Why an “A Plan to Move Forward-Export Version”? It has to do with the middle of the night realization. The vision of ever more harm done by the continuing lockdown kept me awake. We needed a way out before the injury gains permanence. I had a plan for a proactive approach to determine when most people could go back to their lives. Getting it out to a broader audience isn’t easy for an old blogger. Maybe a major news outlet would help. After going down the list, only The Wall Street Journal (WSJ) showed promise. At least they had entertained the idea we might be running off a cliff. Hence, the more formal “Export Version.”

Alas, the only thing I received from the WSJ was a 4/6/20 email noting they had received the OP-ED. That was it. Rather than tossing this version of the plan, I thought it better to post it here. It just might be more accessible and quicker for people to understand. Since the WSJ submission, others such as Dr. Scott Atlas and Dr. John Ioannidis have made many of the same points. Just not a practical, comprehensive plan for right now. The test of a program is if we had it all over again, would we shut down the world? Would we put 30 million and counting out of work? Wouldn’t a more targeted plan have been vastly better? Remember, on March 20, the day California became the first state to issue a lockdown order; I proposed an alternative route in the “Some Thoughts” post. Ruined lives keep me up at night. Every day the depression gets worse and the road back longer. How can I get the word out? Any Ideas?

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.

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We thought our plan for moving forward was pretty clear and would be seen as workable. Apparently, we were wrong. We feel the wind generated by east-west and back head movements. The identification and protection of the most vulnerable are seen by some as impossible.
Others contend they’re already hunkered down. Neither of these things is presently valid. As we have pointed out, almost all of the at-risk group is known. The government and/ especially to the medical community know how to contact them. People with preexisting conditions are under medical care. We know this because a doctor has to prescribe their necessary medications. Doctors know how to reach people with diabetes, HIV, cancer, heart disease, and the many other conditions, COVID-19 puts them in grave danger. They can definitely contact their endangered patients. The government sends almost all the elderly social security checks, so they too can surely send them information.

Sheep are highly at risk of being attacked by hungry wolves. Shepherds of old didn’t just tell the sheep of the danger and advise them to lay low. Wolves can be seen as COVID-19 infected. The sheep are vulnerable. The shepherd’s job is to keep wolves and sheep apart. They could hunt the wolves down, but they don’t know where they are, so that takes a lot of work and time. On the other hand, the whereabouts of the sheep are well known so we can gather and protect them. In the best of worlds, we can do both, but which is more easily achieved?

We may think we’re protecting our susceptible, but the facts say otherwise. Over 76% of those needing extreme care are those with preexisting conditions. We can narrow it down even more. According to the Wall Street Journal, “Men are seen as three times more at risk of death in a hospital from COVID-19.” This experience is mirrored in other countries and our experience with other pandemics. We know who is in danger of overloading the system. It’s not healthy 12 yr school kids. Yet, we still have coronavirus outbreaks in nursing homes. Seniors stand in dangerous crowds during special grocery store hours only come up empty of necessities. According to today’s Wall Street Journal, the government is just now issuing guidelines for nursing homes. It just makes sense to build a dam upstream rather than be overwhelmed by the flood.

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We are at a point where carping about what was or wasn’t done in the past is useless. We have to move forward in ways to savie lives and, at the same time, preventing a deep depression. Many solid ideas are floating around to help make this possible. This is our attempt to combine them into a workable program. 

Segregate and Protect the vulnerable. It would’ve been much better to have done this right from the beginning, but better late than never. Virtually all the at-risk are known to the medical community. Those with underlying conditions young and old have been treated by a doctor. Someone writes their prescriptions. Doctors need to immediately contact patients with instructions to self-quarantine. This should be accompanied by a letter identifying them as at-risk with a barcode, and directions to an online questionnaire to find each person’s ability to comply. Also, this should include a release to share the info with others at the end of the survey. This is needed to resolve medical confidentially issues in allowing others to asist. It would be best if these forms were quickly created at the federal level for speed and uniformity. It would help if there were public service announcements to make people aware of these forms and the need for a quickly filled out questionnaires. This will allow us to know who needs help and support. We can then center maximum efforts keeping them from being exposed. If they’re not exposed, they won’t need the ICU or to be put on ventilators because of Coronavirus. Remember, anyone needing intensive care is a failure to protect them from exposure. Nursing home residents still dying from Covid-19 shows us we haven’t even protected the most easily identifiable at-risk group. 

Extend Testing and Tests.  We need to know who is presently infected, who isn’t, and who has recovered. To identify the infected, we still need to quickly expand the quantity and speed of Covid 19 tests. Also, we need two other types of tests. The polymerase chain reaction test (PCR) presently used to determine the genetic signature of the live virus to identify those very recently infected. Now in development, a serology test studying the serum and other bodily fluids to identify antibodies formed in response to the infection. The knowledge of who is or isn’t infected and who has recovered will provide us with better tools. These can be used to keep the space between people having the disease and those in the greatest danger. Knowing who is immune can be a game-changer. Just having them available to care for the vulnerable would significantly improve safety. The tests will provide us the data to move forward.

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What are we hearing? Hospitals are in danger of being overwhelmed, resulting in needless deaths. We are going to spend trillions of dollars to offset a near shutdown of our country. Who are the ones needing acute care threatening to swamp our medical facilities? As we pointed out in our last post, the vast majority are the elderly and those already compromised. This at-risk population is the one contributing by far the most to the death tolls. Common sense cried out; these were the ones to protect and segregate from the carriers. After all, this has been true in every epidemic experienced. Identifying those infected and putting distance between them and the most endangered is the first thing to do. In response to past epidemic experience, countries such as Singapore and South Korea moved immediately to widespread testing. They enlisted all public and private resources to make testing kits available as widely as possible. Blocking travel with infected areas was a given. President Trump acted with reasonable speed in shutting down travel with China buying precious time. The time that should’ve been used to test widely and protect and segregate the vulnerable. Instead of following countries such as South Korea and getting widespread help in producing and using test kits, our CDC and FDA refused help in favor of their own paltry number of test kits. Then theirs proved faulty. We slipped behind the testing curve. The CDC has offices all over the world, so they were well aware of what others were doing and experiencing. They just elected to go their own way and do inadequate testing.

It’s a good idea when faced with an attack to take stock of your arsenal to see what works. With this Coronavirus attack, we have to look to what has worked on virus-immune assaults in the past. There seems to be quite a list of possibilities. For instance, a 70 yr old malaria drug, Chloroquine, seems to show some promise. Sadly it was the French initially tested it, not the US. Again the CDC and FDA were slow off the mark.

Still, one would expect we would have robust procedures to alert and segregate the compromised and those close to them. They are the ones filling the ICUs. They are the ones most in danger of dying. Even today, we haven’t taken many of the most straightforward targeted measures to protect the most vulnerable. For instance, Honeywell and 3M are increasing the production of n95 masks by 1 1/2 million a day. Wouldn’t it make sense to make some of these available to 1-2 % most at risk? These could be used whenever they have to interact with others. Older people and others at high risk still need to eat and procure necessities. One would think they could get delivery and avoid contact, but this is spotty at best. Fresh produce, an immune enhancer, for delivery service has been overwhelmed by demand. Even “pick up and go” when available have extended lead times. A week seems a minor miracle. Many grocery stores have tried to accommodate seniors with special early shopping hours. Now we have a mass gathering of the vulnerable. Just one infected person could wreak havoc. How could this happen? An 86 year old acquaintance went to Costco for needed hearing aids and also went shopping at the local grocery. Maybe masks might’ve prevented a potential virus hot spot. Governor Cuomo of New York fears health care in his state will be swamped by a flood of the sick One of the best ways to prevent a flood is to build a dam in the narrows upriver. Once you have a torrent, you have a vastly more extensive problem. Our leaders have been thinking Macro when micro might’ve have given better results.

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