Eradicating, not just mitigating, COVID-19 should be Iowa’s goal

A postelection return to a pre-COVID-19 'normal” requires our understanding the difference between mitigation and eradication. The most important step in reaching one's goal is to clearly define what it is.

Hospital beds and health workers, masks and social distancing are examples of essential, ongoing mitigation efforts when numbers of sick and dying coronavirus victims are surging.

But the goal is - or should be - global eradication of the virus. Mitigation efforts may slow the surge of COVID, but they won't eradicate it. It continues to spread.

What about a vaccine, or herd immunity?

Yes, a vaccine ultimately eliminated global smallpox. But consider the history.

Edward Jenner's first experiments and papers were in the 1790s. The disease was not eliminated in the United States and Europe until the 1950s.

In 1959 the World Health Organization began its global eradication effort. The last death occurred in 1978, and WHO declared mission accomplished in 1980.

Although herd immunity ('survival of the fittest”) or 'vaccination” might mitigate, neither is the answer. Each is rejected by many, takes too long, and produces many thousands of avoidable additional deaths.

Yes, the 'test, trace, quarantine, and isolate” procedure would have been multiple times cheaper and easier when experts first urged it. (See my April 4 column, 'How to Eliminate COVID-19.”). But it still is the fastest and most effective path to the goal of eradication.

Impossible? Too expensive? Too slow? A Chinese city of 9 million tested everyone in five days. We've spent trillions trying to boost a COVID-crippled economy. Even massive testing could be done for low billions.

It works.

The World Health Organization reported countries' COVID cases and deaths per 1 million population during an October week (not our worst). The United States was 23,000 cases and 576 deaths per 1 million. Australia had 1,068 and 35. New Zealand had 314 and 5.

It also works politically.

The New Zealand prime minister's electoral victory is credited to her management of COVID-19. And President Donald Trump's lack of response was a major issue in our recent election.

There are many alternative ways to do it today. Here are samples.

Start with a dozen or fewer cities or states. Choose the most successful, with metrics such as infected people per 100,000 population, or lowest percentage infected of those tested.

Test-trace everyone in the selected areas every two weeks including newcomers to the area. Isolate or quarantine those infected and their contacts.

In about two months, when no one tests positive, all businesses can open while testing continues. Gradually expand the number of participating areas. Disinterested cities and states need not participate.

Or the focus could start with the most vulnerable (the 5 percent age 80 and older; those in long-term living facilities). Or groups working in proximity (meat packing and factory workers, college students). There are many alternatives.

Mitigation, yes. But until we make eradication our goal, as Dr. Anthony Fauci has put it, 'We're in for a whole lot of hurt.”

Nicholas Johnson of Iowa City is a former co-director of the Iowa Institute for Health, Behavior and Environmental Policy. Contact: mailbox@nicholasjohnson.org