Buckle Up, Folks, Because We'll Probably Endure Waves Of COVID-19

We Will Likely Be Dealing With A COVID-19 Pandemic For 18+ Months

April 3, 2020 Updated April 4, 2020

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Just. Stay. Home. The sooner everyone stays home and stops the spread, the sooner life will return to normal.

It’s a popular refrain around the web right now in discussions of COVID-19. It sounds good, doesn’t it? Shelter in place. Wait out the storm. And when it’s all over, go back to normal life.

We talk about herd immunity. “Flatten the curve,” we say. Spread out infections over time — a few months, a year, maybe — until we reach herd immunity.

But there are a few problems with this projection. First, herd immunity is not a set number. The percentage of people required to be immune in order to prevent spread of a disease is contingent upon variables like transmissibility, contact rates, and the expected duration of infection. Mumps, for example, has a reproductive number of 10-12, meaning that in a population with zero immunity, for every one person infected, another 10-12 will get infected. With mumps, 92% of the population must be immune to the disease in order to achieve herd immunity — to stop transmission.

COVID-19 is believed to have a reproductive number of roughly 3, requiring a population immunity of around 70%.

Some simplified herd immunity math …

The U.S. population is around 330 million.

70% — our presumed requirement for herd immunity — of 330 million is 231 million.

As of the writing of this article, the U.S. has 217,000 confirmed cases of COVID-19. Yes, there are significantly more folks who are quarantined at home to ride out their symptoms or asymptomatic contagious carriers, so we will never have a truly accurate count.

But, it is safe to say that we are nowhere near herd immunity status nor will herd immunity be what saves us here. Attempting to attain herd immunity without a vaccine is just not going to happen, folks. It’s not a thing.

To prevent our hospitals from becoming overwhelmed, we slow the spread with social distancing. There are still cases floating around, some undetected. Essential workers keep working, and of course we have that delightful segment of the population who gleefully flouts social distancing guidelines and continues to gather in large groups, either because they don’t like being told what to do, because they’re making a political statement, or because they think they’re just plain tough.

So we slow the spread, but we can’t halt it.

So what if we went under total lockdown and managed to contain the spread? What would happen the moment we went “back to normal?” Exactly what is happening right now in Hubei, China, where the outbreak began: 600,000 have now been locked down again after new coronavirus infections started popping up once restrictions were lifted.

Without a near-total eradication of COVID-19, we are likely going to be enduring periods of social distancing for a long time. But how do we eradicate COVID-19? Or at least control its spread?

How long will we have to wait for a vaccine?

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Experts estimate that we will have to wait, at minimum, 12 months for a vaccine. More realistically, it will be closer to 18 months.

Also consider that for other known coronaviruses — the ones that cause the common cold, for example — a person having been infected doesn’t guarantee them lifelong immunity, and some are more susceptible to reinfection than others. Most experts agree that someone who has recovered from COVID-19 will likely be immune to reinfection, but we’re not 100% sure, and we also don’t know how long that immunity will last. The virus may also mutate year to year, like influenza. We may need to develop COVID-19 vaccines annually, as we do with the flu. We just don’t know yet. It’s a brand new virus, and we’re still learning about it.

Um … does that mean it’s time to panic?

It is never time to panic. It is always time to think scientifically and ask ourselves how we can protect ourselves while maintaining some semblance of a normal life and, yes, while buttressing the economy. Humans are social creatures, and we thrive on stability –health, emotional, social, political, and financial.

This is a new normal we are going to have to accept for a while: while we wait for a vaccine, we will likely be playing a surreal game of virus whack-a-mole for the next 18+ months, undergoing periods of social distancing and lockdowns, ideally using testing, testing, testing, to identify where infections are popping up so we can strategically lock down certain geographical areas while allowing some semblance of normalcy to exist in other places where testing shows that transmission is under control.

So, what can we do?

Woman in bed with the flu
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We will have to dramatically ramp up our ICU capacity as well as our healthcare workforce — this is already happening — in order to handle the waves of people needing acute care. Because, as has been discussed ad nauseum, COVID-19 is not the flu. When it spreads unchecked, hospitals become overwhelmed. That’s because, for a high percentage of people who are infected, COVID-19 causes acute respiratory distress and pneumonia, requiring intensive care for a prolonged period of time, sometimes as long as three or four weeks.

The question we’re trying to answer here is, “How much social distancing is necessary to keep our healthcare systems functional? To protect our healthcare workers?”

It’s unrealistic to simply let the virus run its course in an effort to achieve herd immunity. The loss of lives would be catastrophic. The UK discovered this when they ran models on what was likely to happen if they moved forward with their initial plan to allow the virus to spread with the hopes of reaching herd immunity. Again, it’s that problem with the load on healthcare systems. People would die needlessly while waiting for treatment.

And we desperately need social solidarity. As a country, we need to get on the same page about social distancing, sheltering in place, and our collective understanding about why these things protect our healthcare workers.

This needs to come from the top down. The president needs to stop swinging wildly between assuaging us with false platitudes and causing panic by warning us about how “painful” this is going to be.

Instead, tell us how we’re going to work together to get through this. Tell us exactly what the plan is and why it will work. Trust doctors and scientists, and for the love of god, just stick to the facts. Tell Americans to stop slinging mud across the aisles and instead come together to defeat this thing as a united nation.

It is shameful that it has become a political act to brazenly display nonchalance about the coronavirus. Hey Trump, could you maybe tell your followers to quit doing this? It is somewhat reassuring — and sobering, because of how unusual it is — to see the president abdicating to Dr. Fauci and other experts when it comes to informing U.S. citizens, but Trump’s rhetoric is still far too dismissive. We have no hope of acting in solidarity with one another unless and until he can get his shit together and be inspiring, rather than divisive and self-aggrandizing, for once.

And we need to test.

This is our “new normal.”

And yet, even with social solidarity and testing scaled up to accommodate these kinds of measures, it is still highly likely that we will see waves of coronavirus for an extended period of time. With a virus that has so many “silent carriers” and is believed to be spread through simply breathing, people gathering is the number one factor that contributes to exponential spread.

And so, even after long, painful periods of shelter-in-place, the moment we return to work and resume social activities, we are likely to see reinfections popping up in areas of high density populations. Until a vaccine is available, it is extremely unlikely that we will see a return to what we think of as normal life. Periodic school closures and cancellations of sporting events, concerts, weddings will likely become commonplace.

For now, and possibly for many months or even years — unless we can come together in one of the greatest acts of social solidarity man has ever known, where we each agree to take personal responsibility to maintain physical distance from others, and until we can majorly scale up our testing capabilities — this, what we’re experiencing now, is our new normal.