This is a thought experiment rather than the result of a well-designed study. Keep that in mind. Nonetheless, I have always found such experiments a good basis for ad hoc heuristics – empirical rules of thumb, as it were. I designed such a scheme to help me identify particularly unstable health plan enrollees who were likely to need more than routine services. I was working for United Healthcare, and I needed a way to sort our health plan members from least stable to most stable. I created a point system that was based on each individual’s number of ER visits in the past 12mos, their number of hospitalizations in the preceding 12 months, total medical expenses in the same interval, diagnoses related to cancer, lung disease, heart disease, and so forth. The more points that an individual accumulated, the more urgent it was for us to evaluate that enrollee, face to face, in order to determine what we might be able to do to help them maintain their health and independence in the coming year. For a simple heuristic, it worked quite well.
Fast forward to today. If I had to make such a heuristic for COVID risk, it might look something like this. If you are over 65, give yourself a point. If your BMI is over 25, give yourself a point. If you have hypertension, add another point. If you have diabetes, add still another. If you have a history of heart failure, add another. If you have a history of lung disease requiring medication, add another. If you have a history of cancer, especially lung cancer, give yourself another point – hell, maybe two. If you take immunosuppressive medications or chemotherapy of any kind, you earn another point.
I’m sure that you can see where this is going. The more points you accumulate, the more likely that if you contract COVID, you are fucked. Vaccination can be a mitigating factor. So can taking monoclonal antibodies or the Pfizer and/or Merck anti-COVID antiviral medications. Still, it would be foolish to rely heavily on mitigators that are only 30-90% effective in mitigating severe illness. It is better to heed our personal point score by modifying our behavior. The higher our score, the more careful we need to be.
Susan and I had planned to have Christmas dinner for a small group – two invitees and ourselves. I have a score of three or four. Susan’s score is three or four as well. It turns out that our guests, both having had their initial vaccinations, had not had a booster. That’s so unfortunate; we had looked forward to seeing them because it has been a very long time since we had. Sigh: we will be dinning alone this Saturday.
I’ve always thought of heuristics as lying somewhere between hard science and magic – having a plausible basis, a shitload better than tossing a coin, but still not meeting the strict, uncompromising demands of the scientific method. So it goes, I am heeding my point system heuristic on this occasion.