The Time Is Right for People at High Risk to Shelter in Place

Surges of new infections in Florida, California, Texas, Arizona and other Southern states are prompting some governors to threaten shutting down their states again. Images of people crowded into restaurants and sunbathing on beaches not wearing face masks is disquieting to many. Will such behavior bring about a tsunami of hospitalizations and deaths like what New York experienced in April?

The lessons learned over the past four months of the COVID-19 pandemic is that each person’s risk of a poor outcome, namely hospitalization or death, largely depends on the presence of underlying health conditions, or their age. Conditions such as chronic lung disease, diabetes and chronic kidney disease are significant factors for poor outcomes including death due to COVID-19. Hospitalizations and deaths are six and 12 times higher, respectively, for people with underlying health conditions, compared to those who reported no such conditions.

In general, the older a person, the more vulnerable they are. More than 27 percent of confirmed cases over the age of 85 have died. This rate dropped to 18 percent for those between 75 and 84, and 9 percent for those between 65 and 74. The rate among those between 5 and 49 is 0.3 percent, with more than one-half of all infections occurring in this age cohort.

With the United States setting new daily records for COVID-19 cases, the demographics of these cases will dictate the outcomes in late July. Since the pandemic began in early March, there have been over three times more infections in people between the ages of 30 and 39 than people between the ages of 75 and 84. However, there have been almost 22 times more people between the ages of 75 and 84 who have died than those between the ages of 30 and 39. If all the new infections being reported today are seniors, the health care systems in these cities would be overwhelmed. If they are predominantly under 50 years of age, the systems should be expected to meet their health care needs.

The lesson learned from this analysis is that not all cases are the same. The population risk with 5,000 cases among college-age students with no underlying health conditions means something quite different than 5,000 cases among people with chronic lung disease or octogenarians. Our nation’s challenge today is protecting high-risk people. And how do we do this? By limiting virus transmission from low-risk people to high-risk people.

As the number of cases continues to grow, high-risk people must voluntarily shelter-in-place, including all senior living facilities. Maintaining strict social distancing precautions, face mask use and good hand hygiene are important measures to best assure protection against COVID-19, but critically so for the most vulnerable. This represents the only way to protect such individuals and give them more control over their health. This solution is not ideal, but far more acceptable than an entire state, or the country, including low-risk people, sheltering in place. For their own well-being, and the well-being of the nation, it is imperative for high-risk people to voluntarily shelter in place.

Breaking down new cases by risk group provides a more accurate picture of how current cases will convert into hospitalizations and deaths. This deep dive into the data will make it possible to plan accordingly and forecast hospital and ICU bed requirements. The well-being of our nation depends on it.


Sheldon H. Jacobson, Ph.D., is a founder professor of computer science at the University of Illinois at Urbana-Champaign; he applies his expertise in data driven risk assessment to evaluate and inform public policy and public health and is an active member of INFORMS.

Janet A. Jokela, M.D., MPH, is the acting regional dean of the University of Illinois College of Medicine at Urbana-Champaign and has served as an infectious disease and public health consultant throughout her career.

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