Is Social Distancing Really the Best Way to Fight a Pandemic?

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Army Garrison Casey conduct pre-screening for coronavirus
Soldiers stationed on U.S. Army Garrison Casey conduct pre-screening processes on individuals awaiting entry to the base, USAG-Casey, Dongducheon, Republic of Korea, Feb. 26, 2020. Additional screening measures of a verbal questionnaire and temperature check are in response to the heighted awareness of Coronavirus (COVID-19) following a surge in cases throughout the Republic of Korea and are meant to help control the spread of COVID-19 and to protect the force. (U.S. Army photo/Amber I. Smith)

Joseph V. Micallef is a best-selling military history and world affairs author, and keynote speaker. Follow him on Twitter @JosephVMicallef.

The Trump administration is following the strategy employed by China and many European Union (EU) members to contain the spread of the novel coronavirus, or COVID-19, in the U.S. That strategy, based on encouraging and enforcing "social distancing," is designed to reduce the rate of person-to-person transmission.

The Centers for Disease Control has recommended that gatherings of 50 or more people be discouraged, and that this policy be followed for the next eight weeks. On Monday, President Donald Trump went one step further and encouraged Americans to avoid groups of more than 10 people.

That strategy has resulted in the cancellation of professional sporting events, music concerts and scores of other public events, including New York's annual St. Patrick Day's parade. It has also imposed enormous economic costs on the travel, leisure and hospitality industries, and on many retailers and businesses that deal with consumers face-to-face.

In addition, more than 34 states have instituted school closures, some for the rest of the year, that cover more than half of all students in the U.S. Many governors have ordered or called for all bars and restaurants to close or have imposed curfews on the citizens of their states.

Related: You Can Thank a Military Parade for Social Distancing

As of Tuesday, the Pentagon has confirmed that there were 37 confirmed military cases of COVID-19: 18 active-duty service members, three civil servants, 13 dependents and three contractors.

In response, the Defense Department has implemented a ban on domestic travel for all service members, civilian employees and their dependents until May 11.

In addition, the Pentagon has canceled African Lion 2020, a war game exercise planned in Africa, and announced that Defender-Europe 20 would be substantially revised. The Pentagon has also confirmed that routine deployments will be scaled back, but those in current theaters of active operations, so called hot spots, will continue as needed. Unofficial visits to the Pentagon have also been suspended, and new rules have been imposed on permitted visitors.

Containing COVID-19

COVID-19 is the disease caused by the SARS-CoV-2 virus. The term coronavirus is often applied, incorrectly, to both terms.

There are literally thousands of coronaviruses in nature. Not all of these are harmful to humans. There are more than 200 coronaviruses, for example, associated with just the flu and the common cold. Two previous variants of the coronavirus, severe acute respiratory syndrome (SARS) in 2004 and Middle East respiratory syndrome (MERS) in 2012, were significantly deadlier than the ones associated with influenza and the common cold.

The typical flu has a lethality of between .01% and .05%. That means roughly 100 to 500 people per million people who come down with the flu ultimately die as a result. Many of these deaths are in patients who are old or otherwise already sick. It's always tricky to determine how significant a contributory factor the flu can be, but it is undoubtedly a factor.

By comparison, the lethality of COVID-19 has been estimated at anywhere between .5% to as much as 3.5%. Although the current thinking is that, after adjusting for unreported cases, it is likely to be at the lower end of the range. That makes COVID-19 at least 10 times more lethal than the flu, and possibly up to 100 times more lethal. That's a significant increase, even if it is from a relatively low base.

What makes SARS-CoV-2 particularly dangerous among coronaviruses is that the virus is most contagious in the early period of infection. That means that, by the time a patient feels sick enough to stay home or seek medical help, they may have already infected scores of other people. Moreover, some patients are completely asymptomatic, which means they can infect others without ever getting sick.

It's likely that many people who contract COVID-19 experience it as a mild cold or flu and never report it or seek medical help. If the base of infection is larger, as many medical professionals believe, then the corresponding lethality would be lower. Italy's fatality rate, currently the epicenter of the COVID-19 crisis in Europe, is estimated at around 3.5%. That high number reflects, in part, the lack of widespread testing in Italy, meaning that many patients who have a mild case are not being counted. Most of the deaths in Italy have been in patients between the ages of 63 and 95 who were suffering from other medical conditions. Italy's population is, on average, substantially older than the U.S. -- a median age of 45 versus 38.

American medical authorities readily acknowledge that it is now too late to contain the spread of COVID-19 in the U.S. The strategy adopted by the Trump administration, on the advice of the CDC, is to "flatten the curve." In other words, minimize social interaction, i.e. encourage "distancing" to slow down the rate of transmission so that the number of cases referred to hospitals does not overwhelm the medical system. The net effect of that strategy is to create more economic dislocations in the short term, and also extend the length of the epidemic, but to minimize the number of deaths and keep the overall scope of the crisis within the capabilities of the U.S. medical system to manage.

An Alternative Strategy

COVID-19 is not the first viral epidemic to sweep the world. It certainly is not going to be the last. In the past, the human cost notwithstanding, such epidemics, in their wake, bestowed a degree of immunity on the population at large. The technical term for this phenomenon is called "tribal immunity."

Additionally, over time, viruses tend to evolve toward less lethal forms because the more benign variants are more likely to be spread than the more lethal ones. Eventually, a population will build up a significant immunity to the reemergence of that viral pathogen.

Initially, the Boris Johnson government in Great Britain had indicated that it was adopting the latter strategy, although it was criticized by the U.K. medical establishment for doing so, and had been accused of putting the minimization of economic impact ahead of minimizing the loss of life. As of Monday, however, the Johnson government was changing course and emphasizing the need for social distancing to reduce the transmission of COVID-19.

The suggested trade-off between minimizing the economic impact and the loss of life, however, is not a given. The strategy of letting the epidemic run its course in order to bestow tribal immunity may ultimately prove to be both the most effective and the most humane. Currently, we do not have the ability to protect at-risk populations, so social distancing, despite its enormous economic cost, is the only alternative available.

Notwithstanding our current response strategy, we need a more workable long-term solution to dealing with such outbreaks. The fact is that the emergence of SARS CoV-2 type viruses will occur again in the future, and that the containment of such viruses will be difficult, especially in a globalized world economy.

It is now believed that the first case of COVID-19 appeared in Wuhan in November, and was diagnosed on Nov. 17, 2019. By mid-December, there were 20 confirmed cases, and Chinese authorities had identified several clusters of the disease in Wuhan. China first reported the presence of COVID-19 to the WHO Country Office in China on Dec. 31. By Jan. 6, nearly 60 cases of COVID-19, with seven being in critical condition, had been identified. On Jan. 7, a variant of the coronavirus was identified as the cause of COVID-19. China's Center for Disease Control reported a "novel coronavirus as the causative agent of this outbreak, which is phylogenetically related to the SARS-CoV-1" virus on Jan. 9.

The Trump administration moved to ban travel from China on Jan. 30. Initially the administration was roundly condemned for the ban, with critics calling it racist and xenophobic. Since then, Iran, the U.K., Ireland and the EU countries that comprise the Schengen zone have been added. In retrospect, the initial ban helped reduce the spread of COVID-19 in the U.S., even if such bans cannot fully insulate America from such diseases.

The global spread of COVID-19 was exacerbated by the failure of civil authorities in Wuhan to move faster to contain the virus and by the failure of Beijing to advise medical authorities around the world of its emergence. There have been numerous reports that medical personnel who tried to publicize the emergence of COVID-19 were muzzled by Chinese authorities.

On the other hand, even if the Wuhan and Hubel governments had moved faster to contain the virus and Beijing had been more forthcoming with information, the disease likely still would have spread. Given that thousands of people had been infected before the nature of COVID-19 had been understood, as well as the centrality of Chinese-based supply chains in the world economy and the travel associated with those supply chains, the virus would have likely gotten out -- though a slower rate of spread would have given governments more time to react.

The COVID-19 crisis will pass, although it will cause extreme, trillion-plus-dollar economic losses in the process. Unfortunately, the relentless speculation by the national media about what future, "what if" steps might be taken, including a nationwide lockdown or ban on all travel, is only exacerbating a difficult situation and feeding public anxieties about the disease.

What is needed now, and most certainly in the future, is to address the medical needs of those populations that are most at risk from the emergence of SARS-CoV-2 type viruses and to do so without bringing the rest of the country to a standstill. That means improving our ability to screen incoming arrivals to the U.S., setting up temporary hospitals as needed and to effectively quarantine those populations most at risk.

Historically, the American military has played a significant role in curbing pandemic diseases in the U.S. It's time to re-establish that capability. The U.S. also needs to beef up its ability to develop and mass-produce vaccines, even if this is a long-term response to viral disease outbreaks and will not prevent them from occurring.

In addition, it is imperative that the U.S. restore its ability to be self-sufficient in the production of critical drugs, antibiotics and medical equipment. This is no longer an issue of economics but one of national security. Dependence on a foreign country, China or any other, for the supply of critical medicines is simply irresponsible.

The U.S. cannot simply shut itself off from the rest of the world. The time window in which to react to new, more virulent coronaviruses is too narrow to give much notice or to insulate the U.S. from the consequences. The notion that every time a particularly deadly coronavirus emerges the U.S. should simply shut down its economy, however, is not a practical or a realistic long-term solution.

The answer is a more robust capability to respond to such outbreaks so that we can protect at-risk populations while continuing to function nationally. Oh, and a more responsible coverage by the national media wouldn't hurt either.

-- The opinions expressed in this op-ed are those of the author and do not necessarily reflect the views of Military.com. If you would like to submit your own commentary, please send your article to opinions@military.com for consideration.

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