How to Stop COVID and Reactivate the Economy. A Concrete Proposal.
We are on time to change our strategy since we are not attacking the root of the problem: the virus must be contained, not people. Our central responsibility is not to infect others..
A few weeks ago I read a text that made me laugh a lot, despite the concern that every day I am overwhelmed by what we are facing. With sarcasm, an author spoke of the people who in recent months have graduated in epidemiology, virology, public health and the like from the "University of Twitter". I admit that I'm one of them. However, what I propose in this writing is the result of what I have been working for many years in innovation.
When a person has a problem, a reality that you want to change, you look for new ways of looking at things and propose alternatives that must be put in place and prove that in fact if they generate new value (they create a better reality). For this, many methodologies are used, but in general, experts from each related area are brought to the discussion, their knowledge is exchanged in various round-trip cycles, they are confronted, articulated and prototypes of new possible solutions are produced. Then they are tested in reality and their results are verified. The process is iterated if the expected result is not obtained.
One of the privileges of working in an entity like Ruta N (rutan.co), is the possibility of accessing all that advanced knowledge, of the state of the art in the world, interacting almost directly with many people and entities, through a network that has been woven into the ecosystem of the city in the last 15 years, with all these highly advanced experts in many of the related scientific and technological disciplines.
A premise learned from some of these experts is that in any system that suffers from contamination; of any kind, best practices always dictate that the appropriate strategy is to contain everything in the source, so as not to have to eliminate all its consequences in countless places once it is distributed as to several destinations.
I still do not understand why the whole strategy in general in western countries is based on the opposite, despite the terrible results we achieve day by day: trying to clean, eliminate, block the virus in all the places where it sits, in instead of avoid the virus from leaving our bodies. It does not sound very appropriate. We should be looking for a way that works from containing it at the source, even if these people do not know that they are or are not infected.
It is important to remember that any strategy of total or partial containment of the population, single or periodic, does not solve the problem, it only delays it. We use it only to prepare ourselves better and avoid that in the future the maximum capacity of our health system is not overwhelmed. Additionally, this has terrible effects on the economy and dramatically affects many people [1] at formal and informal jobs.
Since there is still no definitive solution to the effects of the virus (vaccine, treatment, medication), another problem is created with total isolation: we delay the possibility that most of us create adequate defenses for the virus and that we can obtain a solution from group immunity. In short, let's change our mind: the goal is not to avoid getting it, it is to get infected slowly. In other words our problem is about speed of contagion.
The proposal
As everyone is quickly bored by reading these technical topics, and it is very important not to lose you as a reader, I have already come this far: I am going to recount at once the summary of the proposal obtained from the analysis of the innovation processes and which seems being the only thing that until now allows us to open the economy in a broad way, focusing on the root of the problem: the transmission of the virus:
We must start a flexible confinement method through this essential change: to make mandatory for all citizens of any age the use, even inside their homes, of surgery masks and simple plastic face masks (covering the entire face with transparent plastic and the all the way to nose, mounth and chin),, in order to reduce the transmission of the virus from healthy asymptomatic people. To create mechanisms so that the vast majority of masks can be medical grade. Spread its use as mandatory. Engage the productive sector in the gradual but massive manufacture of both elements throughout the country, which in turn may generate new economic activities.
To allow low-income people, or those who do not have access to specially constructed plastic face masks, temporarily let the use of basic cloth face masks, and simple plastic (acetate), face masks.
Yes, of course, nothing we have been doing until now should be cancelled or stopped. All these actions are very important as complements to that central strategy. Wash your hands well and constantly, maintain physical distance when possible, do many appropriate diagnostic tests, check symptoms such as increased body temperature, keep vulnerable people isolated, increase teleworking where feasible, have mobile applications to follow infected people (electronically find the contacts of those who were close to them so as to then carry out appropriate epidemiological fences), etc. etc. etc.
We already know that with this Covid -19 virus, 100 percent of people can acquire it and transport it to surfaces, objects or other people, but only 1 percent to 3 percent [2] of the population is likely to become seriously ill and / or pass away. Therefore 100 percent of people; whenever possible, they should put in place a mechanism that statistically prevents [3] their secretions from leaving their bodies and reaching nearby surfaces, other people around us and our personal objects.
This proposal has the additional virtue of allowing, with much less danger, that the effective radius of proximity between people can be temporarily reduced in some situations, and that on average we have fewer infections in public spaces, thoses generated by some crowds. That would make it possible for the cities' mass transit system, and other similar activities to be reactivated more safely with the same number of people.
The root of the problem
The speed of contagion is actually our difficulty. Technically the so-called Basic Reproduction Number of a virus, which is designated with the variable R0 This number measures how many people on average [4], a person infect within a non-immune and susceptible population.
When the Covid pandemic started in China and then spread to Europe and the US, R0 could have values between 3 and 6 or even higher than [5] (this means that an average person infect between 3 and 6 people).
R0 is the result of the multiplication of 4 factors (The Rules of Contagion. Adam Kucharski. 2020):
D. Duration: Number of days that the sick person can infect others.
O. Opportunity: How often does an infected person meet healthy people.
T. Transmission Probability: What is the probability that an already infected person will infect a healthy person in each interaction.
S. Susceptibility. Depending on how you live, your previous diseases or genetic condition, how likely you are to be infected.
It is clear that the multiplication of these four factors allows experts to calculate the basic reproduction number of the virus: R0 = D.O.T.S
Factor D is not modifiable until now. Factor O is changed somewhat by the will of people to maintain physical separation, but it is essentially modifiable through confinements of the entire population like the one we are living. However, it is this same point that affects the economy in an inverse and terrible way.
The S factor intrinsically cannot be changed easily in people (only if they have already been immunized), but it can also be decreased with some external protection measures.
It is known that to stop the epidemic R0 must be less than 1.
As you can see, only by attacking the value of T aggressively and a little the value of S, it is possible to reduce enough to R0 and not have total population confinement, start again and keep the economy open (without diminishing much to O).
I know that every day we have been told; to exhaustion, that if we do more diagnostic tests than many countries have done, we can stop the virus. It could be? In light of the above, it is not very clear that is at the crux of the problem. Undoubtedly, knowing that someone tests positive and isolating them completely immediately is very useful, but we cannot do the tests on all the inhabitants of the country and repeat them at all times, let alone manage the costs and logistics of it.
You can do millions of diagnostic tests, but in the end T and S are not going to vary significantly. On the other side, if all people have their mouth and nose covered, these parameters are modified significantly and we will prevent the virus from spreading. This works well, whether or not the person is asymptomatic, and regardless of when they are aware of their symptoms started.
When one person have Covid, if we achieve what in each interaction with two persons, only one person is infected with the virus, the value of T is reduced by half. If only one person is infected out of 10 contacts with other persons, then T will be only a tenth. It is not unreasonable to achieve that only one out of every +100 contacts transmits the virus, if people always wear surgery masks & plastic face masks and regularly wash their hands, despite sometimes reducing their physical distance.
The problem of tests and data systems
Covid's diagnostic tests can demonstrate; at the moment of taking your sample, those who do not have the virus. However, they cannot avoid that only seconds later, that same person may already be infected (for example, by touching a surface where the diagnostic test was performed).
Diagnostic tests are vital to treat people infected in the health system, to preventively isolate those who test positive, and are key to enabling the entry of people through external and internal borders of the country (towns without having the first infection yet), as well as in airports.
They are also essential, in sufficient numbers, to really know how our country strategy is going and to make the most appropriate decisions for our leaders.
Diagnostic tests help enter immunized citizens back into the economy. However, they are not effective in getting us to revive the entire economy without having to return too quickly to total new confinement.
Something exactly the same happens with the people tracking applications on our mobile phones, as well as with all solutions with artificial intelligence, analytics and the like. We all need them and they are a great complement to move forward. However, the latter lead to a huge discussion about the risks to the privacy of citizens. They do not solve the problem at the root and they get us into discussions that frankly we should not have now, when all the energy and resources should be focused on solving the tremendous mess we are in.
How many times we touch our faces
As already explained, a simple, reusable and washable surgery mask , plus the addition of a simple plastic (acetate) face mask will very well serve to quarantine the virus inside our bodies, in most situations. This, in combination with a permanent hand washing routine, will significantly reduce the transmission rate of the virus. Let's see the reason for this.
Where does the virus enter a person? Almost all of infections enter through the so-called T area of our face. It is estimated that an average person touches his (her) face 23 times per hour [6]. Without controlling that factor, the battle is lost. The continuous use of boths masks also manages to avoid those physical face contacts.
If the person is already infected, the cloth mask in the chin, mouth and the nose, is a first line that stops the explosive expulsion of secretions, the plastic face mask in its inner face, is a second line of containment. The outer face of the plastic mask also prevents you from unintentionally touching your face or the face mask and bringing those infected secretions to your hand, and then from it to external surfaces and other people.
On the other hand, if the person is not infected and their hands come into external contact with the virus, the mask prevents contact with their face and the contagion of the person, maintaining protection until the next cycle of hand washing. Any contaminated aerosol that cannot stop the plastic external mask can be minimized and probably avoided by the internal cloth mask.
Finally, the scientific community agrees that the chances of falling ill after the infection increase according to the size of the viral load to which you will be exposed. Without a doubt, with this proposal, those who become infected will do so with a lower viral load, in most cases.
Because we are not doing it
The idea presented here have resistance by some people when I have shared with them. You can also include me ... initially!
We have two people, coworkers in the Ruta N (rutan.co) team who came from two Asian countries. They were very surprised that we did not wear masks in every person since before the first contagion in our region and they decided to use them despite our skepticism. We were all very sure of what the WHO recommended to us, and we thought, ahh... theses people are caming from other cultures. How wrong we were, gross mistake on our part.
Some tell me that we don't have the culture of Asian countries to do apply these practices. Will it be easier, in a only few days, to have millions of diagnostic tests and trace applications in the mobile equipment of all citizens, than to get leaders to promote the importance of using these simple elements well?
If we do not acquire that cultural trait quickly when we face a pandemic of this magnitude now, when are we going to adopt it? With the second or third epidemic in the future?
I have an open mind to learn from someone who can teach me why it wouldn't work. The question now would be: what do we lose if we try something like this at least? Doing more of the same, which is not working in most parts of the world, we can not obtain something different. I propose something simple: If we can't do it all at once for the whole country, let's carry out a pilot test in some cities and compare the result.
To finish, I want to share something with you: I think the one who defined the economy of a country like a multiple bicycle in which each citizen has their seat and their way of helping to push it with their own set of pedals, described the correct idea.
If many people stop pedaling that the bicycle can no longer move, even if it were slowly, she will fall and it will be very difficult and painful to get millions of people back on track (how and when to get up the bicycle and pedal at the same time), so that she advances and stays in balance.
Hence the importance of this moment, to regain momentum before the economy stops completely, save time for business re-open, prepare them adequately for possible new confinements of people, as we did in the first instance with society and the Health System.
I just want to remind the reader that with such few days we have available, the only feasible measure to implement in a massive way is the one already described above. It only requires the will of public and private leaders to get it fully underway and allow the economy to restart without further total confinement or to remain enforced for several months.
This proposal also has the great virtue of allowing each citizen to feel that they can contribute, that they have the solution in their hands, if they are properly inspired and linked.
Note: What is proposed in this writing is exclusively the responsibility of the author.
Note: This text is based on one originally published in Spanish, requested by some people who contributed to their generation.
[1] Although they are not exactly comparable phenomena, when the USSR disintegrated around 1990, as a consequence of the crisis it had been suffering and which was It extended beyond the year 2000, it is calculated that it decreased 14 points in its economy. This had a huge impact on public health. This effect was similar to a great illness for all of your peolpe, since its average life expectancy fell from 65 to 60 years between 1987 and the year 2000.
[2] There is not yet enough data to accurately conclude this percentage for the population profile of each country, but its maximum and minimum extremes are already delimited with a high probability of success by the scientific community.
[3] This mechanism operates seeking to achieve that, on average, the majority of the population does not infect another, thus, can NOT ensure that 100 percent of the contacts can avoid it. This is very different from the protection elements that medical personnel and the entire vulnerable population must have. Which should always employ medical grade elements that ensure almost 100 percent isolation on each contact. This point seems to be the source of the confusion and controversy of many experts in various areas on this subject.
[4] The Patient 31 in South Korea is believed to have infected more than 1,000 people without knowing it.
[5] There is no agreement ion the appropriate number for that value of R0 for Covid-19, but the scientific community estimates that it will be, a value of 2 and 4 in concordance with the geography (temperature and relative humidity). Compared to the Seasonal flu, R0 is in 1.3.
[6] https://www.ncbi.nlm.nih.gov/pubmed/25637115