The consequences of the COVID-19 pandemic have been enormous, and New York has suffered more than anywhere else in the world. Compared as a separate country, the New York area would rank, by far, as No. 1 for deaths per capita.
The New York-New Jersey-Connecticut tri-state area accounts for approximately 60 percent of all US deaths. Theories abound, but the New York area itself is different: New York is the top port of entry for the hundreds of thousands of tourists coming to the US every month from China; Gotham has a uniquely high density of living that swells daily by millions from workers and tourists; and Manhattan sees some 1.6 million commuters daily, mostly on crowded public transit, including 320,000 from Jersey alone.
Yet the pandemic toll is falling, dramatically so in New York, including both hospitalizations and deaths per day. Few doubt that the unprecedented isolation policies had a significant impact on “flattening the curves.”
Now, we face another, even greater problem: how to sensibly re-enter normal life. This must be based on what we now know, not on worst-case projections, using facts and fundamental medical knowledge, not fear or single-vision policies.
First, we know the risk of dying from COVID-19 is far lower than initially thought, and not significant for the overwhelming majority of those infected.
Multiple recent studies from Iceland, Germany, USC, Stanford and New York City all suggest that the fatality rate if infected is likely far lower than early estimates, perhaps under 0.1 to 0.4 percent, i.e., 10 to 40 times lower than estimates that motivated extreme isolation.
In the Big Apple, with almost one-third of all US deaths, the rate of death for all people ages 18 to 45 is 0.01 percent, or 13 per 100,000 in the population, one-eightieth of the rate for people aged 75 and over. For people under 18, the rate of death is zero per 100,000. Of Empire State fatalities, almost two-thirds were over 70 years of age. And regardless of age, if you don’t already have an underlying chronic condition, your chances of dying are small. Of 7,959 NYC COVID-19 deaths fully investigated for underlying conditions, 99.2 percent had an underlying illness.
Second, protecting older, at-risk people helps prevent hospital overcrowding. Of New York City’s 38,000 hospitalizations, less than 1 percent have been patients under 18 years of age. Studying 4,103 confirmed COVID-19 patients with symptoms bad enough to seek medical care, Dr. Leora Horwitz of NYU Medical Center concluded: “Age is far and away the strongest risk factor for hospitalization.”
Recent studies show a far more widespread rate of infection and lower rate of serious illness than early World Health Organization reports that noted 80 percent of all cases were mild. The vast majority of younger, otherwise healthy people don’t get hospitalized.
Third, due to fear and the single-minded focus on COVID-19 regardless of cost, other people are dying. Critical medical care isn’t being provided. Millions of Americans have missed critical health care for fear of encountering the disease, and people are dying to make room for “potential” coronavirus patients.
When states and hospitals abruptly stopped “nonessential” procedures and surgery, that didn’t mean unimportant care. Treatments for the most serious illnesses, including emergency care, were missed. Some estimate about half of cancer patients deferred chemotherapy. Approximately 80 percent of brain surgery cases were skipped. Perhaps half or more of acute stroke and heart-attack patients missed their only chances for early treatment, some dying and many now facing permanent disability. Transplants from living donors are down 85 percent from the same period last year.
And that doesn’t include the skipped cancer screenings, avoided childhood vaccinations, missed biopsies of now undiscovered cancers numbering thousands per week — and countless other serious disorders left undiagnosed.
Lastly, total isolation prevents broad population immunity and prolongs the problem.
We know from decades of medical science that infection causes individuals to generate an immune response (antibodies), and the population later develops immunity. Indeed, that is the main purpose of widespread immunization in other viral diseases: to assist with “herd immunity.”
In the COVID-19 epicenter, Gotham, higher immunity is likely, although undoubtedly muted by the extreme isolation. More than 20 percent of those tested had antibodies. While we don’t know with certainty that antibodies from COVID-19 stop infection, it would be expected, based on decades of virology science, including other coronavirus respiratory bugs, where immunity post-infection is thought to last for a year or more. That’s why scientists are hopeful about using COVID-19 antibodies to treat the sickest patients.
For population immunity, it is great news that half of infected people are asymptomatic and that medical care isn’t even necessary for the vast majority of people. That fact has been incorrectly portrayed as an urgent problem requiring mass isolation.
On the contrary, infected people are the immediately available vehicle for establishing widespread immunity. By transmitting the virus to others in lower-risk groups who then generate antibodies, pathways toward the most vulnerable people are blocked, ultimately eradicating the threat.
The curves have been flattened. Now, we must use established medical science and the evidence we have gathered, and for New York City in particular, limit the enormous harms accumulating from broad isolation and economic lockdown. While New York is unique, strategy should now focus on rigorously protecting the most vulnerable and strictly regulate access to senior-care centers.
Officials must issue rational distancing guidelines to the elderly and their families, including self-isolating the mildly sick. Masks could be required for public transit. We know children and young adults in good health have almost no risk of any serious illness from COVID-19, so logic means opening most schools. With sensible precautions and sanitization standards, most workplaces and businesses should reopen. This would save lives, prevent overcrowding of hospitals, restore vital health care for everyone and allow the socializing essential to generate immunity among those with little risk of serious consequences.
Scott W. Atlas, MD, is the David and Joan Traitel Senior Fellow at Stanford University’s Hoover Institution and a former chief of neuroradiology at Stanford Medical Center.
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