Researchers say we face a horrible choice: practice social distancing for months or a year, or let hundreds of thousands die.
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 new scientific report stresses: Only the most severe distancing measures can prevent hundreds of thousands of deaths
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.
On March 13, the journal Science published an analysis that concludes 86 percent of all the Covid-19 cases in China before January 23 were not at the time detected by public health authorities (though, that doesn’t mean these cases were asymptomatic). It’s estimated these undiagnosed cases infected 79 percent of the total cases. The results suggest that without aggressive testing to confirm cases, Covid-19 will sneak past our best efforts to contain it.
Jennifer Nuzzo, an epidemiologist at Johns Hopkins Center for Health Security, agrees that the social distancing measures might need to be in place for at least months. “I don’t think people are prepared for that and I am not certain we can bear it,” she writes in an email. “I have no idea what political leaders will decide to do. To me, even if this is needed, it seems unsustainable.” She adds that she might just be feeling pessimistic, but “it’s really hard for me to imagine this country staying home for months.”
President Trump so far has announced guidelines that call for social distancing and other measures for 15 days. When asked at the Monday press conference “how long all of this might last,” he responded, “people are talking about July, August, something like that.”
Can we find a new balance between the need to “flatten the curve” and the need to live our lives and revive the economy?
Given the likelihood of the need for social distancing measures for weeks or months, public health authorities may need to strike a balance: What can they put in place that will prevent a huge wave of deaths but also make life a bit more manageable? Here, greater knowledge about the virus will help. Time will teach us what the right mix of social distancing measures are, health experts tell me.
“The way we deal with the uncertainty is we have to cover all of our bases,” says Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College. “A year from now we’ll realize some of the things that we did may not have been necessary.” But we have to proceed with extreme vigilance due to the unknowns of this virus.
Scientists are still working out which groups of people — and in which locations — are the most likely to transmit the virus. If it turns out that children aren’t playing a big role in transmitting the disease, it could make some sense to reopen schools. Perhaps travel bans, which may prove to be ineffective, will be lifted. People still may be asked to telework, but restaurants may open back up with limited seating.
“Once things get better, we will have to take a step-wise approach toward letting up on these measures and see how things go to prevent things from getting worse again,” says Krutika Kuppalli, an infectious disease physician and Emerging Leader in Biosecurity fellow at the Johns Hopkins University Center for Health Security.
We also don’t know how long we’re in for because we don’t know how bad the outbreak is in the US — due to the lack of testing.
“How are you supposed to implement effective containment measures if you don’t know the actual prevalence in the population? And we still don’t,” Angela Rasmussen, a Columbia University virologist, says. “That’s unfortunately why I think we need to take these steps, where, if they work, they will be seen as an overreaction. Because if they work, it won’t get worse.”
An aggressive social distancing policy could also become a victim of its own short-term success, Tara Smith, a Kent State epidemiologist, fears. As cases start to come down due to harsh measures, there might be political and economic pressure to lift them prematurely. “Will citizens and our leaders support extended enforced social distancing measures?” she asks. “I’m not sure they will.”
Even though it may seem as though China and South Korea are turning the corner on Covid-19, Kucharski stresses it’s not over. China may be relaxing some of its most stringent social distancing policies and is reopening schools, but the threat remains.
“It would take a few weeks for transmission to take off again,” Kucharski says. “They haven’t solved this. In China they’re still reporting a few [new] cases, which means there’s still virus in the country. If things go back to normal, we’ll be in the situation we were in a month ago, two months ago.”
We can also look, though, to South Korea and China to see what’s working there for long-term mitigation and tailor our strategy. For instance, South Korea has been very aggressive with testing, finding cases, and tracing their contacts, to keep cases declining. “That has proven to be successful so far, from the data we get from South Korea,” says Mauricio Santillana, the director of the Machine Intelligence Lab at Boston Children’s Hospital, who has been working on modeling the future of the outbreak. Perhaps with more aggressive testing, we could achieve a better balance. “That alternative requires a lot of testing, and our government hasn’t done a good job on that front.”
It’s okay to be upset by all of this. And there are still a lot of unknowns about this virus, and how it will all play out. Perhaps the worst will spare us. But we still need to prepare for it and tap into our resiliency. Life may feel very hard and very stressful over the next several months. It’s a real burden, and you don’t have to like it. But know: This pandemic will end eventually. What we don’t yet know is when.