The spread of COVID-19 worldwide requires drastic measures to be taken by all countries. The most extreme measure is a total lockdown, but selective “closure” methods are being analyzed, in an effort to reduce mortality and the overall impact on the global economy.

A very recent study by the Institute for International Political Studies (ISPI), proposed the “partial lockdown” in order to cope with the increasing number of SARS-CoV-2 cases, the consequent increase in deaths, and the pressure on the Italian Health System. Let’s see what all this is about.

The study begins from the analysis of data on the spread of SARS-CoV-2 across Italy. If we were to try to reach the so called “herd immunity” — if it’s possible — considering the latest published data, about 70% of the Italian population should be infected and manifest antibodies.

An uninviting scenario

This would imply a total of about 42 million infected people, which would lead to an estimate of between 430,000 and 700,000 more deaths than the average of the past several years. Bear in mind that each year in Italy, about 650,000 people die, or 1.1% of the population. Trying to achieve herd immunity, leaving the virus free to circulate, would lead to adding to this 1.1% a further 0.8% in addition to throwing hospitals into a(nother) serious crisis. It’s important to understand that this is an addition, since there is no evidence to suggest that people who have died from COVID-19 would have died anyway, and therefore there is no substitution effect but rather, this addition.

It’s clear, at least to me, that accepting such a sacrifice is unacceptable; on the other hand, it’s equally clear that a total lockdown would completely end the economy. Therefore, while waiting for more effective treatment and vaccine, it’s necessary to implement concrete actions that limit (as much as possible) the circulation of SARS-CoV-2 and find that delicate balance between deaths caused by the new coronavirus, burden on the National Health System, and the maintenance of the national economy.

The advantages of a selective lockdown by risk categories

One of these concrete actions could be the “selective lockdown“. That is, a lockdown for the age groups most at risk (i.e. those in their sixties, with multi-pathologies and who are immunodepressed).

According to the available data, the greatest benefits would be:

  • A 50% reduction in mortality by isolating those over the age of 80, alone and a reduction of 75% by isolating those over the age of 70. Recall that, to date, 82% of those who’ve died from COVID-19 were over 70 and 94% were over 60. Therefore, by isolating those over 60, mortality would be reduced tenfold.
  • Reduction of pressure on the National Health System.
  • Maintenance of hospital care (i.e. diagnostics, treatment and monitoring) to non-COVID-19 patients who postpone, for fear of infection, scheduled visits, or have their visits postponed due to lack of availability of hospitals.
  • Availability of places in intensive care for non-COVID-19 patients (e.g. heart attack, accidents, etc.). We’d like to remind you that it’s possible to make choices when faced with a COVID-19 patient over 60 years of age and a young accident victim — only one to be placed in intensive care. Switzerland, for example, has already officially communicated the provisions on this matter and last Spring, Italy did so as well.
  • Reduction of the economic impact, since the rest of the productive population would continue to be active in compliance with rules of conduct and physical distancing; thereby securing financial support for their families.

The disadvantages of a selective lockdown

Knowing well that every action has consequences (and not always positive), we must also analyze the difficulties in implementing a “selective lockdown”.

  • Practicability: how should we isolate the elderly? In Italy, most elderly people live among younger generations. The fact that in the last twenty years, the average age at which you have your first child has risen a lot, has as a consequence that easily, over the age of 60 (especially men) have children in school or university age with whom they live. In today’s society, the help of grandparents aiding with the care of grandchildren is often crucial; also, from a financial point of view (i.e. replacement of the babysitter) and therefore depriving many families of this resource requires a plan to help from the Government. Isolating the elderly in residences or hotels used for this purpose could have a boomerang effect, because the infection could cause mass contagion. It would therefore be preferable for the elderly to remain in their homes with the problems of living together, as described above. In addition, many elderly people have a caregiver, who should be continuously monitored to prevent them from becoming a vehicle of infection.
  • Health-care: isolating the elderly doesn’t mean making them immune to other diseases. Knowing that with age, the likelihood of developing chronic diseases increases, the question is: how would these people be treated, while respecting isolation? A possible answer lies in telemedicine, but it’s still not widespread and there is no infrastructure, especially IT, that can support it.
  • Impact on the isolated elderly: it’s widely demonstrated that depression is the elderly’s worst enemy, much more than a physical disease. Isolating them from their own affections, in most cases, would cause psychological damage that would lower their quality of life and would burden their close relatives, since the elderly person would quickly experience a degeneration that would rob them of their self-sufficiency.
  • Impact on the economy: the number of employed people in Italy in 2019 was just-under 26 million. Of these, 9% (2.3 million) were over 60 years old. Not an insignificant percentage. If remote-working is an option already in use and relatively easy to adopt, especially for the younger segment of the population that’s more used to working with “virtual” means, I have my doubts as to the transition for the elderly being so immediate and obstacle-free. Also, how would you choose to protect those over 60 who can’t work remotely for the specific needs of their job? Should their positions be frozen, pending the end of the pandemic? Or should they “pre-retire”? What economic resources would you use to deal with either of these two solutions?

There is no right choice, only the “least worst” one

In conclusion, any measure to contain the spread of SARS-CoV-2 has consequences that must be carefully evaluated. In our opinion, a “selective lockdown” may be a good way forward, but in combination with other strategies and simple rules, such as:

  • Implement remote-working
  • Use masks and hygiene recommendations
  • Respect Physical Distancing
  • Improve safety on public transport
  • Improve the management of COVID-19 patients in hospitals and by family doctors
  • Develop telemedicine further
  • Build mobile stations for diagnosis with molecular buffers and antigenic swabs

The Swedish model: does it really work?

We have the example of Sweden that has adopted the isolation of the elderly last Spring, and the available data suggests that the spread of the virus and the impact on the health-care system is similar or better than those we’ve observed in other European countries that have imposed more restrictive measures, with the commensurate economic damage.

However, Sweden has a social structure, culture and social habits that are very different from those of the Italian population and, in my opinion, can be taken as a model (but not as a guarantee) that would also work in the same way here in Italy.

This post is also available in: Italiano

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