Tuesday, March 17, 2020

COVID-19 and the Birthday Party Model

I have long believed that the real reason kids have birthday parties is so that they can trade microbes. When else do we let strangers blow on our food? We let kids share microbes so that they will develop herd immunity. The contagion is contained because the kids' parents are largely immune to the bugs kids bring home. Not all of them, but enough of them for the birthday "system" to be a net plus.

COVID-19 differs from other diseases that are milder in childhood in one important way: adults are not immune to it. But that does not seem to me to rule out allowing young, healthy people, including otherwise healthy pre-senior adults (aka parents of school children) to contract and purge the disease as a way to create herd immunity. Instead of the total social distancing we are practicing, we should only be isolating high-risk populations. The rest of us should be getting on with our lives.

I also wonder how the economic effects of social distancing affect death from all causes. We don’t have universal healthcare, and, even if we adopted it tomorrow, one may expect that the economic dislocations of businesses shutting down will cause an increase in homelessness and death by other causes, including fear of emergency rooms.

My guess is that history will record that we over-reacted to this bug, not in the sense that we worried too much about it, but in that our response was insufficiently nuanced. The social distancing will last much longer than necessary because herd immunity will not be achieved until nearly everyone’s been vaccinated (as with smallpox in its day). We will look back and realize that we could have done more by doing less.

[Update: The herd immunity method was tried in the UK, but data suggested that the hospital system could not handle the surge of severe cases. A policy of case and family quarantine plus social distancing of high-risk populations might in fact reduce total cases, the so-called "area under the curve," but hospital beds create as constraint outside the simple epidemiological math.]

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