Identifying the vulnerable

In my last post, I revisited my idea that quarantine of suspected infectious people is no longer a wise course of action.   Instead we should react as we do normally with seasonal flu or common cold, allowing people to choose on their own whether the are able to go out their daily activities and accept the fact that they might spread the disease.   It appears that this disease has a higher than normal rate of severe or fatal complications. To minimize the demand for medical services and the number of deaths, the better strategy is to isolate those who are most vulnerable.   The available data strongly suggests we have a good idea of who are vulnerable and they are easy to identify without need for new testing.

The data indicates that the vulnerable are older adults above the age of 50, and the vulnerability rapidly increases as the age increases.   The data also indicates that the vulnerable have specific (but common) preexisting conditions of heart disease, respiratory disease, cancer, diabetes, or hypertension.   Of course, there is a lot of overlap for both categories but I would assume they are independent variables.

Isolate every healthy (uninfected) person over 50 or with the most common preexisting conditions present for those needing intensive care or eventually dying.

This is a clearly a radical proposal that is all but impossible to achieve in the societies that believe they are democratic and free.   Such a proposal would require a form of authoritarianism that if attempted certainly would trigger a rebellion.   However, I still think it is our best chance to minimize the effects of the disease and of the disintegration of the supply chains.   For example, we can’t allow quarantines to stop farmers from planting, managing, and harvesting their crops.   We have to accept that potentially infectious but healthy-enough people need to continue their jobs.

Another view is that the quarantine processes especially when applied to people who are not severely sick will disproportionately remove from the work force the younger people who are more likely to be doing the jobs needing in-person activities.   Meanwhile, these are the people who are least likely to experience severe complications.    At the same time, the older people not yet quarantined are likely unable to step in to do the work to replace the younger quarantined worker.

I am curious about what the data is showing about the vulnerable.   Intuitively the older or those with preexisting conditions have some form of degradation of bodily resilience to diseases.

There is the curious absence of a lot of severe complications or death among the very young under the age of 5.   I would expect them to be less resilient to older children, adolescents, or young adults but the data is not showing this.   Why are there not more problems with the very young?   People who are infected are highly likely to pass the infection to their young children living in the same home.  Also those children will expose each other through normal close-contact play with their peers.

These children must be getting infected and yet they are not getting sick.

There may be more involved than just age and preexisting conditions.   I wonder if there is a mental dimension at work as well.   People might be getting sick because at a deep subconscious level they expect to get sick.   I do recognize that there are still other infections going on with flu and common cold yet only this one virus causes the severe reactions.   The virus is necessary but it may require some mental cooperation to allow it to advance to severe levels.

In particular, preexisting conditions likely come with a mental component.  By the very definition, the patient is diagnosed or at least is aware of this condition.   This awareness will include a sense of dependency on medical care to manage the condition.  This awareness may also come with an expectation of being more vulnerable if conditions go beyond a certain point.

There may be a period of disease progression where there is no difference between those with and without preexisting conditions.   There may come a point where the conditions cross into more severe where bed rest is the only option.  Both groups may reach this stage but mentally they may react differently.   The ones without preexisting conditions will have more confidence in their core health and fight off the symptoms.   In contrast those with preexisting conditions may overreact because they are more convinced of their vulnerability.  The overreaction itself may accelerate the progression of the disease.  Alternatively, the lack of overreaction may give the body the peace it needs to fight off the disease.

This is purely speculation from a point far removed from actual healthcare.   However, it is relevant when discussing the identification of the vulnerable to isolate from the possibility of being infected.   Maybe another criteria for vulnerability is mental state, in particular the self-confidence in ones health conditions or the fear of the unrelated but preexisting health condition.

This may also include the older age with neither of the major preexisting conditions associated with poor outcomes.

I return to the very young being more resilient to this disease.   Among their traits is an unawareness of various topics outside their immediate lives.   They have not been educated to learn these topics, and their attention is not drawn to them even if they were able to learn them.   These topics include politics and suspicions of what other groups may be plotting against them.

Almost immediately after the appearance of this disease was speculation of it being a human designed pathogen.   This was made credible by the close proximity to a biological lab that specifically worked with viruses and other pathogens.   Adding to the credibility are the now decades old warnings about the extreme effectiveness of weaponized pathogens.   Also, there is now a current acceptance of a constant threat of terrorist inspired attempts at mass casualty events.

Older people are more likely to entertain these thoughts.   My intuition suspects that the acceptance of these ideas increases with age especially given the events and discussions that have been escalating over the past several decades.   Older people are more likely to believe that now is the time they feared would come.

None of this needs to be true to have an impact on people’s minds.   If they are convinced they are infected with a bioweapon, they may overreact similar to those who don’t trust their innate healthiness.   That overreaction alone could deny the body the peace it needs to fight off the infection.

One thing the body needs to fight off viral infections is for the person to get good uninterrupted sleep.   Such sleep would be less possible if the person’s mind obsesses over his own vulnerability even if it is just imagined vulnerability.

There are likely other reactions that are different between the person who feels doomed and the person who has confidence and accepts the symptoms as normal.

I would like to see some more data on the preexisting state of mind for those who eventually experience severe complications or death.   I don’t know how that can be done.   Even if it were possible it would probably require some immediate and frequent testing similar to the need for immediate and frequent testing needed for positive results for infection.

Perhaps I am doing my part with this blog.   If I were to get ill in the future and eventually get counted as having severe or fatal complications, someone will have the opportunity to read this blog and see what my state of mind is.

This does go back to my thoughts on a dedomenocracy government that values data, especially data from individuals including their private thoughts and their gossip.  Similar to how medicine benefits from knowledge of preexisting conditions, it may also benefit from knowledge of preexisting mindsets.

I wonder whether mental treatment may offer some curative effects that could quicken the recovery of the infected, resulting in fewer people needing hospitalization or facing death.   They may need convincing very early on that this is not the disease that will do them in.

If this is true, then it points to yet another reason why the current discussion of quarantines of potentially infectious people.    The strict enforcement of these quarantines convinces more people that this disease is more dangerous than it is, or that it would be for them.   The more convinced they are are of the fatal consequences of their getting the disease.   This may be just what the virus needs to complete its final solution.

One thought on “Identifying the vulnerable

  1. Pingback: COVID19: data begins to tell a different story | Hypothesis Discovery

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