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The Way Ahead on Dealing with COVID-19

I am not a medical professional. However, my background has involved extensive training and experience in crisis management. Speaking from that perspective, I would like to share my observations regarding forward dealings with our most recent crisis, that of COVID-19. My comments are not meant to be critical of our approach thus far. I have largely supported our National, State and Local responses to the virus. We knew little about the virus when we began this journey except that the potential deadly effects were very significant. We now know a great deal more about the virus, how it transmits, how deadly it is and to whom, and how various strategies enacted across our globe have worked out. These comments are an attempt to define a better path forward using our increased knowledge.

While recognizing that the health and welfare of everyone is important, there are two demographics of special concern to me, and which I believe deserve particular focus in our dealing with COVID-19. The first is the medically vulnerable: those at particular risk of complication and death from the virus. We know this to be those persons with underlying medical conditions and the elderly. These individuals require information and resources adequate to protect themselves from the illness, but also to provide the dignity and lifestyle necessary to continue in good health. The second group is one which many might argue deserves our greatest consideration, but which has been the most overlooked under current policies, and that is our youth. Although relatively spared from the more serious effects of viral infection, the initial measures implemented to control the virus have had an adverse impact on the health of our youth. Human social interaction, especially with age-peer groups, is vital to the emotional, mental, and physical wellbeing of children. And while a year or two of altered living is a small fraction of the total life experience for an adult, that same time frame in the life of a youth can significantly impact development into adulthood. Taking care to provide a near-normal social and educational experience for our youth is of paramount importance. Every week that we keep our youth from that setting is another week denying them the human interaction that is critical for personal development.

In order to comprehensively address the public health needs of our community as a whole, any strategy that we put into place to deal with this threat must not only provide protection for our highest risk groups, but must do so with minimal unintended harms. As a consequence of current infection control policies, depression and suicide are up, especially in our youth. Youth runaways are up. Alcohol consumption and drug use are up. Domestic violence is up. Diagnosis of potentially fatal conditions such as cancer and heart disease are down – not because they are less prevalent – but because access to routine medical services is limited by the COVID-19 response. All of these will invariably result in more and earlier deaths. While original infectious disease control measures had the effect of sacrificing these matters, it is now time to start taking them into formal consideration in our policy decisions.

Projections about the extended duration of this virus require us to review our approaches to provision of public health. Public health is not just epidemiology and disease management. Social, mental, emotional, and other aspects of physical health all contribute to the overall health of a community. I do not believe that we can long endure our current approach to combating this virus. As such, a two-pronged approach is urgently needed. First, we need to provide the resources to allow protection of our most vulnerable from the deadly aspects of this virus. These resources should provide a protective cocoon of services such that, when indicated, needs can be met without the risk of venturing out. Second, we need a return to near normalcy. This is especially vital for our youth. We need to get our children back into their educational, recreational, and social environments as soon as possible. Parents need to be able to work, and childcare services need to be available.

The original stated purpose of the lockdowns, which continue today some four months later, was to “flatten the curve”. That is, to spread transmission of the disease to prevent overwhelming our health care capacity. It was never to eliminate the spread of the disease, or even to lessen the number of people who would ultimately contract the virus. We have largely accomplished that measure, and it is now time to step back, re-evaluate and adjust policy to accommodate the long view of disease management. Lock down, open up, lock down, open up is not a strategy our society or our economy can sustain. The future of our children and the future of our society requires us to do better.

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