst cases, people may have to be turned away at overcrowded hospitals, increasing the virus’ fatality rate by killing people who might otherwise be saved.
Why the Stay-At-Home solution might not even work
The primary purpose of Stay-At-Home is to slow or stop the spread of the virus and allow health care systems to cope. Slowing the spread will “flatten the curve” by limiting infections and freeing up healthcare capacity and resources for those who require hospitalization.
The expectation is that if everyone stays at home for the next several months, we will minimize COVID-19 infections and deaths. However, allowing people to return to their normal routines will quickly result in the virus flaring back up which may require subsequent lockdowns. This scenario is already playing out in several countries in Asia.
The Emerging Global Economic Crisis
When people stay at home, consumption of goods and services plummets. Everyone stops traveling, going out to restaurants, shopping at stores, and buying automobiles. Consumer consumption is 70% of GDP, meaning the bulk of the world economy evaporates with consumers staying home.
In order for Stay-At-Home to be effective, it needs to be in place for several months, with some experts estimating 6 months or even a year. Meanwhile, the economic damage from the lockdown deepens with each passing week. Tens of millions of people are losing their jobs. Many businesses will close their doors. Banking systems may fail. Oxfam is predicting that the coronavirus could plunge half a billion people into poverty. The world has never experienced a global economic freeze of this magnitude.
Fear as a Blunt Tool
Our governments, media, and communities use fear to enforce Stay-At-Home orders. In order to maintain lockdowns, everyone must be fearful of the virus. But to keep it in place, we are dependent on “essential” workers who keep our supply chains of food and other necessary products operating. Already, these workers are protesting and sometimes refusing to work.
Fear also compromises our immune systems and will result in many more people becoming critically ill when infected. People who are sick with COVID-19 often develop shortness of breath. Fear of dying makes this symptom even worse; scared people panic when infected and need to be hospitalized far more often.
Stay-At-Home is a short-term solution
With each passing month, as essential workers become more fearful of working and as the pressure of a stalled economy builds up, it will become increasingly challenging to maintain Stay-At-Home orders. It is not a viable path to winning the war. Staying at home does, however, buy us time. We need to use this time wisely and formulate a viable solution capable of saving lives, helping hospitals cope, and restarting the economy.
Coming up with a viable solution to win the war
Fighting any war effectively requires intelligence on the enemy. We need to answer the following questions:
- Who is most at risk from dying from this virus?
- Should everyone be fearful of this virus?
- Who is likely to need hospitalization and/or be admitted to an ICU?
- What percentage of the population will need hospitalization?
And, to come up with a viable solution
- Are there alternate ways to significantly reduce the number of people that need to be hospitalized?
- Can we save more lives than we would with Stay-At-Home?
- Can we come up with a solution that does all three: save lives, help our hospitals cope, and restart the economy?
Know Your Enemy
Impact on people with and without existing conditions
Based on a study of 481 deaths in Italy, 99% of deaths occurred in people with chronic conditions like heart disease, lung disease, and diabetes. The majority of people dying from COVID-19 are older than 65 years old, but even when people who are younger succumb to the virus, they typically have one or more chronic existing conditions.
New York State provides up-to-date demographic data on all COVID-19 fatalities. If we assume that all age groups are equally likely to have been infected by the virus, and the virus has an overall fatality rate of 1%, we can calculate the relative fatality rate of each age group. Unlike Italy, where 99% of fatalities have one or more chronic existing conditions, the New York State data indicates this number to be around 90%. If we assume the remaining 10% of fatalities have no chronic condition, we can calculate the fatality rate for people in each age group with no chronic conditions.
The common flu has a fatality rate of 0.1% across all ages, but its impact is greater for infants and increases with age. Excluding infants (who appear to be spared by COVID-19), the fatality rate of this virus by age for people with no chronic conditions is very similar to that of the common flu.
The takeaways from this information are clear:
- The segment most at risk consists of people of any age with one or more chronic conditions.
- The remaining people of all ages not currently suffering from chronic conditions face a fatality rate similar to that of the flu and should not fear COVID-19.
It is true that some young, healthy people have died from COVID-19 even without chronic conditions. However, young people also die of the flu. The fatality rates of COVID-19 and the flu are similar for young, healthy people, but the differences are perception and fear. We don’t read stories about young people who die from the flu. On the other hand, the media loves to report stories of young people who die from the coronavirus; these stories help with scaring everyone into complying with Stay-At-Home orders.
Finding those most impacted within those that have chronic conditions
In the US, out of a population of 330 million people, about 130 million have at least one chronic condition. However, even within this population, people have a different number of conditions with different levels of severity.
Based on the data from Italy, people with 2+ chronic conditions made up 75% of the fatalities.
It should be fairly straightforward to build a predictive model that uses a person’s age, the number of conditions, the type and severity of each condition, and then determine the probability that this person would succumb to this virus. This model would help determine the top 10%-20% of people with conditions to be most likely to succumb to the virus. This CDC report shows how many people have 1, 2 or 3+ conditions.
Who is being hospitalized and who needs to be admitted to ICUs?
In addition to understanding the make-up of the at-risk population, it is also important to understand the characteristics of two more groups: those who require hospitalization and those who need to be admitted to ICUs. This CDC report provides some data on hospitalizations.
People with chronic conditions make up 76% of the total hospitalizations and 80% of those requiring an ICU. This means that if we keep the people who have chronic conditions from getting infected, the load on our hospitals will be reduced significantly.
The same report indicates that when people without existing conditions are infected with COVID-19, roughly 20% require hospitalization and 3% require an ICU. As the totality of reported cases do not account for everyone infected but not tested, these numbers are likely smaller when accounting for the whole population. In the US, people with no chronic conditions make up about 200 million people, and if 10% or 20 million require hospitalization, our hospitals would not be able to cope with this kind of surge at once.
What this intelligence tells us
- The segment most at risk consists of people of any age with one or more chronic conditions. Within this population, we can determine who has the highest risk. If we protect the highest risk people, we save lives and keep them from overloading our hospitals.
- The remaining people of all ages not currently suffering from chronic conditions face a fatality rate similar to that of the flu and should not fear COVID-19. However, a large percentage (potentially 10%) may need hospitalization. We will need a solution to keep them from over burdening our hospitals.
- As we transition out of Stay-At-Home, lack of fear will help the group of people with little risk to seamlessly return to their normal routine and become part of the solution. If and when this group contracts the virus, they need to fight it with confidence, knowing they are highly unlikely to die.
A Viable Solution: ‘The Proximity Solution’
‘The Proximity Solution’ is a 3-step plan to win the war against the virus by saving lives, helping hospitals cope, and restarting the economy.
PR-OX-IM-ity: Protect-Oxygen-Immunity
- PROTECT the at-risk population: The first step to saving lives and helping our hospitals cope is to protect the people most at risk of dying. Every high-risk person who is protected reduces the burden on our healthcare system and is potentially a life saved.
- OXYGEN Home Delivery: As a significant percentage of the low-risk population needs hospitalization, the second step is to put in place an Oxygen Home Delivery system that significantly reduces the number of people that need to be hospitalized.
- IMMUNITY for the rest of the population: With the first two steps in place, the final step is to allow the rest of the population to resume their normal routines and develop immunity.
1. Protect the at-risk population
90% of the people dying from COVID-19 suffer from chronic conditions. When these people get infected, they have a higher chance of dying, but also a disproportionately high chance of suffering from severe respiratory issues and requiring hospitalization — potentially including critical care and ventilators.
We must proactively isolate and protect the group most susceptible to dying from COVID-19 by placing them in a Protective Quarantine. While Quarantine applies to sick people, Protective Quarantine applies to high-risk people who have not yet been infected. Ideally, we can protect them until we have developed a vaccine. Once developed, this high-risk group should be the first to receive the vaccine. Every high-risk person who is protected reduces the burden on our healthcare system and is potentially a life saved.
Protective Quarantine for high-risk individuals can occur in their homes. Isolated people should stay in their own rooms with the goal of reducing risk of transmission from other members of their household. It will require that all members of the household be disciplined to prevent infection of the high-risk individual. As people can transmit the virus without showing any symptoms and it can be transmitted through the air, it is important that all members always wear masks in the house.
A preferable approach would include communities and governments assisting in quarantining high-risk individuals in specially protected hotels or nursing homes.
2. Oxygen Home Delivery
Even with the high-risk population under Protective Quarantine, a large percentage of the rest of the population without any chronic conditions may also develop respiratory issues, possibly requiring hospitalization and ventilators in ICUs.
Currently, when someone is infected, they call their health care provider to report their symptoms. With mild symptoms, they are instructed to stay at home and recover. However, if severe breathing difficulty is reported, people are instructed to visit a hospital. Once they are admitted, they are given oxygen to facilitate breathing.
Most of these people recover after several days, but the hospital is not the best environment to speed up recovery. In the hospital, patients are confined to a bed and have to recover alone, as no family members are allowed to accompany them. And simply being in the hospital makes them much more fearful of dying, which negatively impacts their ability to recover quickly.
Fortunately, there is a solution that will aide those with severe breathing problems without overburdening hospitals. In the last 20 years, portable oxygen concentrators have enabled people with breathing difficulties to receive oxygen at home. These portable machines run on electricity and extract nitrogen out of air to produce concentrated oxygen gas.
Instead of sending patients who develop severe breathing issues to the hospital, portable oxygen concentrators can be proactively delivered to the homes of those who need them to help relieve breathing issues. High-risk patients would be provided oxygen concentrators as soon as they develop symptoms. As soon as they experience shortness of breath, they could immediately use the oxygen concentrators to alleviate any challenges in breathing. With early intervention and the comfort provided by staying at home with their families, the ill may have a higher chance of recovering.
Patients with no chronic conditions would be provided oxygen concentrator machines only when they first develop breathing issues. The majority of these low-risk patients will likely recover on their own at home after a couple days. Without unnecessary fear of dying, their recovery should be even faster. Of course, individuals with severe breathing issues that persist even after receiving oxygen at home would still need to visit a hospital.
Portable oxygen concentrator machines cost between $500 and $2500. All these machines are designed for home use and are much easier to manufacture than ventilators.
A delivery network would have to be implemented to deliver machines to those who need them. After recovery, machines would be picked up and delivered to others who need them. Here, too, we need people who are not fearful of contracting the virus to assist with delivery and picking up of the machines. Machines could be moved around to different communities and cities based on which areas have the greatest need.
3. Immunity for the Rest of the Population
With the first two steps in place, the final step is to allow the rest of the population to resume their normal routines. The combination of protecting the people most at risk and allowing the remaining population to receive oxygen at home is the fastest way to flatten the curve and allow our hospitals to cope better by handling only the most critical cases. It is important to appreciate, however, that we cannot remove Stay-At-Home orders without implementing the first two steps.
With the Protective Quarantine and Oxygen Delivery steps in place, it won’t be necessary to continue social distancing. Actually, the objective will be to have most of the low-risk individuals catch the virus and become immune in a span of a few months. People who live in households with high-risk individuals, however, will need to continue to take extra precautions.
Local Proximity
The Proximity Solution can be applied locally and independently by each community, and does not require coordination with other communities, states, or countries.
It needs to be driven at the local or community level and will need each community to identify and protect their high-risk population and put in the network to deliver portable oxygen concentrators to homes. Once these are in place, the rest of the community can resume their normal routines and develop immunity to the virus.
Once a community successfully wins the war against the virus, other communities will have the confidence to follow. The Proximity Solution can be applied by a single community, village, college, or city. It is a solution that can work for all countries, regardless of wealth or other circumstances.
Stay-At-Home is a top-down solution for immediately slowing the spread of the virus, but it is not a long-term viable solution to winning the war. It might be that the only viable solution is a bottoms-up solution and implementing such a solution will be the difference between communities that beat the virus and have their economies thrive and those that beat the virus at the cost of destroying their economies.
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