As an octogenarian, I’m well aware of the shortcomings in aiding and securing the at-risk. It’s dismaying how little we do to protect the most vulnerable. However, this realization has led me to ponder how an all-out effort to correct this situation might be a way out of our present untenable position—a proactive three-phase plan to move us from our virtual national lock-down to a reopened nation. We can do this in a time frame we determine by our actions. Action is preferable to watching our economy and lives unravel awaiting a vaccine or an effective therapy.

Phase 1. From the first data we received from Asia, Italy, and our own experience, the findings have been consistent. The vast majority of those requiring intensive care are those with pre-existing conditions and the elderly. Even the lowest figure we’ve seen shows these make up 78 % of ICU admittance. The vast majority of deaths occur in this group. We can refine this even further. Men are three times as likely to die of COVID-19 than women. Italy reports 85% of those dying from COVID-19 are above70. By all indication, the majority of the remaining 15% had underlying conditions. In short, we know who is overwhelming our health services, and it’s not healthy 12 yr olds. It’s the group that cries out to be segregated and protected. 

With the present, almost universal lock-down, one might think the protection of at-risk populations would receive our utmost efforts. The facts say otherwise. We still have coronavirus outbreaks in nursing homes. Seniors stand in dangerous crowds during special grocery store hours only come up empty of essentials. According to the Wall Street Journal, the government is just now issuing guidelines for nursing homes. Nursing homes account for 20% of COVID-19 deaths. We knew the dangers months ago from the Washington States’ Kirkland Life Care Center. I was just listening to a state health official say they need to something about those in assisted living. Of course, they have no masks or anything else available. Ask any of the vulnerable or those who care for them, and you’ll hear a horror story. Every day the at-risk are endangered out of necessity. 

So how do we protect the truly at risk? The government speedily needs to prepare a doctor’s letter and a survey to be conveyed by physicians to every one of their highly at-risk patients. Each dangerous condition has its doctors, and it’s their job to communicate with and help their patients. This letter must be a stern warning that they are in great danger of dying from coronavirus. The message would identify the recipient as at risk. It should contain a supporting barcode. This measure will allow them to get to the head of the line for needed services. If a therapy becomes available, the most endangered would be listed and could receive it as needed. At the same time, the government should duplicate the effort for everyone above 70.

Accompany the letter with a link to a short online survey to identify the person’s circumstances and what they might need for segregation. One would either land in one of three groups. Those needing only priority to get necessities, those requiring some help and those needing significant help or to be moved. This questionnaire would also contain a release so the information could be shared. Email the letter and link to the online survey ASAP—mail backups. Use public service announcements to get the word out as soon and as wide as possible. We can expect robust compliance and cooperation. Imminent death tends to focus minds. A consortium of government agencies and Non-Government Organizations in every area will review the surveys. The NGOs would seem the best bet for quick help. At least a dozen were listed in our local paper as ready and willing to aid the at-risk. They just don’t know where they are. Government agencies could backstop the NGOs while concentrating on clusters of endangered. Nursing homes assisted living, and retirement communities leap to mind. When an area has secured all its at-risks, report it as part of national accounting. We can all see the progress.

While some may only need aid in getting priority in getting delivery or safe pickup of essentials, others will require more extensive help. A support plan put into effect. Move some people under some circumstances. Households with elderly or other people at-risk in some cases will need to be separated. Place elsewhere either the at-risk person or the ones that must go out in the world. Under epidemic circumstances, this isn’t a problem. We have an almost endless number of empty hotels and motels across the nation. The owners would like nothing better than getting some revenue and work for their employees. Quality and location would be the standard for those who have to leave a multi-generational home to do essential work. Use the very best facilities for the at-risk. After all, we’re talking about someone’s loved one. Accommodate caregivers desiring to accompany the vulnerable. Most hotels have kitchen facilities, but where needed, conveniently located restaurants can offer their services. This action sounds expensive but will prove to be a great bargain compared to an endless lock-down. 

Those with fewer means are dying in numbers disproportionately. People of color are prominent in the figures. These are the people likely to operate outside the conventional financial system. A remote operation to receive the delivery or safe pickup of necessities depends on some sort of credit or debit card. The poor are more likely to deal in cash. The high-risk situation is the norm. A large proportion of the at-risk needful receive snap cards (food stamps). Only a few states issue them as prepaid debit cards. Exchanging these for debit cards would allow them to distance themselves from dangerous situations. 

Vitamin D is essential to our immune system, and deficiency is common among people of color. Covid-19 thrives on poor immune function. Most people with underlying conditions get blood tests. The Physicians letter should tell the recipient how much to supplement and how to get this inexpensive vital vitamin.

This plan will require priority for specific resources. Test kits, face masks, and other safety apparel, along with a supporting workforce, will have to be diverted to achieve this great separation. Curbing the supremacy of the medical community may have to happen. They may resist giving up assets. Just giving up some face masks to the at-risk and those serving them may result in howls of danger to health workers. How shortsighted. It would be akin to denying resources to build a dam upriver to use far more fighting a near-endless flood. We must make a cost-benefit analysis to allocate the assets. If people don’t end up in your ICU, you don’t need as many resources. Remember, every one put in the ICU represents a failure to protect. The majority of COVID-19 patients put on a ventilator die. The facts favor the dam.

Phase 2. Once the vulnerable are secured, we need to open the rest of the country. By that time or soon after, we hope we have the required tests to determine who recently became infected, who has had the disease and is now immune. Antibody tests will help us to infuse the ill with lifesaving antibodies. Maybe even more important, tell us who can safely work without protection for themselves and others. The at-risk can find someone certified and registered as immune to tend to their needs. A hairdresser or dentist and so many others they need will become available Even the quarantined endangered can begin to emerge.

 Knowing who has achieved immunity will be a great gift. It will help us determine when we have gained herd immunity. We know once the reasonably predominately younger and healthy go back to work, school, and normal life restored, the virus will rapidly spread. They may become sick, but few will die. At some point, we will achieve herd immunity, and the disease will die out. 

During this phase, it will be essential to continue income supports for the at-risk to avoid forcing dangerous situations.

Phase 3. When we achieve herd immunity, the quarantined can return to normal. The only problem may be getting Nana to leave the Four Seasons. The best guess is the protection lasts at least a year. Hopefully, by that time, we have a vaccine or at least effective therapies. If there is a recurrence, we should be in good shape, and we would know those needing help right off the bat.

The major strength of this plan is it will give us a good idea when the lock-downs can end. It’s probably is too optimistic securing those with underlying conditions in a month. Still, we will be able to track progress as each area reports compliance across the country. Everyone can start making plans to return to the field. The vast amount of people with a vested interest in a quicker return will get behind the effort. High profile people in sports and the arts can help speed up awareness and help. The prospective comeback of these segments will lift people’s spirits. Of course, the most significant lift will come from seeing the light at the end of the tunnel. Instead of waiting endlessly in place for a vaccine, this is a proactive way to get control of the epidemic. We determine when we get most people back to work and open the schools. 

Once people realize we’ve done everything in our power to protect those truly at risk, people can turn morally and ethically to saving the country from a terrifying depression. It isn’t a choice between saving lives and the economy. We did our very best, and nobody can expect more. We can move forward.