Covid-19: How To Rapidly Get To The Only Possible End Game – Herd Immunity Three new game-theoretic strategies that improve on ‘Sheltering in Place’ to battle the current Covid global pandemic. All three strategies balance the impact to both human lives and the economy within weeks. XLABS By Travis Dirks PHD, CTO, XLabs AI March 26, 2020 Contributors Dr. Lorna Tumwebaze*, MBChB, MD/MPH, DPH, Epidemiologist & Global Policy Advocacy, The Gates Foundation Dr. Monica Bucci*, MD & Director of Clinical Research at The Center for Youth Wellness Emmy Sobieski, CFA, MBA, 25-year institutional investor focused on disruptive technologies Radhika Dirks, PhD, Top 30 Woman in Advanced AI & CEO XLabs AI 1 * The views and opinions expressed by these contributors do not reflect the positions or policies of their respective employers
XLab XL abs We Need To Get To Herd Immunity ASAP Herd immunity is the only destination in sight for Covid-19. Ifherd immunity is not possible, there is no end game. Everything else is just living with the problem. It is very important to • understand that there is literally no other way to win. 1 Herd immunity is defined as: • 1. a significant number of people have had the disease and can no longer pass it on, and 2. the chances of someone infected with the virus meeting someone, who has neither been infected nor is mortally vulnerable, is near zero. Vaccines are a shortcut to herd immunity. But ETA to Vaccines is: ~12 months. • There Are 3 Other Tech-enabled Strategies That Can Be Ready To Implement In 2-3 Weeks That Save Lives & Preserve The Economy ¹Fundamentally we can not control whether the end game of herd immunity is available to us. Nature has decided already, and we will learn as 2 time passes. What we can control is which potential road to herd immunity we are on and what death & economic toll we will pay.
XL XLab abs Solutions: Fast Track to Herd Immunity ECONOMIC IMPACT SEVERE MEDIUM MINOR (potential depression) (minordip) (very littlechange) Problem with Current Strategy: Basic Social Distancing is basically Freeze Tag. Everyone is • (weeks) SHORT frozen. Social Distancing 3.0 (Improved Strategy 3 It will work, but experts state that it needs to be in effect for 12 • Tech Enabled) months: unviable for the economy South Korea’s ‘Test Broadly and Quarantine’ saving the economy • from the worst but creates a near permanent state of disease & TIME IN CRISIS lockdowns (fewmonths) NOT LONG What we must do now is clear and MUCH easier technologically • Social Distancing 2.0 Change the Odds than creating a vaccine. (Improved Strategy 1; (Improved Strategy 2 Tech Enabled) Tech & Science Enabled) The RouteForward: 1. Invest heavily in vaccines and in raising the thresholds at which our hospitals (could be years) VERY LONG breakdown & mortality rates jumps from <1% to 5-10%. Social Distancing Test Broadly & Quarantine 1 . 2. Invest aggressively in the technology & policy needed for Social distancing 2.0, 3.0, (Current in US, UK, (Current in South Korea) Change the Odds etc.) 3
XL XLab abs There are Only 3 Ways to Get To Herd Immunity There are only three different mortality rates available to us: roads to herd immunity. We need to be on Roads 2 & 3. Road 1 . Hospital Overwhelm: Mortality Rate ~5-10%.If herd immunity happens at around 90% of the population recovered, then this route equates to 15,000,000-30,000,000 deaths in the United States, mainly among those over 70 year s old. This is not a road we want to be on. Deaths to Reach Herd Immunity @ 90% Infected Rate in United States Road 2 33 Million Road 1: Hospitals Overwhelmed Hospitals Functional: Mortality Rate ~0.5-1%.Ifherd Immunity happens around 90%, this route equates to 1,500,000 to 3,000,000 deaths in the United States, again mainly among those over 70 years old. Until a vaccine or other cure is available, this is the best road we have in our power to take. Road 2: Hospitals Functional 3.3 Million Road 3 Vaccine or other Cure: Mortality Rate ~0.0001%. can’t get to without heavy Road 3: Vaccine or Other Cure 330 investment and passage of time for testing. Ifherd Immunity happens around 90%, this route equates to 230 deaths in the United States. Age distribution unknown. This is the road we would dearly love to be on, but won’t be available for 12 months. - 5 10 15 20 25 30 35 Deaths (Millions) 4
XL XLab abs Covid-19 The Complete Playbook – 3 Unacceptable & Unavailable Strategies DO NOTHING 1. Do Nothing - Let nature takeits course NO Vaccine, No Flattening the curve. This potentially leads to 15-30M ECONOMY dead. Not an option. (GDP) Length of Crisis (Months) 2. Develop aVaccine People have been working on a coronavirus vaccine for YEARS. It will not come tomorrow. Ifwe discovered the vaccine today, estimates are it would take 18months to get it into enough people’s hands to help. While this is the best strategy and should be heavily invested in, it must be paired with one of the strategies for flattening the curve until the vaccine is available. NUMBER INFECTED Total Real Infections 3. Raise theThreshold Raise the Threshold at which hospitalization service breaks down to the Hospital Overwhelm rate of death, i.e., raise total nationwide hospital 5-10% of known infections dead. treatment capacity. Downside – huge lag time of months until supply Death toll in the millions. chains adjust to the critical equipment needs Like ventilators and Total Seeking ICU beds, this is necessary but is not an immediate alternative. Known cases above threshold - Mortality 5-10% Treatment Hospital Breakdown Threshold Known cases below threshold - Mortality 0.5-1% TIME SINCE FIRST INFECTION These 3 strategies are all unacceptable or currently unavailable 5
XLab XL abs Current Covid-19 Playbook – 3 Working But Painful Strategies SOCIAL DISTANCING AND QUARANTINING ECONOMY Flatten theCurve Test Broadly and Quarantine ECON (GDP) Flatten the Curve: Find a way to slow the spread or otherwise keep the number of OMY critical hospitalizations below threshold. Basic Social Distancing Length of Crisis - New Normal 4. Basic Social Distancing Very Negative Economic Impact and Prolongs the Emergency. Social distancing is a game of freeze-tag, with everyone frozen. It will work, it ) T U O will also wreck the economy and cause incredible negative downstream B WA effects. O NUMBER INFECTED N EK W 5. Test Broadly and Quarantine R E Lowers Economic Impact, but still Prolongs the Emergency. The South B M U Korean Strategy – test broadly and often. Pull the infected quickly into N 0.5-1% of known infections dead. ( D quarantine. Everyone else goes about life a little more carefully. Has the Death toll in the tens of thousands. E T C great advantage of not decimating the economy. The biggest downside E F is that herd immunity is never reached. You have only paused the game. N I R Total Real E B Infections Known cases above threshold - Mortality 5-10% Hospital M U Breakdown N Known cases below threshold - Mortality 0.5-1% L Threshold A Total Seeking E R Treatment T I M E S I N C E F I R S T I N F E C T I O N TIME SINCE FIRST INFECTION Both these strategies have such broad economic impact because they manipulate the entire society to indirectly effect the total real infections. But their ultimate goal is really to reduce the total seeking treatment. 6 What if we could manipulate the curve that must stay below threshold directly?
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