Proposal For Data-Driven COVID-19 Public Policy Decision Making This is an open proposal to Government leaders from a concerned American citizen, engineer, businessman, and family man. I believe it is now critical to start honest, open, and fact-based discussions about our handling of the COVID-19 crisis in the USA. We should try to follow a logical progression of decision making when defining public policy in response to such a crisis. Like with any problem-solving methodology, it is imperative to truly define the problem we are trying to solve before defining solutions. I have read and heard that the problem is that the disease is extremely contagious, so we need to stop the spread of it. I contend that the level of contagiousness is not THE problem. If there were no fatalities from this new virus, I believe there would be no intrusive or unprecedented reaction by the world authorities or the public. We would take basic care to avoid getting sick and although the suffering and health concerns would be significant, I believe the reaction would be similar to the ones from the last 100 years.1 Another problem often referenced is related to overwhelming the health systems due to the peak load on providers. For example, on March 11, 2020, the Los Angeles Times reported that, “The goal is no longer to prevent the virus from spreading freely from person to person, as it was in the outbreak’s early days. Instead, the objective is to spread out the inevitable infections so that the healthcare system isn’t overwhelmed with patients.” This objective is often referred to as, “flattening the curve.” It is clearly an important factor in policy making, including decisions about “hot spot lockdowns.” However, even after the curve has flattened in many locations, the concerns remain to an extraordinary and unprecedented degree. Examples can be seen in multiple states where lockdown Governor orders are extended. I see the primary problem as one of mortality. Almost every reference to COVID-19 starts by referencing the high mortality rate such as this one from Healthkleadersmedia.com, “Study Shows COVID-19 Body Count 20 Times Higher Than Seasonal Flu Deaths.” There is, of course, lots of discussion and reporting about the difference between the seasonal Flu and COVID0- 19, but for the sake of logical thinking, I believe everyone needs to stipulate that we can make a simple and clear primary problem statement as follows: COVID-19 results in excess loss of life at an unacceptable rate and quantity. I contend that this statement is appropriate because we as an American society have not stopped or severely curtailed our way of life as a result of a pandemic for more than 100 years. The H1N1 virus (Spanish Flu) pandemic that killed more than 600,000 Americans and more than 50 million people worldwide was the last time that similar severe restrictions were imposed in the US. Even those restrictions were comparatively limited in many states.2 Of course, no level of fatality should be taken lightly, but disease, accidents and the resulting mortality are a fact of our lives as humans. There needs to be something profoundly out of the ordinary and well beyond our daily experience to trigger such extensive measures as shutting down entire economies. The extraordinary level of fatalities related to COVID 19 leads to the concept of, “excess deaths.” Per the CDC3, “Excess deaths are typically defined as the difference between the observed numbers of deaths in specific time periods and expected numbers of deaths in the same time periods.” So, if we stipulate that the primary problem is excess loss of life at an unacceptable rate and quantity, then the solutions should be based on solving that problem first. Other discussed COVID-19 problems, such as steep hospitalization curves, suffering even without fatality, and virulent contagiousness can all be addressed without the economic devastation from lockdowns and other draconian measures. We hear a lot about following the science but any pragmatic, logical thinker knows that science is the foundation of decision making and not the process for it. There is clearly limited science related to the new coronavirus but it can and should be a basis for developing a strategy to cope with this new viral reality. As I understand the science (studies) most of them are focused on modes of transmission, therapeutics, and the effects of preventive measures on transmission. Science related or data- driven discussions related to directly addressing the primary problem, as defined above, are scant. For example, they are not yet peer-reviewed but many of the experiments show that the virus can transmit via droplets suspended in the air after expulsion from a sneeze, cough, or even from loud talking. The World Health Organization (WHO) continues to recommend social distancing of 1 meter4 and the USA Centers for Disease Control and Prevention (CDC) recommends maintaining six feet distancing,5 (approximately 2 meters) “if possible.” Recent studies referenced by the CDC also state that, “It may be possible that a person can get COVID- 19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or eyes. However, this is not thought to be the main way the virus spreads.”6 The CDC recommends that7, “Everyone should wear a cloth face cover when they have to go out in public…” and the WHO recommends8 to, “Cover your mouth and nose when coughing or sneezing.” But the WHO currently and specifically states9 that, “If you are healthy, you only need to wear a mask if you are taking care of a person with COVID-19.” There are many logical discussions about the benefits versus risk of widespread face coverings including additional risk to the wearer if not following a rigorous process to correctly manage it10,11 As one studies the “science,” and the accompanying proposed measures from the aforementioned government bodies, they almost all address the secondary problems as a means toward prevention. We do hear occasionally that our older population is at higher risk and especially those with underlying conditions. But it is very difficult to find analysis with data summarizing and focusing on driving excess deaths to the “expected number of deaths in a given time frame.” This focus should reduce some of the emotional and political factors and allow us as a country to, “get back to normal,” which unfortunately does include a number of expected deaths. Looking at the data, we can see that 81% of US COVID-19 deaths come from a vulnerable age group (65+) that makes up 15% of the US population12. 81% Of COVID-19 Deaths Are From 15% Of Population (65+) % COVID-19 Deaths By Age 19% COVID-19 Deaths % of Total % COVID-19 Deaths By Age 81% 19% 19% 81% Population % of Total 81% 15% Population % Of Total 85% <65 <65 65+ 65+ COVID-19 Deaths And 48% of the US population was employed % of in 2019 butTotal the vulnerable age group (65+) still 13 working made up only 7% of the workforce . Only 7% Of19% The US Workforce are 65+ 7% 81% % Of Total Employed 93% <65 65+ Additionally, data from around the world12 shows that more than 90% of fatalities related to COVID-19 are within the vulnerable age group of 60+ years old. 90% of all COVID deaths in New York State (and around the world) had at least 1 comorbidity13 meaning that people over 60 years old with at least one of the listed comorbidities made up over 80% of the COVID deaths. The table referenced below13 is related to comorbidity in New York State, but VERY SIMILAR data is readily available from the same sources with very similar results. Therefore, if we put 93% of the workforce back to work and add heavy protection for the vulnerable age group (65+) we can restore our economy and be in a better position to support the vulnerable age group. I believe we should focus almost exclusively on protecting the vulnerable including those over 65 years old (or over even over 60) and let the rest of the population take due care to protect themselves. Generally, the proposed concept is: Open the US economy immediately and completely and make protections voluntary. End all exceptional unemployment benefits within one month after the opening. Offer special accommodations for those within the workforce over 65 AND with underlying conditions defined by the CDC as follows: o Extra $600 currently offered until a vaccine is available or the risk is significantly reduced overall (herd immunity) o FMLA protections o Provide free and easy access to Personal Protective Equipment (PPE) including N95 masks that actually protect them (versus everyone wearing cloth face covering trying to protect each other). o Provide free and home delivered testing to this small group o Formalize the special timing and conditions provided for 60+ seniors at shopping centers, restaurants, movie theaters, etc… o States should offer special accommodations for the vulnerable population including food delivery, rent/mortgage relief, nursing home support, etc… Start an aggressive nation-wide education process emphasizing the level of vulnerability of people over 60 with specified underlying conditions using data and facts. Make it clear that people in this category make up almost all of the fatalities so special care should be taken to shelter in place, stay out of situations with group gatherings, go out when necessary but during the specially designated times offered by places listed above. I know that there will be reasonably significant cost to the proposal above, but we should be able to support it much more readily than shutting down or constraining our economy and funding country-wide support. If we accept that there will be a relatively low level of suffering and risk for the 85%+ of the population that are not vulnerable as defined above, then we can focus on the lethal aspects of this virus. As a country, we can drive down, “excess deaths” by staying laser focused on protecting and caring for the vulnerable group making up 15% of the population while taking personal responsibility for due care for the other 85%. Additionally, focusing our efforts on the minority of the population that is vulnerable, will help avoid Additional Deaths of Despair. A new study14 estimates that the US could see “Additional Deaths of Despair” of approximately 100,000 over the next decade using the recession of 2008 as a model. It is also interesting that the study identifies younger people as more vulnerable to Additional Deaths of Despair which affects the exact population that is less vulnerable to COVID-19 death. The study likely does not completely correlate to COVID-19 but we should understand that there will be a level of Additional Deaths of Despair related to unemployment, fear, and depression. This letter is meant as a facts-and-data-based proposal to focus on the primary problem of “excess deaths” without regard for political or ideological considerations. The proposal could be seen as callous or superficial because it disregards the risk to those not “vulnerable,” but I contend that COVID-19 would not be addressed so severely if there were little to no excess deaths. Note: this is clearly not a research study or paper but, rather, a summary of information readily available (generally from government sources.) All of my data and assertions are notated for source below. References: 1 https://www.medicalnewstoday.com/articles/comparing-covid-19-with-previous- pandemics#1918:-The-Spanish-flu 2 https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html ,“Some cities managed to implement community mitigation measures, such as closing schools, banning public gatherings, and issuing isolation or quarantine orders, but the federal government had no centralized role in helping to plan or initiate these interventions during the 1918 pandemic.” 3 https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm 4 https://www.who.int/health-topics/coronavirus#tab=tab_2 , “Maintain at least 1 metre distance between you and people coughing or sneezing.” 5 https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html , “Stay at least 6 feet (about 2 arms’ length) from other people.” 6 https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html 7 https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html 8 https://www.who.int/health-topics/coronavirus#tab=tab_2 9 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for- public/when-and-how-to-use-masks 10 https://www.who.int/docs/default-source/epi-win/when-to-use-a-mask-v0-1- print.pdf?sfvrsn=447aa72d_2 “Masks are effective only when used in combination with frequent hand-washing with alcohol-based hand rub or soap and water.” “If you wear a mask then you must know how to use it and dispose of it properly.” 11 https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-to-wear-cloth-face- coverings.html 12 The data table below was collected from the CDC, WHO, and departments of health. References for each country are listed in the table. United States Asia Europe World New US York South Netherla Population State Idaho Massachus Ohio Connecti China Korea Japan Spain Germany Italy Switzerlan Sweeden nds Korea Average Age Total Covid Covid etts Covid Covid cut Covid Covid Covid Covid UK Covid Covid Covid Covid d Covid Covid Covid Covid Group Deaths Death Death Deaths Deaths Deaths Death Deaths Deaths Death Deaths Deaths Deaths Deaths Deaths Deaths Deaths 0-9 0.2% 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% 0.0% 0.5% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 10-19 0.4% 0.0% 0.0% 0.0% 0.0% 0.1% 0.7% 0.0% 0.0% 0.1% 0.7% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 20-29 1.3% 0.4% 0.0% 0.0% 0.1% 0.3% 0.7% 0.0% 0.0% 0.4% 0.5% 0.1% 0.0% 0.0% 0.2% 0.1% 0.2% 30-39 1.8% 1.3% 0.0% 0.2% 0.5% 1.1% 0.7% 0.8% 0.5% 1.1% 0.7% 0.2% 0.2% 0.3% 0.4% 0.2% 0.5% 40-49 2.9% 3.6% 0.0% 0.8% 1.5% 2.0% 1.4% 1.2% 2.0% 1.9% 1.4% 0.7% 0.9% 0.3% 0.7% 0.5% 1.3% 50-59 6.9% 9.6% 2.8% 1.7% 5.7% 4.3% 4.5% 5.8% 4.0% 7.6% 3.3% 3.3% 3.7% 2.2% 3.1% 2.3% 4.3% 60-69 12.3% 19.6% 12.5% 9.7% 15.0% 13.8% 12.5% 14.6% 11.0% 19.4% 11.5% 9.1% 7.4% 7.3% 7.2% 8.2% 11.9% 70-79 20.4% 26.3% 20.8% 22.1% 26.3% 22.3% 27.9% 29.6% 25.5% 33.3% 33.0% 22.5% 28.7% 20.5% 22.4% 27.5% 25.9% 80+ 53.8% 39.2% 63.9% 63.4% 50.8% 56.0% 51.6% 48.1% 57.0% 36.3% 48.5% 63.9% 59.0% 69.5% 65.9% 60.2% 55.5% 60+ 86.5% 85.0% 97.2% 95.3% 92.2% 92.2% 92.0% 92.3% 93.5% 89.0% 93.0% 95.4% 95.2% 97.3% 95.5% 95.9% 93.4% Ref: Statista.com, Data Ref: Ministry Ref: National 2/11/20, of Health, Ref: Ref: Institute for Chinese Social Ref: Robert Ref: Bundesamt für Ref: Public Health Ref: New Ref: Center for Ref: Toyo Services and Koch- https://epice Gesundheit Folkhälsomynd and the York State Ref: Ohio Connecticut Disease Ref: Keizai, Ref: The Equality, Institut, ntro.iss.it, (Schweiz), igheten, Environment. DOH Ref: Idaho Ref: MA DOH, DOH, Data DOH, Data Control and Statista.com, Statista.com, Lancet Statista.com, Statista.com, Statista.com, Statista.com, Statista.com, Statista.com, 5/13/20 DOH 5/15/20 Data 4/27/20 5/6/20 4/17/20 Prevention Data 5/15/20 Data 5/15/20 4/16/20 Data 3/12/20 Data 5/14/20 Data 5/13/20 Data 5/13/20 Data 5/15/20 Data 5/12/20 1.nyc.gov https://public.tableau.com/profile/idaho.division.of.public.health#!/vizhome/DPHIdahoCOVID-19Dashboard_V2/Story1 https://www.mass.gov/doc/covid-19-dashboard-april-27-2020/download https://www.fox5ny.com/news/connecticuts-coronavirus-death-toll-tops-1000 https://www.cleveland.com/coronavirus/2020/05/jarring-numbers-for-how-dangerous-coronavirus-has-been-for-older-ohioans-and-how-few-younger-people-have-died.html https://www.statista.com/statistics/1099662/china-wuhan-coronavirus-covid-19-fatality-rate-by-age-group/ https://www.statista.com/statistics/1105080/south-korea-coronavirus-deaths-by-age/ https://www.statista.com/statistics/1107703/japan-patients-detail-coronavirus-covid-19-cases-by-age-and-state-of-health/ https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(20)30311-X.pdf https://www.statista.com/statistics/1105596/covid-19-mortality-rate-by-age-group-in-spain-march/ https://www.statista.com/statistics/1105512/coronavirus-covid-19-deaths-by-gender-germany/ https://www.statista.com/statistics/1105061/coronavirus-deaths-by-region-in-italy/ https://www.statista.com/statistics/1110092/coronavirus-covid-19-deaths-age https://www.statista.com/statistics/1107913/number-of-coron https://www.statista.com/statistics/1109459/c 13 The table below is related to comorbidity in New York State but VERY SIMILAR data is readily available from the same sources with similar results. New York State Comorbidities by Age Groups (23713 Fatalities) Coronary Artery Renal Atrial Age Group Hypertension Diabetes Hyperliidema Dementia Disease Disease COPD Fibrillation Cancer Stroke <60 1408 1243 461 36 163 331 145 61 122 117 +60 11338 7160 4505 3061 2575 2125 2045 1769 1618 1420 Total 12746 8403 4966 3097 2738 2456 2190 1830 1740 1537 https://covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-Fatalities?%3Aembed=yes&%3Atoolbar=no&%3Atabs=n Total Fatalities <60: 3521 Total Fatalities 60+: 20192 Total Fatalities All Age: 23713 % Fatalities with at least 1 comorbidity: 21305 Total Fatalities with at least 1 comorbidity: 90% 14 https://wellbeingtrust.org/wp-content/uploads/2020/05/WBT_Deaths-of-Despair_COVID-19-FINAL-FINAL.pdf
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