I find the original post has several flaws, including lack of secondary and tertiary effects analysis, theoretical assumptions which may not prove out in reality, and reactive only vs proactive behavior with a lack of responsibility to the outcome.
The first theoretical assumption I challenge is that “herd immunity” only results from unrestrained R0, or infection rate. “Herd immunity” can also be gained over time with a lower R0 as the total population infected rate converges to the same percentage, just to a different future date.
The second omission I challenge is the lack of secondary effect on the current healthcare system design. An unrestrained R0 can overwhelm a healthcare system, in more than one way: financially and staffing. Very similar to a bank run, the system can collapse and create extreme chaos for more than the infected, but for the healthy as well as standard healthcare evaporates. In that scenario, current curable or manageable illnesses turn deadly, as maintenance care is no longer available and the indirect death rate rises as well.
Third, studying human behavior and having a wife work along side doctors in the medical field, I find that most of the medical field in hospitals and primary care are in a reactive situation only. They react to what walks in the door, they have prescribed methods to deal in their situation in front of them. And like a teacher, they are the expert but have little control over what comes in, and some control over the outcome. But once out the door, they have much less control on the eventual outcome. This reactive position struggles with strategy and proactive behaviors. In my field of finance, I try to quantify risk, a concept of uncertainty, and be proactive to minimize the risk across the organization. That’s where my wife works, dealing with data, the risk and the outcomes to the total organization. Most, not all, primary care or emergency room doctor lacks that perspective, the strategic long term perspective of the entire organization, and the secondary and tierary effects which risks must be mitigated. I see the same blind spot in other people and professions.
Finally, I see and hear the differences with “older” doctors to whom I have had appointments, who have tough time with data analytics, with large systems, which collects more data for better outcome analysis, and don’t understand the trade off between time and cost to clean data, and the improvement in outcome, to the point that I hear about doctors who shun medical systems in favor of a blackboard with a single number. Again, from personal experience watching and studying questions of process or strategy, outcome or process, reactive versus proactive risk behavioral adjustment.
In my risk analysis, the choice before us is one of balance between economic damage, human damage, and healthcare system damage. As society progresses with medical advances, there is more emphasis on the value of life, and minimizing human damage. Having just bought a retirement home and a year or two away from retirement and joining the villages life, I am doing everything I can to survive to be able to enjoy the outdoor and active lifestyle I enjoy. Wanting to risk that with an outcome I can’t control, not sure I agree with the assumption of “herd” immunity by unrestrained R0 versus a constrained R0 which will give the healthcare industry time to prepare for a scenario that is rarely seen.
A comparison could be made between corona virus and H1N1 virus, in which little proactive behavior was initiated with H1N1 and the death rate will probably be higher with H1N1 (a prediction which is not yet proven nor disproven). The economic damage will be much higher, but again temporary, and recoverable in the medium term. There are ways to recover from temporary economic dislocations, not so with healthcare dislocations. Doctors, nurses take years to educate and prepare.
We have not read the MIT article, but we have had lots of discussions after being well prepared as I saw this coming in January. I asked a life long nurse with 10 letters after her name, about the virus in January. She said she wasn’t worried. Now both she and her husband have it, and we are hoping they survive. The person they got it from is on a ventilator.
Sportsguy and CoachK
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