Over time, coronavirus has turned our social calendars from normal to nonexistent. We’ve been cut off from friends and family, banned from gathering in public venues, and discouraged from going to the store more than absolutely necessary. “Social distancing” became a buzz term, and then a new way of life.
We are starting to flatten the curve. In some of the earliest and hardest-hit areas in the country ― Washington state, New York City, California ― the virus’ doubling time is increasing, meaning we are slowing the spread of the illness and tapering off exponential growth. This will allow medical personnel to better help the sick and avoid an overwhelming surge of hospital admissions.
It’s promising; so much so that one question is starting to bubble into daily news headlines and public consciousness: When do we go back to normal? When can we leave our homes and see friends again?
Not too soon, according to experts. Here’s what might happen if we get too excited about flattening the curve and lift social distancing restrictions before the virus is truly contained.
Claiming premature victory could be fatal.
COVID-19 spread like wildfire around the globe, and there are a couple of reasons why. The virus is “moderately infectious,” and for every person who catches the virus, they’ll likely pass it to several more people, said Thomas A. Russo, chief of the division of infectious diseases at the University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences.
On top of that, there are a lot of silent carriers. While experts originally thought asymptomatic transmission was rare, some now estimate a quarter of people with COVID-19 have no idea they’re infected.
“This is the importance of social distancing,” said Michael LeVasseur, a visiting assistant professor of epidemiology and biostatistics at Drexel University’s Dornsife School of Public Health. “Since individuals are likely capable of transmitting the virus when they are asymptomatic, limiting the number of contacts any individual has to the household, for example, will limit the spread of the virus.”
So, what happens if we loosen up social distancing measures? It depends on the point in the so-called “curve” that each state or municipality decides to lift its guidelines.
“If we have the public health infrastructure that individuals can report to a testing clinic to receive a test and then self-isolate while awaiting results, [maybe it would work],” LeVasseur said. “If we don’t, then they’ll likely continue infecting people and we will see a surge of cases.”
“Even if the surge of cases is not as large in more rural areas, it’s still a surge if it overwhelms the local hospital system.”
A city’s fate and the force of the infection in a given area will probably depend on its population density. Like we’re seeing right now in New York City, “the more dense the population, the more contacts any individual has, the more opportunity to transmit the virus,” said LeVasseur, who noted that New York City has seen over 87,000 cases at press time and has a population density of 66,940 people per square mile.
Philadelphia has more than 5,200 cases and a population density of 11,234 per square mile. “My hometown of Wolcott, Connecticut, has 21 cases and a population density of 790 per square mile,” LeVasseur said. “The force of the infection ― meaning, the rate at which susceptible individuals become infected ― is dependent on population density.”
This reality is potentially deadly and devastating for metropolitan areas, and dicey for the rest of the country. Even if the surge of cases is not as large in more rural areas, it’s still a surge if it overwhelms the local hospital system, LeVasseur said.
What can help slow the spread so we’re back to ‘normal’?
Besides the social distancing measures in place now, Russo sees four other potential game-changers that could slow the spread of this epidemic so we can potentially revert back to “normal life.” (“Normal” isn’t going to be the normal we know for a while, but more on that in a moment.)
The first is a vaccine, which we don’t have and likely won’t have for at least a year, he said.
“Number two is a drug or drugs that could either prevent infection or very effectively treat someone who does become infected, so they don’t develop a serious infection,” Russo said. “We don’t have that, either.”
The third factor is “hoping it’s seasonal, which is really just buying time,” Russo added. “The virus will go to the Southern Hemisphere and then come back, and that seems really unlikely in general. There are no signs of it slowing here.”
The fourth game-changer would be herd immunity, which is when enough of the population becomes infected and has “natural protective immunity” that the virus can no longer spread. Some 50% to 75% of the population would need to be infected, said Russo, and we are nowhere close to that — nor do we want to be. Going this route would result in a lot of deaths, which is why the lack of social distancing in Sweden is raising alarm.
So, when do we go back to normal? The answer is unclear.
“I don’t believe that we go back to normal at all,” LeVasseur said. “Not until there’s an effective treatment or vaccine, anyway. We can regain some semblance [of normalcy], but we will need to remain vigilant as citizens and scale up our public health efforts in order to prevent future surges.”
Here’s what we need before transitioning back to public life.
What’s happening right now in Wuhan, China, is a critical test of what will occur when societies go from social distancing to what somewhat resembles regular life.
“The cases went down to zero, or very low, and then they waited a couple extra weeks to account for the incubation time,” Russo said. “After that period, they relaxed social distancing ― but decided to do lots and lots of testing, monitor the population very carefully.”
The United States needs a similar approach after the outbreak dies down, the experts reiterated.
“When the number of infections in certain areas gets close to zero ― from a pure biology, medicine, infectious-disease and public-health point of view ― that is the metric that will enable us to relax those conditions,” Russo said.
“But it needs to be combined with very careful, expansive monitoring for clinical symptoms, resurgences and testing of individuals so that we can reinstitute social distancing if needed,” he continued.
Of course, we would need to ramp up testing capacity a lot in the meantime; there is still a backlog of tests for COVID-19, and not enough happening to move the needle.
Another potential way to “catch up” on monitoring the population is an antibody test, which can tell experts which segments of the population have already had COVID-19 or were asymptomatic when infected.
“As far as we know from other similar viruses, this should incur at least short-term protection from the virus,” Russo said. “We can stratify individuals ― if you’ve been infected and we believe you have short-term immunity, those might have more relaxed standards to get back to work and do other essential activities.”
Perhaps a combination of those two methods could be applied to get people back into the world again, Russo added.
All that said, we need to have a certain health infrastructure in place to truly manage COVID-19 outbreaks that might arise in post-social distancing life. This includes ramping up testing, so we can isolate the sick faster, Russo stressed.
“We need to have a certain health infrastructure in place to truly manage COVID-19 outbreaks that might arise in post-social distancing life. This includes ramping up testing.”
Even post-outbreak, we will probably still need to maintain distance and limit social contacts, LeVasseur said.
“That doesn’t mean don’t be social, but it will likely mean that restaurants should limit the number of tables they can seat, it means workplaces should continue to allow employees to work from home, and it means we need to limit our classroom sizes,” he said.
In other words, the “normal” that we had before all of this may not be feasible for quite some time.
LeVasseur said we should not be caught off-guard if we must have another lockdown, either.
“If we see an increase in cases in a given area, we will need to respond quickly so as to not overwhelm our health care system,” he said. “I think that there are ways to do this intelligently that will require a lot of coordination between communities, public health, health care and government, and I’m certain that these plans are being developed nationwide.”
The reality is that if we relax restrictions now, we may undo all the progress we’ve made with social distancing, Russo said, explaining that we’re “far from done” with this virus.
“Until we get a vaccine or a drug that can prevent severe illness by allowing us to aggressively treat the infected, even if it decreases a little in the summer, it’s going to come roaring back,” he said. “We are set up for a more long-term scenario.”
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