One virus – two approaches

It would seem that countries are choosing between two fundamentally different approaches when faced with the coronavirus and the Covid-19 disease:

Most countries are trying to delay the spread of the virus through social distancing, for instance by shutting down the schools, banning large events and sending home non-essential workers. The theory behind it is that the health service won’t be able to cope with too many cases at once, but on the other hand it’s too late to prevent the virus from spreading, so we need to slow it down to ensure that there aren’t too many critical cases at the same time, potentially overwhelming the hospitals. The downside of this approach is that it’s likely everybody will get infected eventually (unless a vaccine is found in time), and the economy is likely to suffer immensely because almost everybody is sitting at home all the time, potentially for many months.

The other approach, chosen by the UK and Sweden (and possibly by the US, although I’m not sure whether they actually have a plan) is based on the insight that the coronavirus only really poses a danger to old and vulnerable people. The plan is therefore to isolate only those who are in danger and let the rest of the population get of with their lives. In theory it’s a great idea – the economy won’t suffer a lot, there will be enough hospital beds for those people who unexpectedly react badly to the virus, and once everybody in the main group have had Covid-19, the population at large will have developed herd immunity, so the old and vulnerable won’t ever need to catch it at all, dramatically lowering the number of casualties. The problem is whether it’s really possible to isolate everybody who’s at risk – potentially for several months. How will they get fed? What will happen to vulnerable people with a job – will they need to go into complete isolation, too, potentially losing their livelihoods in the process?

If you think about it, it’s extremely hard to isolate the vulnerable people in society completely. What do you do about a pensioner with a working-age spouse – leave the pensioner to die or fire the spouse? What if a working couple have a lot of kids, one of whom has a severe lung disease – isolate the lot of them? What about pensioners who are working because they cannot afford their rent? The list is endless, and if you don’t get it right, the second approach won’t be successful. It’s also interesting that the UK are delaying the isolation of the vulnerable, claiming the moment isn’t right yet – what if they miss the boat and wait too long till too many of them have been infected?

I can see the logic behind both approaches. They both make sense and have their own strengths and weaknesses. I don’t think they mix well, however, which is probably one of the main reasons why so many countries have shut their borders – e.g., Copenhagen couldn’t really maintain social distancing while Malmö across the bridge were trying to get every able-bodied citizen infected as soon as possible.

Strangely, Scotland seems to be employing a mixed approach – it’s like the instinct is to go with the majority approach, but being part of the UK necessitates implementing the latter. The result is they don’t seem to be planning to isolate old and vulnerable people completely, but only to encourage them not to go out, and they’re shutting down the universities, but not the schools. I’m not entirely convinced this won’t be much worse than going wholeheartedly for one approach or the other.

Nobody knows what the best approach is – I presume epidemiologists will have a field day comparing them afterwards – but I do worry that the lack of a unified strategy in Europe will make it hard to reopen the borders soon.