Coronavirus, isolating the elderly is not as simple (or effective) as it seems

Was it possible that a solution that seems so trivial had never been considered? Obviously not, but the idea is extremely complex, as well as unfair

(Photo: Ross Sneddon / Unsplash) We are now in the much feared scenario 4, the one for which according to the Higher Institute of Health could trigger a new generalized lockdwon . And while the government is deciding in these hours which strategies to implement in an attempt to contain the coronavirus, avoiding a total closure with dramatic effects, among the various hypotheses proposed by some expert economists there is also that of a selective lockdown, which aims to isolate the age groups most at risk, such as the elderly, to be able to reduce mortality from Covid-19. An idea, however, that has generated quite a few controversies among the scientific community.

In recent days, an analysis by the Institute for the study of international politics has estimated that the isolation of the over 80s would be enough to halve or almost the direct mortality for the coronavirus, while if they also effectively isolate the elderly over 70, it would be possible to bring mortality down to 0.07%, about ten times less. The possibility of an age-selective lockdown, comments the author of the article Matteo Villa, is not a panacea: "it is only a strategy to delay as much as possible the moment in which a new restrictive and tragic measure becomes necessary. of the caliber of a lockdown and, at the same time, we want to significantly contain the pressure on the health system compared to a status quo scenario ”. In addition to avoiding the most severe setbacks from an economic point of view, "it is important to know that selective isolation would greatly alleviate the pressure on the national health system", comments the researcher. "By effectively isolating people over sixty, the pressure on the health system could be reduced by almost three quarters."

An analysis, however, that has generated much controversy and dissension in the scientific world. For example, Luca Ferretti, a researcher at Oxford University's Big Data Institute, commented in a tweet on the idea of ​​an age-group lockdown in exact words: “It seems that many (respectable, as far as I know) economists are recently proposing the idea of ​​physically distancing the elderly from the rest of the population causes Covid. Spoiler: Epidemiologists are not as stupid or naive as you obviously think they are ”. In fact, Ferretti recalls how these proposals have already been considered by epidemiologists for some time now, and precisely since January.

Now, I understand falling away from the pear tree.

But to think that these proposals do not have been taken into consideration means to consider the epidemiologists idiots.

Perhaps these did not make a good impression during the pandemic, but they have considered this possibility since January!

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- Luca Ferretti (@LucaFerrettiEvo) October 30, 2020



So why not propose this very simple solution instead of, for example, Immune? "Because it is a simple measure to state, but of a disarming complexity", comments Ferretti, underlining how Immune, compared to selective lockdown, is a simple intervention to manage. “We all find it easier to protect our parents / grandparents than to develop an app. But this is not necessarily the case at the country-system level. ”

First of all because it is extremely difficult to completely isolate oneself from the virus. Also, a selective lockdown should go on for a long time to work. "We do not know how long ... it would depend on the evolution of the epidemic and on how many doses of the vaccine may be available and since when. Initially it would be essentially indefinite ", comments the expert. “The proposal has not been taken seriously by any government that I know of. Nobody is able in a short time to propose a model for managing such a complex situation and which should be extended indefinitely ”. Finally, concludes Ferretti, it is an unfair measure. "You can't ask all Italians to spend 5 minutes downloading an app and follow its directions, because it violates personal freedom, but can you ask a third of them to shut themselves up at home indefinitely? Seriously?" .

The protection of the most fragile individuals is important in the response to the virus, and we should have already done so.

The radical proposals on the other hand, either come seriously with an action plan to manage 20 millions of people, or are solutions that leave the time they find.

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- Luca Ferretti (@LucaFerrettiEvo) October 30, 2020



The biologist Enrico Bucci also expressed his opinion on this in a recent post on Facebook. According to the expert, in fact, isolating the elderly will not avoid the saturation of hospitals. The percentage of hospitalizations in this age group is perhaps 50% of total hospitalization cases, as both US and Italian data suggest, where the average age of hospitalized patients was 65 years in the first wave. “We have a doubling time of hospitalized people which varies between 5 and 10 days, according to the region considered”, comments Bucci. "Even if we halved the pool of the susceptible, selectively securing, segregating or isolating (you do) the elderly, but leaving the others free, we would have an even larger reservoir of susceptible than what the virus needs to duplicate the current inpatients , and to double again in the subsequent doubling period by sending the hospitals into a tailspin (this is what is needed, given the current conditions); not to mention that no effect of isolation of a part of the population is instantaneous ”.