By MAAYAN
JAFFE-HOFFMAN
APRIL 13, 2020 23:09
The man who developed the driverless technology firm
Mobileye and then sold it to Intel for $15.3 billion – the largest Israeli exit
to date and the world's biggest purchase of a company solely focused on the
autonomous driving sector – says he has a plan to get Israelis out of lockdown
and back to work.
“Physicians help us when we are sick, but they are not
going to release us from this crisis,” Amnon Shashua told The Jerusalem Post.
“This is a problem to be solved by mathematicians, statisticians, computer
scientists, epidemiologists and economists… Our duty is to make sure that all
the right minds are putting their CPU power into this problem.”
Shashua and Prof. Shai Shalev-Shwartz of Hebrew
University’s Computer Science Department came up with a plan, which they first
laid out on March 26 on the online publishing platform Medium in English in an
essay titled, “Can
we Contain COVID-19 without Locking down the Economy?” The next week,
Shashua presented his proposal before the Knesset Coronavirus Committee. On
Sunday, he updated and adapted the plan in Hebrew.
Now, it is among the programs being considered by the
National Security Council and eventually the prime minister.
The model: Risk-based selective quarantine.
The idea, Shashua explained, is that the population can
be divided into low- and high-risk groups. People under the age of 67 and
without underlying medical conditions are low risk. Those over 67 – “which
represents the retired segment of society” – or with co-morbidities are
high-risk.
“The low-risk group... is released to their daily routine
while following certain distancing protocols that are aimed at slowing the
spread – while keeping the economy undisrupted to a large degree, but
ultimately reaching a herd immunity level,” and “quarantine the high-risk,”
they wrote.
Given the herd immunity of the low-risk group, the team
predicted, the country could gradually release the high-risk population.
Shashua admitted that we still don’t even know for sure
that a person develops immunity to COVID-19 and cannot be reinfected with the
virus a second time – although with most similar viruses, this is the case.
Nonetheless, in his latest version, he maintains that this is not an essential
factor.
“The question is how do we guarantee that the health
system will not be overwhelmed during the spread of the virus in the low-risk
group?” Shashua said, explaining that the program is designed to allow the
health system to cope with the expected number of severe cases.
The percentage of Israelis on ventilators that are from
the low-risk group is around 15%, Shashua explained. Through a complex series
of mathematical equations that are included in the essay, Shashua and
Shalev-Shwartz determined that the number of ventilators that would be needed
to handle the low-risk group if the country rolled out risk-based selective
quarantine would be around 2,000.
According to the Health Ministry, Israel has around 3,500
ventilators, or roughly one for every 2,500 citizens. And Shashua said that the
need for 2,000 ventilators was pessimistic.
“What we propose here is a worst-case analysis,” they
wrote on Medium. “The idea is to adopt a pessimistic view and show that even
under this pessimistic view, the health system is not likely to collapse” with
this plan.
“Everyone is putting their hopes into surgical
quarantine,” Shashua said, the idea that the country will test anyone who has
coronavirus symptoms. If the person tests positive, he or she is quarantined,
epidemiological tracking is carried out and all those who they were in contact
with are also isolated.
“Testing is expensive and finite,” he argued. “And even
if you did try to test the entire symptomatic population, chances are you will
miss people and then you will have an exponential increase of infection.”
Moreover, since as many as half of all coronavirus
patients are asymptomatic, they spread the disease but don’t get tested. Add to
these people those who will not cooperate and report their symptoms because
they don’t want to be tested, and the virus spreads quickly.
“So, take all your technology and apply it to the
high-risk group – surgically quarantine the high-risk group,” he said, arguing
that screenings should be done daily in senior homes, for example.
“A full population-wide quarantine is not a solution in
itself,” they wrote in their essay. “The lockdown could take anywhere from
weeks to months. This is the safest route but does not prevent a ‘second wave’
from occurring.”
He said that in all other selective quarantine models,
the high-and low-risk are equally susceptible to be infected so that even if
the health system is not overwhelmed, the mortality of the high-risk group is
still likely to be higher than in the risk-based model.
“We are in one of the biggest crises of humanity in 100
years… and I don’t hear a diverse set of voices in this crisis. I only hear the
voice of the Health Ministry, and they are in hysterics,” Shashua stressed.
“Send the young kids to school,” he continued. “Their
parents are the lowest-risk population. Release the lock-down on these people.
You have flexibility with the low-risk population, and you can maintain the
economy this way for 18 months until a cure or vaccine is available.
“This strategy is backed by mathematics,” he concluded.
***
My comment:
I am worried that this might end up similar to what happened
in the UK when they initially wanted to build herd immunity, in that all seems very
logical until young people from the low-risk group start dying . This is the
part of the paper I am worried about:
“We ignored the fact that some severe cases could end up in
the mortality statistics even when given proper care. In fact, there are two
probabilities to estimate (i) the probability of being in the ”severe” category
among the low-risk group, and (ii)
the probability of mortality given proper care. We have bounded
the former and ignored the latter.
The reason for doing so is that the latter is beyond the scope of this
paper because it is essentially a moral tradeoff between ”safety” and
”usefulness” that is employed in every aspect of society. For example, society does not put a lockdown
on passenger car use in order to significantly reduce car accidents even though
such a lockdown will save lives. Likewise, governments do not allocate infinite
budgets for the health system even though there is a correlation between
increased investments and saving lives.”
There are no easy solutions and
this could be the least painful one, but the moral tradeoffs
will have to be discussed. Just like epidemiologist Marc
Lipsitch’s proposal that 100 altruistic young people should volunteer to get a
vaccine for Covid-19 and then be infected with the coronavirus on purpose.
