In the past few weeks there have beencontroversial proposalsAsk older, more vulnerable adults to isolate themselves from society while younger adults build herd immunity to COVID-19. These strategies have been identified by leaders as “practically impossible” and “unethical”. However, requires shielding from COVID “stratified according to risk“continue.
A new high quality algorithm for predicting people’s risk of developing COVID-19 and dying. published in the BMJcan give credibility to these proposals. This algorithm could be useful in enhancing measures to help shield people at high risk through vacation programs or advice from general practitioners. However, the predictions are not as accurate when lower risk adults assume they are safe. are less careful and increase the risk of contracting COVID. Given the speed at which the coronavirus can spread, an algorithmic approach that encourages young people to take the risk of disease could solve the problem A-level result algorithm look like a success.
In order to properly inform someone that they have a “low risk” of COVID, we need better information about what they are low-risk for. While the algorithm can predict the risk of hospitalization and death from the disease, we cannot yet adequately predict the risk of long-term health effects known as “long-term COVID”.
Long COVID is poorly understood but causing reports about it debilitating fatigue, brain fog, or shortness of breath For months now, young, healthy people with milder cases have been suggesting that this is a result that shouldn’t be ignored.
A lower risk does not mean a lower risk. Deciding who is at acceptably low risk and how many of us it would mean will be complex. While most of the COVID deaths focused in older adults or those with health problems, half of the patients admitted to intensive care due to COVID were in Adults under 60 years of age. So we may need to shield a significant part of the working population. Many employees want to decide for themselves whether the risk is acceptable to them and they may have trouble saying no to a boss who wants them back at work.
With infectious diseases, the main problem is not necessarily individual risk. It’s group risk. Many young people live in multi-generational households and their main desire may be not to pass them on to more vulnerable loved ones. While spikes in infection are common in young people, they pass on quickly older Groups.
Monthly separation of households is not a viable solution, especially for families with informal caring responsibilities – and employers may be reluctant to allow low-risk workers living with high-risk adults to work from home.
While shielding cues can be helpful, promoting or accepting higher levels of infection in younger populations may not be enough to protect people at higher risk. The algorithm’s predictions, trained on data when shielding and precautions were in place, show that groups recommended shielding remained massive disproportionate risk of death.
Another difficulty for shielding strategies could be providing safe medical care for their other health conditions. Individuals receiving chemotherapy may be classified as high risk for COVID, but would have to reduce their shielding to continue receiving treatment.
Although every effort is made Make hospitals COVID-freeAn increased incidence in younger populations, including doctors, nurses, caregivers, and taxi drivers, would make participating in medical treatments riskier.
Structural inequalities and racism affect who is able to do so To work from home, on sick leave, dependent on public transport and living in overcrowded households. All of this brings together working class ethnic individuals and minorities higher risk from COVID-19.
The desire to reduce these discrepancies likely led to the inclusion of ethnicity and disadvantage indicators in the algorithms. However, using an algorithm to selectively exclude people from society and from jobs based on race, age, disadvantage or health status is not an equitable solution. Especially when those most likely to be asked for isolation live in cramped households.
With a Recession loomsWorkers who have already been excluded could run the risk of losing their job, training or promotion because of their postcode and ethnicity.
Requiring vulnerable adults to bear the burden of the pandemic in terrible isolation for an unknown period of time would undermine core public health principles. Isolating everyone indefinitely or having repeated bans doesn’t sound like appealing solutions either. The UK is already in a second lockdown phase and when infections aren’t low enough to fit on one Excel tableit could stand before a third.
There are difficult decisions to be made as to whether we need to use a more aggressive strategy of repression in order to open again more fully.