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Coronavirus: What is vertical isolation (and why is this not a good idea)?

Gustavo de Paula
Por Gustavo de Paula,
CEO e Fundador da Asset School e criador do método de ensino Asset.
Publicado em 27 de março de 2020

Quarantine. Suppression. Mitigation. Isolation (vertical or horizontal). Flatten the curve. You must have heard a lot of these terms in the past few days, correct? Yes, in the face of the threat of new coronavirus, much of the world has adopted strategies to restrict social contact among its citizens.

This point is easy to explain: if a subject is infected and stays at home, without interacting with others, he does not pass the Covid-19 virus. On the other hand, those who are healthy and remain closed in their home are not at risk of getting the disease.

But this is exactly where it starts to get complicated: if people don’t work, what about the economy? And companies, how are they going to get the money to pay their employees? The fear of the consequences of a global recession is legitimate: after all, unemployment and rising poverty also have serious health impacts.

Thinking about it, some government officials and scientists started to suggest an alternative path: the vertical isolation. In the questions below, you will understand exactly what this strategy is and why it has everything to be even more disastrous.

What is vertical isolation?

The idea is simple: instead of sending everyone home, closing schools and businesses, why not just isolate the people most vulnerable to the new coronavirus? From what is known so far, the rate of complications and deaths is much higher in some groups: individuals over 60 years of age, with diabetes, hypertension and heart or lung diseases.

At least in theory, this would allow younger people to return to their studies and work, turning the wheel of the economy. Following this line of reasoning, companies would maintain their pace of work and people would continue to consume with a certain normality.

There is another argument here: with 20, 30, 40 and 50-something individuals leaving home, they would invariably become infected with the coronavirus. As they are not part of risk groups, they would not have major health consequences and would be protected. In the long run, this would create “herd immunity” and prevent further outbreaks or epidemics caused by this infectious agent.

The proposal gained traction after U.S. President Donald Trump said on March 23 that the United States would change the current regime soon and would not wait for the three or four months of general closure, as expected.

Speech has gained resonance in Brazil. President Jair Bolsonaro declared on March 25 that vertical isolation should be the way forward.

Has vertical isolation been tested anywhere?

To some extent, yes. In the first weeks of March, the governments of the United Kingdom and the Netherlands took little action to combat the coronavirus. According to a magazine report Science, Dutch Prime Minister Mark Rutte rejected “closing the country completely” and opted for a “controlled contagion” of his population.

The same guideline took place in the lands of Queen Elizabeth II (whose son, Prince Charles, tested positive for Covid-19): letting young people become infected and protecting only the most vulnerable part of our population.

But everything changed on March 16, with the publication of a scary study, which is the subject of our next question.

What made these countries go back?

A team from Imperial College London, England, published extensive research showing the impact of non-pharmacological measures to reduce mortality by Covid-19.

The work evaluated different scenarios and the consequences they would have in both the UK and the United States. We will explain the two main strategies that were evaluated:

  • Mitigation: focuses on braking, but not necessarily stopping the circulation of the virus. Protects those most at risk. It is the vertical isolation that the English themselves were betting on.
  • Suppression: tries to reverse the growth in the number of cases, reducing as much as possible the social contact of all inhabitants. It is the general isolation practiced in parts of China and in several other countries around the world.

And what did the results show? Even in a scenario with reduced peak cases, twice as many ICU beds would be needed to meet the demand for critically ill patients in the UK. There would be thousands of deaths in these two countries, which are among the richest and most powerful on the globe.

In a way, this really happened in Italy. The government was slow to take measures to protect the population. When they realized, the number of infected was already frightening. There were no hospitals or devices to meet all demand. Today, there are 81 782 confirmed cases and 8 215 deaths in that European country.

What would be the main problems with vertical isolation?

First, it is difficult to isolate just a few people. Think about the reality of the elderly who live with their children or grandchildren. If young people go back to school or work and have contact with the coronavirus, they will bring the disease into the home. It is difficult to think of complete social isolation in the face of the reality of our society.

And look that the hole is much lower … According to the Brazilian Diabetes Society, 14 million Brazilians are diabetic and half of them never made the diagnosis. O Ministry of Health calculates that one in four people living in our country has high blood pressure. World Health Organization data reveal that up to 20% of our countrymen suffer from asthma and 10% live with chronic obstructive pulmonary disease, COPD.

Translating: millions and millions of individuals are part of the Covid-19 risk group, many below the age of 60. Even more frightening, several of them have not even been diagnosed and live with the disease in the shadows. How is their health? How are you going to isolate yourself with the requirement to return to jobs?

Supporters of vertical isolation are also based on figures from South Korea, a country that has achieved great results in combating the new coronavirus (on March 26, there were 9,241 confirmed cases and 131 deaths there). The argument is that the mortality from the disease in this Asian country was around 1%, which would justify smoother measures.

But the point is that South Korea has taken another very effective action: do mass testing on the population. In this way, they were able to detect even the slightest cases and isolate these people, so that they would not pass the disease on to others.

The drama is that the world does not have the capacity to perform so many exams. There is neither material nor money to make this service available on a large scale. Brazil itself only performs tests on the most serious patients, who are hospitalized.

And what does this mean in practice? In summary, we do not know the actual number of people infected with the new coronavirus. If the death rate was 1% in South Korea, it rose to 2% in China. And it jumped to almost 10% in Italy.

A simple bakery bill gives the dimension of the problem. We will take into account the projections that 70% of the world population will be infected with coronavirus. This means that 4.9 billion people will have Covid-19 (most with mild or even imperceptible symptoms).

If the mortality rate is 1%, as seen in South Korea, we are talking about 49 million deaths on the planet, a number that is close to the Spanish flu of 1918.

So which way to go?

As a matter of fact, nobody knows (and it can vary from nation to nation). But what has been most effective is a more comprehensive isolation: schools and universities closed, home office companies where possible and essential open services, such as supermarkets and pharmacies. This is the strategy that is in place in much of the world, with different levels of rigor. In Singapore, for example, citizens who take to the streets without good reason get a heavy fine.

Of course, eventually, people will need to leave their homes to make a living. But when this is done gradually, the demand for care and hospitalization in the health system becomes smaller and more sustainable.

This is what experts call “flattening the curve”: instead of everyone going to the emergency room in one week, social isolation measures hold the bar and allow the population to become infected with the coronavirus at a slower rate, to the point of ensuring greater access to ICUs and respirators.

The example of Wuhan, the city in China where it all started, of course: after three months of total quarantine, the authorities begin to rehearse the return to normality. And the time when this will be done will make all the difference.

A study by the School of Hygiene and Tropical Medicine from London published in the journal The Lancet shows that if the isolation in Wuhan is lifted in late March, a new peak of Covid-19 cases will take place there in August 2020. If you wait until April to promote this release, the increase in cases will occur around October, which means more time to prepare and withstand the second wave of this storm.

Other essential attitudes to overcome this crisis are the construction of field hospitals, as happened in China, the conduct of mass tests (South Korea’s case) or the closing of borders before the first cases appeared – Panama made this decision early on, which delayed the arrival of the disease there a little (there are now 558 cases and 8 deaths in the Central American country).

And how is the economy in the middle of it all?

There is no escape: the recession is already being calculated by all who are economists. In the wake of other countries, Brazil has zeroed out the expectation of growth of its gross domestic product (GDP) for 2020. The tendency is that we have a drop in this index, which measures the totality of a nation’s wealth.

To minimize this, we need to have public policies that protect the most vulnerable parts of the population, especially those who work without a formal contract or are self-employed. It is also necessary to think about a protection plan for small and medium-sized companies, as their bankruptcy means more unemployment.

In the United States, politicians are sewing a $ 2 trillion economic stimulus package. The proposal is to hold the bar in this period of three or four months of economic break. Really look like? If the government lets things go wild and a large number of Americans die, the loss of money would exceed that investment more than 20 times. It would be tens of trillions of dollars lost to the coronavirus.

Regarding the economic impact that the closing of trade and companies can cause, a study published last Thursday (26) helps to illustrate the situation. Signed by experts from the Massachusetts Institute of Technology (MIT), in the United States, the work analyzes how the Spanish flu of 1918 impacted the economy of several American municipalities. And the conclusion is very clear: “We found that cities that made interventions quickly and aggressively [com medidas de isolamento total da população, por exemplo] they had no worse performances and even grew faster after the pandemic ended. These non-pharmacological measures not only decrease mortality, but also mitigate the adverse financial consequences of a pandemic ”, write the authors.

And Brazil?

Despite declarations and pronouncements, for the moment there is no official position on how the issue of isolation will be dealt with in Brazil. Depending on the attitude of the representatives of the Ministry of Health in the last press conferences, the tendency is towards individualization: some cities or states will need to do total quarantine, while in other places this type of strategy will not be put into practice.

Certain states stepped up and decreed the closure of schools and non-essential trade. This is the case of São Paulo and Rio de Janeiro, for example. But there is no provision for stricter measures, such as a ban on driving on the streets or fines for those caught hanging around.

And how should I act?

To avoid any unnecessary risk, it is ideal to stay at home if you have this possibility. Exit only when necessary. And, of course, follow the guidelines of the health departments of your municipality and state and the Ministry of Health.

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