In Six Sigma we have an often repeated question: what are we solving for? This question is applied to the Six Sigma program as a whole as well as to meetings, projects and even individual analyses. It also applies to the lock downs. For example, is the lock down is solving for …
- Flattening the curve. The healthcare system will be overwhelmed if we don’t lock down. Unless we mitigate the effects of this virus the predicted peak number of COVID-19 cases will consume all of the [rooms, ICU beds, ventilators, PPE, etc.]. This is what were told we were solving for initially, but the scope has recently gone well beyond this. By the way, we have successfully avoided overwhelming most healthcare systems, with Italy being an exception.
- Slowing the spread. If we accept the fact that the coronavirus will eventually “run its course” and spread until we reach herd immunity, and if we assume it would be better if this occurred slower rather than quicker, then we are solving for slowing the spread. This goal applies (I assume) even if we already succeeded with the flatten the curve goal. It means we should continue the shut down until we reach some level that can be considered herd immunity. Slowing the spread is the goal stated in a letter from my U.S. senator Krysten Sinema in response to a letter that I sent to her.
“Continuing to slow the spread of coronavirus is the key to safely re-opening Arizona.”
- Saving lives. The meaning of this goal is debatable, after all we will all die eventually. But I’ve seen this stated as a goal of the lock down by numerous commentators and even some medical experts.
- Lowering the overall death rate. This is a variant of “saving lives” that has the advantage of at least being measurable. I’d love to see some good research on whether this was accomplished by the shut downs. The study would need to be extended to include the entire disease cycle to account for subsequent “waves” as those protected by isolation eventually become exposed to the virus, and as subsequent waves lead to additional shut downs. Collateral damage from the shut downs would also need to be accounted for.
- Saving QALYs due to coronavirus. The U.K. NIH site states “The quality-adjusted life-year (QALY) is a measure of the value of health outcomes. Since health is a function of length of life and quality of life, the QALY was developed as an attempt to combine the value of these attributes into a single index number.” I’ve not seen this metric applied to the coronavirus, but it would be interesting. COVID-19 hits the very elderly and sick disproportionately. I’m old (nearly 72) and I have my fair share of “comorbidities,” including a recent stroke. I can tell you that if I were bedridden by a stroke, as many of my friends and relatives have been, and if I became ill with the coronavirus, extending my life for a few months or years at the cost of wrecking the economy of my country and the lives of my kids and grand kids with a lock down would be too high a price to pay.
- Saving QALYs due to all cause deaths. The collateral damage from the lock downs includes loss of life from the economic damage. People are unemployed, landlords are loosing their properties and livelihoods, small businesses are being ruined, parents are struggling to feed and clothe their children. These things lead to violence, alcohol and drug abuse, suicides and all sorts of other physical and emotional harm. And lost QALYs.
Is locking down the best approach?
We should not forget that there are things other than locking down that we could do. For example, this virus strikes the elderly with comorbidities especially hard, which was know very early. And it is particularly gentle on children. This suggests considering a strategy of locking down nursing homes and opening schools. This strategy would also speed us towards herd immunity, which many experts believe is the only way we will defeat this virus.
The virus is also not all that deadly to any healthy person under the age of 65, which means most of the economy can remain open. Guidelines for less healthy younger people can be targeted towards their particular comorbidity, such as morbid obesity or diabetes.
In future posts I will explore different aspects of these ideas. For now, the data are either not available or they are not reliable.
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