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05/25/2020

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He has an interesting thought on “differential mortality” being the driver of devastating pandemics. It takes people who don’t quickly die but carry the decease without significant effects to take down the more vulnerable portion in huge numbers. In case of COVID-19, the vulnerable portion is people who are older and who have chronic or serious deceases or weaker immunity. And the carriers are the younger people who have mild symptoms or none at all. This creates the danger that will propagate the spread in the future. As a working parent, I am acutely aware of the parents’ anxiety and the need to send kids back to school, as working and homeschooling your children at the same time is an impossible task. Also, the parents are not be as worried about the kids, since kids are not seriously affected by the virus, at least not seriously enough to keep them at home. As virus is destroying the economy overall, it is also destroying the families’ “economy” and sanity with the stressors and constraints of being stretched so thin performing multiple tasks and being anxious over the ability to keep up work performance. As kids return to schools, they will contribute to spread of the virus, carrying it asymptomatically or with mild symptoms, continuing the deadly attack on the vulnerable group of the population. A potential solution to this could be facilitating re-training the employees who lost the jobs to work as nannies and homeschooling teachers, provided they were willing, properly re-trained and passed background checks and vetting. This would probably require lowering or suspending the minimum wage laws, as most working parents would not be able to afford paying the current minimum wage for these services or subsidizing such services from school/government funds. Another potential solution could be to keep apart the “carriers” and the vulnerable population as much as possible but this, of course, presents another set of challenges: we may be dividing families across generation lines and isolating the section of society that is already lonely and isolated as it is, with the need for support and help from the younger generation. In this case, the care for such vulnerable sections could also be subsidized or accomplished by re-training those who lost jobs to be caregivers. One of the functions of these caregivers could also be to maintain social engagement of their clients through technology and social platforms by keeping up with their families through virtual meetings or following friends and family on social media. The bottom line is that the society should be thinking about effectively dealing with the “differential mortality” to put a stop to the pandemic and minimize its final death toll.

I enjoyed the historical perspective, especially to those of the plagues and the long-term positive impacts to the survivors. With COVID-19, I would argue that the timing is unfortunate. We are a decade from the 2009 financial crisis, economically, we were due for a recession. However, that is two major economically crippling event of a global scale. I would be interested to see the country by country impact in the long run (10+ years) as I would think it is devastating for countries with large inequality in wealth distribution such as Brazil.

However, that said, even within the U.S., it would be interesting to see generational differences. While it is true that the older population is more susceptible to the negative effect of COVID-19, the younger generations may suffer a great deal more economically as wage growth and employment both grinds to a halt in prime wage-earning years.

I enjoyed reading this piece of writing by Prof. Jared Diamond. It has such a comprehensive historical analysis of public health challenges. Although it might be a bitter pill to swallow, the inequality in the distribution of disease burden and mortality rates is well-captured.

"Finally, there is the issue of who is suffering most from Covid-19. The big killers of history and prehistory have involved differential mortality: peoples with some genetic and acquired protection from previous exposure, who then infected and caused mass mortality among previously unexposed peoples with no protection."

I think this phenomenon of mass mortality is also possible if measles and polio resurface due to coronavirus fear and halted access to immunizations. As discussed in the following article https://www.nytimes.com/2020/06/14/health/coronavirus-vaccines-measles.html, there are consequences of the strict steps taken to prevent spread of coronavirus. It illustrates how the Covid19 pandemic has halted and disrupted immunization programs in many countries, which has further increased the burden of deadly diseases such as measles in countries like Congo. Measles virus, which also spreads via droplets and is extremely contagious, increases the risk for spread and mortality in kids residing in poorer countries if they are not vaccinated.

Another statement I found interesting in Prof.Diamond's article was: "But as we all know by now, there is differential mortality with Covid-19; it just has nothing to do with pre-existing genetic resistance or antibodies. We're seeing big differences in mortality between population groups in the U.S.—between poor Native Americans and African-Americans".

Along similar lines, I have been following the trend of precision medicine- one that means "one size doesn't fit all" that stresses upon the idea of personalized medicine approach based on patient's genetic makeup. In the following article https://www.wsj.com/articles/covid-19-raises-questions-about-the-value-of-personalized-medicine-11588949927, the author discusses how low-cost public health strategies such as hand-washing, quarantine, social distancing and better hygiene tend to fare well during a pandemic than personalized medicine. It further elaborates on the Convalescent Plasma Project where antibody-rich human plasma from recovered patients is used to treat test subjects who are infected with Covid19. Although not conclusive, this approach cites the choice of using population-wide program to relieve societal burden instead of relying on genetic based treatment. Time will tell what will be adopted as a treatment approach, besides prevention by a vaccine.

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