Our situation is improving. Recent updates to the modeling that most health and government officials are using to gauge the pandemic suggest that we are flattening the curve. Growth of new cases and hospital admissions appear to be coming down, according to the respective Governors of New York and New Jersey. There is a light at the end of the tunnel. Whether it’s daylight or another COVID-19 freight train could depend on our decisions and actions over the next few weeks to months. What comes next may be up to us.
If we are at peak, close to the peak, or perhaps even past the peak, what can we expect the COVID-19 situation to look like over the next few weeks and months? When can we start getting back to normal (or at least our new normal)? The answer is not entirely clear, but the models are giving us an idea. And a choice.
If we relax social distancing all at once…
We could see a resurgence of COVID-19 infections, perhaps close in magnitude to that of the first wave of cases. Why? Because, as far as we know, only a fraction of the population has been exposed to the virus and has immunity. Some recent data suggest that, on average, one individual with COVID-19 infects between five and six other people. This means that as more than 80% of the entire population would need immunity to COVID-19 to actually stop the spread (via herd immunity). In other words, 8 out of 10 people would need to become infected (or vaccinated, but a vaccine is probably more than a year away).
The point here is that we cant simply “reopen the US for business” all at once, or else we risk ending up back where we started. Though we have certainly learned a lot about COVID-19 and our hospitals will likely be better prepared, we do not want to risk flooding the healthcare system and putting more lives at risk.
Even if we extend the stay-at-home directive for another 30 days, but then completely remove it along with the other social distancing measures, we risk another wave of cases – a second peak – just the same.
If we relax social distancing over time…
We could settle into a much lower plateau of new infections – a steady flow of new COVID-19 cases spread out over a longer time period. If it is true that over 80% of everyone would need to become infected, then we would want that process to take as long as possible, with as few peaks (rapid influxes of new cases) as possible.
A projection from the Federal COVID-19 Data & Analytics Task Force suggests that if we maintain a “steady state” of partially relaxed social distancing, we could achieve this steady state of infections. This involves keeping schools closed through the school year (through summer), and at least 25% of employees still telecommuting, along with other social distancing measures, perhaps like limiting the number patrons at restaurants and the size of public gatherings.
This leads to arguably the most important question we need answered.
Who can safely leave their home?
One of the reasons why we don’t know when we will be able to return to normal is because we simply have no idea who and how many of us have been infected by and developed immunity to COVID-19. The game-changer in determining how we, as a country, will recover from this pandemic will be the availability of antibody testing.
After someone has been infected with the coronavirus and recovered, their body has antibodies to the virus that can be identified in a test. If someone tests positive for coronavirus antibodies, they are presumably immune to the virus. (I say presumably because we are not yet entirely sure about risk of re-infection, particularly for patients who had very mild cases the first time around).
As we begin to relax social distancing and return back to normal life, those who have immunity to COVID-19 would be able to safely leave their home without risk of contracting or spreading coronavirus. Unless you were tested, confirmed to have COVID-19, and have since recovered (per CDC guidelines), you have no idea whether or not you’ve had the virus. Remember, some estimates say up to 50% of cases have no symptoms at all whatsoever. It is possible, if not probably, that for every case that has been officially diagnosed, there are 10 more cases that were never diagnosed and resolved without any medical attention whatsoever.
With this in mind, perhaps younger, generally healthy people could return to work even without immunity because of the lower risk of severe symptoms. The problem is that we don’t know for sure. Early data show that younger Americans with COVID-19 are still being hospitalized. Also a major problem is that asymptomatic carriers could spread the virus to older individuals or others with underlying health conditions. So until we have access to an antibody test, we are essentially blindly making decisions about when and how to relax social distancing.
Not out of the woods
And we may not be for a while.
Social distancing is having a major impact on slowing the spread. However, this does not mean that COVID-19 has stopped spreading. Nor will it stop spreading just because we pass the peak. Case numbers continue to rise. Lives are still being lost.
Some of us will be home through May. Possibly into June. Possibly again come fall. There is some evidence that there could be a seasonal resurgence of COVID-19 when the weather cools.
While we may be able to begin relaxing social distancing measures and begin returning to some semblance of normal life as early as next month, those decisions and policies will likely be state and city specific. Population density does influence the spread of the virus. Metropolitan areas will likely need to very slowly relax the stay-at-home and social distancing directives over a longer period of time.
A new normal
Face masks? No handshakes? No fans at sporting events? Will we think twice about going to dinner and a movie? One thing we can be sure of is that, regardless of when we start to return to the outside world, our world will look a lot different for a long time, if not forever.
So where do we go from here? For now, we keep doing what we are doing. We stay home. But when we start to return to normal – our new normal – we need to do it cautiously and wisely. Ideally we will make those critical decisions based on evidence and testing, and not just based on days on a calendar.
UPDATE: 4/11/20 10:30AM – New York City has announced that public schools will be closed for the remainder of the school year.
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