Sequestering: a Public Health Strategy for Defeating the Novel Coronavirus

Public Health strategies implemented in each country have the greatest bearing on the impact of Covid-19 on its people and its economy. These strategies will vary from country to country as they must take into account the cultural and social norms in each country such as “social kissing as a means of greeting” and “prevalence of families living with grandparents” that impact the rate of spread (R0) and the practicality of implementing particular policies.

Sometimes the strategies are forced upon a country when the disease threatens or overwhelms its healthcare service. The regional lock-downs in China and South Korea successfully suppressed Covid-19 but their wider populations remain vulnerable to the disease and future outbreaks are probable given the ease with which Covid-19 is passed on asymptomatically. 

The travel bans and social distancing policies that are being implemented in various countries (as of 15 March 2020) are destroying the world’s economies. The aim of these policies are either to keep Covid-19 out of a country by isolating it from the rest of the world or to “flatten the curve,” which will reduce the peak number of hospitalized cases so its healthcare system is not overwhelmed. These policies will work, insofar as they go, but the economic impact is devastating to the working population. The livelihoods of millions are at risk, and given that these policies will persist for a year or more, most households will exhaust their savings long before the policies end. This would be a greater calamity than Covid-19 itself.

"Flattening the Curve" protects the healthcare system but destroys the economy

Sequestering is a strategy that is possible due to the peculiarities of the novel coronavirus and the depth of data that has recently become available from China, South Korea, and others. Sequestering has several advantages:

1.  The impact on the economy is moderate
2.  The impact on daily life is moderate
3.  International travel can be allowed by people that satisfy the Sequestering rules
4.  A country’s healthcare service is used as a gauge for the Sequestering level, so it is never overwhelmed
5.  The R0 within the active population is rapidly reduced to below 1 (for example, in the UK this would take six to ten weeks)
6.  The country would be protected from future Covid-19 outbreaks
7.  A country could adopt Sequestering at any time regardless of its current strategy

Sequestering can defeat Covid-19 because its demographic impact is well evidenced:  children are thankfully spared by the disease; the likelihood of requiring hospitalization increases with advanced age; the likelihood of dying from Covid-19 is 100% correlated with known comorbidities (heart disease, diabetes, etc); and most importantly, the majority of the population will experience only minor symptoms, a fever and a mild cough lasting a week – then they will be immune, no longer susceptible nor capable of passing the virus to anyone else.

Based on the data from China and the other effected countries, each resident in a country proposing to adopt Sequestering will be given a score that determines their likelihood of requiring hospitalization. This can be done with an online questionnaire, though common sense measures will cover people with the highest risk – as the UK has done by proposing that people over 70 self-isolate. 

Sequestering requires people at low-risk (with low scores) to live normal lives as part of the active population. Schools, cinemas, restaurants, shopping centres, sporting events, everything should continue as normal. It will seem odd because the older people will be missing – they are being sequestered for their own safety – but the economy will continue, workers will continue to earn their pay checks, kids will go to school, taxes will be paid, and pension payments will continue as normal. People living normal lives should expect that they have a high chance of becoming ill, but the illness will be mild and short. For some, they will hardly notice the symptoms. It is vital that all illnesses, no matter how mild, be reported to the healthcare authorities. This is easily done via an online app or website. This information on the advance of the virus and the development of immunity in the community will determine when others can be released from being sequestered. 

Employees with medium scores will have to work from home or be supported in self-isolation if they cannot work remotely until the healthcare authorities determine they can re-join the active population. Those who are sequestered must understand that the world outside of their home is dangerous to them, but that the danger will recede in a few weeks. Their isolation is temporary. Visits from family and friends can take place if visitors have already recovered from Covid-19 or if they wash their hands, wear a mask, and follow healthcare authority guidelines.

When R0 in the active population drops below 1, Covid-19 can no longer spread widely, and those at higher risk can gradually be released back into the active population. Life can continue as before, but the population is now resistant to Covid-19.

Sequestering reduces the outbreak time and saves the economy without overwhelming the healthcare system

After Sequestering a high proportion of the population will possess the antibodies in their blood that protect against Covid-19. Thus, there is large number of potential donors of blood plasma that can be used to treat those that become critically ill from Covid-19. For example, a teenager who had only mild symptoms at week 1, could provide the blood plasma that saves her grandfather’s life in week 20. Sequestering is likely to reduce the over-all death rate in the population as compared to "Flattening the Curve," since the most vulnerable are released into a safer environment with ample supply of antibodies.

Sequestering is a vaccine against Covid-19 but one that is applied to the population rather than the individual. Unlike the vaccines that may be available in 12-18 months, Sequestering is available now, and we need it now to save our economies as well as our people.

Sequestering is only possible because of the detailed data provided by China, South Korea and other afflicted countries at a very high cost to themselves. To use a Star Wars analogy many people have died to deliver us the plans to the “Death Star,” now we need to be brave enough to use this information to save the world.

Dr Ye Xing Chi
Cambridge & Singapore
yexingchi@yahoo.com