How to Defeat COVID19 with a Hybrid Strategy

About four week ago, when cases in the state and in our county were dropping steadily, I wrote an article about the two competing strategies for dealing with an epidemic. I called one the “stop-the-spread-at-all-costs model” and the other one the “herd-immunity” model.

For simplicity’s sake we can call the former the “shutdown” model and the latter the “Sweden” model – given that Sweden, alone of all the industrialized nations, chose to protect only the elderly and vulnerable and allow everyone else to continue working and interacting with only protective gear and minimal testing.

In Miami, we adopted the shutdown model, restricting everyone except essential workers to their homes, which halted the spread of the virus but also brought the economy to a rather dangerous halt, particularly among leisure industry workers – who just happen to be the least paid, with the least security and benefits. (In other words, the most vulnerable.)

In order to analyze the effect of what is now somewhat of a hybrid model in which we continue to protect the elderly and infirm, while allowing essentially open commerce and industry, I divide our county’s population in four more or less equal groups.

1. Amounting to approximately 700,000 persons, or 25% of the population are the elementary, secondary and college students. Together with teachers and administrators they have all been absent from campus and experiencing no contact whatsoever. Little contagion has occurred and almost zero mortality.

2. Another 700,000 people are seniors, who have been either confined to nursing homes and long-term care facilities, or consigned to their homes. The ones living in nursing homes and other multi-person facilities will continue being sheltered, subject to all kinds of government regulations as well as privately imposed best practices. The ones living in private residences are also quite sheltered, even without anyone telling them to remain so. (I know of family members who have not left their tiny in-law quarters for three months, and don’t plan to until they hear the “all clear.”)

3. A huge percentage of the office workers are working out of their homes, or furloughed from health care facilities, law firms, banks, non-essential government jobs, and retail businesses that are only half open. They also constitute about a quarter of the entire population of Miami-Dade County. In other words, about 700,000 out of the 2.8 million residents.

4. Last but not least we have the workforce that needs to be on site, including construction and agriculture, and the young and middle age people who gather to demonstrate or recreate and who cater to restaurants, gyms, hair salons, and every other kind of service in which there is some contact between worker and customer. This last group is the one now hardest hit by COVID19 contagion; note, in that regard, that the median age of those infected in recent weeks is 37 in Florida and 41 in our county.

This fourth category has scared all of us in government, because the rate of confirmed cases to tests administered has climbed as high as 19% and stayed in double digits for the entire period in which we have been testing at about 50,000/day clip in Florida. Those rates of contagion were reached in places like New York, and they were accompanied by as many as 3,000 deaths per day.

Yet the mortality rate in Florida, which is more populous than New York, has continued to level off at about 25-30 per day statewide. The number of those hospitalized has increased somewhat, but those in I.C.U. remain manageable and our public health system has enough available beds (over 20%) to handle a critical increase, even though elective surgeries and other diagnostics, which were canceled for close to three months, are still being performed.

So we have a different kind of epidemic, affecting a narrower or more self-selected population, composed mostly of young people and service employees. And, within that population, we are emulating the Sweden model of herd-immunity.

There are also indications that the current virus is either weaker than the original, affects much younger people with better immune systems, or that we have improved our treatment modes to lower its effects. Most likely it’s a combination of all three.

Two big questions remain.

One is whether there will be a critical spike in the number of deaths and critically ill patients, which will tax our public and private health resources. On this question, the experts are all over the place, with some saying we have to wait 14 days from the initial spike and others saying twice as long. In either case, we will soon have the empirical data. In the meantime, we have to keep an eye on bed availability.

The other imponderable is how exactly to manage the start of elementary education, when 350,000 students and almost 50,000 teachers and school board employees will presumably start the fall semester. (College students, one suspects, will probably experience mostly off-campus, electronic lectures for at least a month or two of the fall semester.)

Luckily, we have an able superintendent and highly professional schoolboard, as well as a very responsible private school system, plus excellent college and university presidents, who will not take unnecessary risks to make a profit.