19 Simple Steps to Deal with Future Respiratory Virus Pandemics

Koen Swinkels
4 min readMay 26, 2020

Without a need for vaccines, contact tracing, lockdowns or any other far-reaching measures.

Update January 17, 2021: Added #19 and expanded some other points

  1. Avoid superspreading events, which seem to occur when large numbers of people spend a prolonged period of time in poorly ventilated spaces, especially when there is a lot of laughing, singing, shouting or talking involved.
  2. When possible, move indoor activities outdoors.
  3. When indoors, open windows.
  4. Install or improve HVAC systems so that they take in a lot of outside air and provide excellent filtration. Portable air filtration units are a good cheap alternative. Use CO2 detectors to sound the alarm when there is insufficient ventilation in a space.
  5. When it is not possible to avoid settings conducive to superspreading events entirely, people should spend as little time as possible in them. Duration matters.
  6. Consider advising people to wear masks in such settings as well as in public transport but note that evidence for the efficacy of wearing masks is mixed at best, and people may take greater risks when they believe masks will protect them.
  7. In the large majority of cases it is symptomatic people who transmit the virus (a minority of transmission events is through pre-symptomatic people and a tiny minority through asymptomatic people). Moreover, a very large percentage of superspreading events occurs in meat and food processing plants, nursing homes, hospitals, prisons etc. So you need to prevent symptomatic people from entering these settings and infecting many others. A key reason why symptomatic people don’t stay home is because they can’t afford to. So offer paid sick leave no questions asked but require that people staying home take a Covid test after 2 days (use mobile testing units to visit people and/or use home tests).
  8. Quarantine & protect the vulnerable (the elderly, people with serious other illnesses), and provide them with all the services they need. Create spaces with excellent ventilation, filtration & humidity control where they can meet loved ones.
  9. Quarantine staff with (non-infected) nursing home residents & double or triple (or more) their salaries. (at the very least forbid staff from working at multiple facilities; compensate them for their lost earnings)
  10. Don’t send infected patients (back) to nursing homes. To reduce the burden on hospitals use specific Covid transitional facilities for Covid patients who no longer need acute hospital care but who cannot safely be sent back to nursing homes yet.
  11. Isolate infected patients from others: Create special, isolated facilities for Covid patients, either within or outside of hospitals and nursing homes.
  12. Keep the economy and public life open: Let the healthy non-elderly live their lives.
  13. Promote spending time outdoors.
  14. Encourage people who don’t get enough sunlight to take vitamin D supplements as there is an emerging, strong body of research that shows vitamin D deficiency to be a Covid-19 risk factor. Efficacy against Covid is by no means proven but there are good reasons to think vitamin D supplementation offers some protection, and it is safe and cheap.
  15. Create virus clinics and telemedicine so that suspected virus patients don’t have to go to doctors where they may infect others.
  16. Everybody who tests positive or is a suspected patient receives a pulse oximeter and a thermometer to continually monitor their oxygen levels and temperature.
  17. Order ample PPE supplies before the pandemic starts.
  18. Financially reward hospitals for making treatment data publicly accessible in real-time so that doctors, health officials etc always have available a vast amount of up-to-date information from all over the world about which treatments are effective and which are not.
  19. Devise standardized protocols for recording infections, hospitalizations and deaths (including standardized criteria for what counts as dying from Covid), financially reward hospitals for providing this information, and make the data publicly accessible, to enable meaningful quantitative comparisons between different regions to get a much better sense of the spread and severity of the pandemic.

That’s all.

For many more suggestions (as well as references to academic research) for reopening the economy while limiting the damage Covid-19 is doing, see here.

But if we implement the 19 measures mentioned above, most of these 58 measures may turn out to be unnecessary.

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