© Paul Morris/BloombergPeople wearing protective masks walk on Jefferson Street on Fisherman's Wharf in San Francisco, California, U.S., on Monday, June 22, 2020.
There's no doubt that we are dealing with a major health crisis with reverberations across our society. We need to act decisively, we need to act promptly, we need to act with precision. We need to act in a way that will optimize our chances of saving lives and also minimize the harms, both from the pandemic and from the measures that we have to take.
Shutdowns are an extreme measure. We know very well that they cause tremendous harm — for people's lives, for their health, for their mental health, on their ability to get the best care for major problems like heart attacks, like cancer care. Shutdowns can take a major toll on employment, they can take a major toll on people who are disadvantaged, leaving them even more disadvantaged.
It protects some of us who have the means to shelter, but it leaves essential workers and disadvantaged populations pretty much unprotected. We have many measures to deal effectively with the crisis that lower the case load and decrease the deaths that ensue.
We know far more than when the pandemic started. We know the high-risk individuals to protect, we know the settings that have disaster potential, like nursing homes. We know how to act with precision, and we should do that rather than just destroy our entire society, our entire country, and eventually also the entire world, because much depends on what the United States does.
I think that lockdowns and shutdowns have not really worked in the past. I don't think that the lockdown was what worked in China. I think that the lockdown happened after the epidemic wave had peaked. My colleague at Stanford, Michael Levitt, has shown, pretty convincingly, looking at the epidemic wave curves and modelling them with complex functions, that this might be the case, both in China and in other places.
Even with increased testing, we see that even in hot epicentres that are still brewing, the number of cases is going down. If you look at California, Texas, Florida, the number of cases, even with increased uptick of testing, has peaked around July 12 to 22 and has been plateauing and going down since then. If you look at deaths that follow the peak in cases by a couple of weeks, they're also starting to go down.
The time that we diagnose cases is not when people get infected. It sometimes may be much more than a week. So I think that a shutdown at this point would make no sense. Our whole society is disrupted if our educational system is not functioning. At the same time kids do not really have any chance of dying from the disease, with very, very, very rare exceptions.
So I think that the main issue we need to debate is to what extent kids could possibly infect vulnerable adults and therefore lead to a higher death load. I think that we have evidence from dozens and hundreds of super spreader events and from disaster situations where COVID-19 has massacred large numbers of people and situations that originated at schools are not on that list.
At the same time, I recognize that we need to allow for the maybe five or 10 per cent of kids who have highly vulnerable individuals within their immediate environment. We should have some way that we can allow for a small proportion to join the class remotely. I think that we can be precise about that. The same applies also to the few kids who may be at high risk themselves. I think it's unrealistic to shut down our educational system and suffer major consequences when we can be more targeted.
Would I go for a lockdown in future epidemics? If we have a new pathogen, I think that we need to mobilize science as quickly as possible. We need to mobilize public health. To mobilize public health, we need to have public health. And unfortunately, public health has really not been given enough attention over the years. I think that we need to strengthen our public health institutions. They should be given priority.
Dr. John Ioannidis is a professor of medicine, professor of epidemiology and population health, and professor of biomedical data science at the School of Medicine, professor of statistics at the School of Humanities and Sciences, and co-director of the Meta-Research Innovation Center at Stanford University.
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