Life in America — and in many countries around the world — is changing drastically. We’re physically distanced from our favorite people, we’re avoiding our favorite public places, and many are financially strained or out of work. The response to the Covid-19 pandemic is infiltrating every aspect of life, and we’re already longing for it to end. But this fight may not end for months or a year or even more.
We’re in this because public health experts believe social distancing is the best way to prevent a truly horrific crisis: perhaps hundreds of thousands or more if our health care system is overwhelmed with severe Covid-19 cases, people who require ventilators and ICU beds that are now growing limited in supply.
“Some may look at [the guidelines] … and say, well, maybe we’ve gone a little bit too far,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force, at a Monday White House press conference. “They were well thought out. And the thing that I want to reemphasize … when you’re dealing with an emerging infectious diseases outbreak, you are always behind where you think you are if you think that today reflects where you really are.”
How long, then, until we’re no longer behind and are winning the fight against the novel coronavirus? The hard truth is that it may keep infecting people and causing outbreaks until there’s a vaccine or treatment to stop it.
“I think this idea … that if you close schools and shut
restaurants for a couple of weeks, you solve the problem and get back to normal
life — that’s not what’s going to happen,” says Adam Kucharski, an
epidemiologist at the London School of Hygiene & Tropical Medicine and
author of The Rules of Contagion, a book on how outbreaks spread. “The main
message that isn’t getting across to a lot of people is just how long we might
be in this for.”As Kucharski, a top expert on this situation, sees it, “this
virus is going to be circulating, potentially for a year or two, so we need to
be thinking on those time scales. There are no good options here. Every
scenario you can think of playing out has some really hefty downsides. … At
the moment, it seems the only way to sustainably reduce transmission are really
severe unsustainable measures.”
In time, we may learn how to balance the need to “flatten the curve” with the need to live our lives and revive the economy. But for now, it appears we’re in for a long haul.
The reason we may be in for an extended period of disruption, Kucharski says, is that the main thing that seems to be working right now to fight this pandemic is severe social distancing policies.
Drop those measures — allow people to congregate in big groups again — while the virus is still out there, and it can start new outbreaks that gravely threaten public health, particularly the older and chronically ill people, those most vulnerable to severe illness. “There’s no way [the virus] is going to go away in the next few weeks,” he says.
The way things are looking now, we’ll need something to stop the virus to truly end the threat. That’s either a vaccine (there are some now entering clinical trials but it could be a year before they are approved) or herd immunity. This is when enough people have contracted the virus, and have become immune to it, to slow its spread.
Herd immunity is not guaranteed. Currently it’s unclear if, after a period of months or years, a person can lose their immunity and become reinfected with the virus (which would make achieving herd immunity more difficult). Also, herd immunity will come at the cost of millions of people becoming infected, and possibly millions of people dying.
A sobering new report from the COVID-19 Response Team at the Imperial College of London underscores the need to keep social distancing measures in place for a long period.
It outlines two scenarios for combating the spread of the outbreak. One is mitigation, which focuses on “slowing but not necessarily stopping epidemic spread.” Another is suppression, “which aims to reverse epidemic growth.”
In their analysis, isolation of confirmed cases and quarantine of older adults without social distancing would still result in hundreds of thousands of deaths, and an “eight-fold higher peak demand on critical care beds over and above the available surge capacity in both [Great Britain] and the US.”
(Remember, all projections of possible deaths come with uncertainty and are greatly dependent on how we respond. Estimates can change based on variables that are not quite yet understood: like the role kids play in transmitting the virus, and the potential for the virus to show seasonal effects.)
Suppression, which requires “social distancing of the entire population,” can save more lives and prevent hospitals from becoming extremely overburdened. But it needs to be maintained “until a vaccine becomes available (potentially 18 months or more),” the report states. And it warns “transmission will quickly rebound if interventions are relaxed.” Make no mistake: Suppression comes at a huge cost to our society, economy, and perhaps even personal well-being.
This is not to say social distancing is futile. What Kucharski and the new paper are arguing is that if you lift social distancing and don’t have a strong containment strategy in place to replace it, the virus is just going to cause new outbreaks. This virus is very contagious, with one person infecting 2 to 2.5 others on average without preventive measures. It’s also new, so no one is immune to it. Even in China, it could have a resurgence and infect a huge number of people. This virus can spread before people show symptoms. That’s always going to make it hard to control and detect.