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Experts say the coronavirus pandemic is likely to unfold in three stages. The first is the current effort to limit the impact of the initial outbreak through social distancing and an aggressive public health response. The final stage will come when the bulk of the population attains immunity to the virus, either from a vaccine or through developing antibodies after becoming infected, or more likely some combination of the two.
But the middle stage — after the level of infections has become manageable but before the threat of the virus has been reduced — poses an enduring dilemma. Scientists say a vaccine may be 18 months away or longer, but economists say the human costs of social distancing at current levels are unsustainable.
How we manage this tension until immunity is a reality will make a major difference in the amount of suffering that happens along our path out of the pandemic. Failure to properly navigate the response could mean unnecessary levels of death and economic pain in the months ahead.
Why there’s debate
There’s broad agreement that waiting for a vaccine is the only reasonable path to immunity, since the alternative of allowing that to happen naturally could mean millions of deaths. A number of experts from a variety of fields have released plans for how to get through the next year and a half.
Many of their models call for a gradual reopening of the economy after the initial surge of the outbreak has subsided. This process may happen in fits and starts. Each restriction that’s lifted brings the risks of a resurgence in cases, which could mean distancing measures would need to be reimposed. The timelines on these plans vary, but some suggest that the middle phase could start by May or the summer in certain places.
Another critical step will be identifying and isolating people who have the virus to limit the size of new outbreaks. Most plans call for a significant increase in the availability of testing to accomplish this. A technology called contract tracing, which uses cellphone location data to track people who came into contact with an infected person, could help catch cases early, though privacy concerns may limit how widely it’s adopted.
A number of potential scientific innovations could shift the balance in the months ahead. The emergence of a more effective treatment for COVID-19 — whether it’s the president’s as-yet unproven solution or some other drug — would make the risk of infection less severe. A reliable blood test to identify those who have recovered from the virus and are likely to be immune could also help determine who can return to normal life or serve as help for vulnerable groups.
Each of these steps raises a certain level of skepticism about how feasible they might be and whether the United States has the logistical capacity or political will to accomplish them.
The U.S. could start a “rolling reentry” starting in May if tools to identify and isolate infected people become readily available, the country’s top infectious disease expert, Dr. Anthony Fauci, said on Sunday. Dozens of companies are selling tests that purport to identify coronavirus antibodies, but it’s unknown how accurate any of these tests are. Even if they are reliable, scientists still need to determine whether previous infection does in fact convey immunity and how long that immunity might last. Clinical trials for pharmaceutical treatments have shown some early promise, but more research is needed.
The least at risk will be able to return to normal first
“We should slowly open up parts of the economy in June, while requiring those 70 and older, or others at high risk, to continue to shelter in place, perhaps in isolation. Lifting restrictions could start with children and young adults, who are far less likely to get seriously ill and die.” — Ezekiel J. Emanuel, New York Times
Outbreaks will pop up in different parts of the world
“[A possible] scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.” — Ed Yong, Atlantic
Opening things too quickly risks sparking new waves of infection
“In places where we start the economy too soon and let people go to their jobs and let normalcy return in some fashion, it looks like there’ll be a brisk and deadly outbreak.” — Historian Lynette Nusbacher to Esquire
There are too many unknown variables to make concrete predictions
“The answer depends in large part on uncertainties about the novel coronavirus that causes the disease, including whether you can get it more than once and how quickly the world’s scientists might produce a vaccine. The cost and benefits of a prolonged shutdown and what different countries can afford, from both an economic and political standpoint, are factors, too.” — James Paton, Bloomberg
Safely returning people to work needs to be treated with the seriousness of stopping the virus
“The United States cannot long endure in a state of suspended animation, nor can the nation easily bear the cost of repeated lockdowns. That’s why it is also critical to fund and implement the safety measures necessary to let Americans get back to work, school and play without a recrudescence of the virus.” — Editorial, New York Times
Most plans rely on too many assumptions to be taken seriously
“I deeply understand why basically everyone just wants this to be over and to get on with our lives, but I fear there’s a lot of magical thinking now creeping in that reminds me of the magical thinking that got us here in the first place.” — MSNBC host Chris Hayes
No recovery plan works without widely available testing
“All of the evidence points to mass testing as the only way out of a perpetual cycle of social distancing and caseload spikes. Social distancing is buying us time, but without universal testing, this period of pause delays the inevitable.” — Suraj Patel and Viral Patel, Wired
The return to normalcy will be slow and incremental
“When the medical evidence starts to show that the situation is improving, then it’s time to look at a gradual and orderly return to normal operations. Rather than flipping the switch back on, responsible mitigation measures will still be needed even if they may be less severe.” — Mark Harvey, Boston Globe
Contact tracing will be a major tool in limiting new outbreaks
“The US can only relax stay-at-home orders and social distancing policies if it’s doing enough contact tracing to catch new outbreaks before they explode.” — Nicole Wetsman, The Verge
The public needs to understand that the pandemic isn’t over when case numbers start to go down
“Despite the near-drowning of hospitals and intensive care units we’ve observed in many countries, and may soon witness in the U.S., we must think clearly and understand that getting through the first phase of this pandemic only gets us into the life raft, not to dry land.” — Marc Lipsitch and Yonatan Grad, STAT
The paths out of the pandemic are possible if executed well
“It will require an immense amount of leadership, coordination, and more sacrifice. It would take a sort of moonshot-level effort. But the tactics they outline aren’t unfamiliar. They’re textbook epidemiology — they just need to be scaled up to a level never really seen before.” — Brian Resnick, Vox
Hospitals need to be fully stocked before any distancing measures are lifted
“If we lift the restrictions and risk rising cases again without being prepared in our hospitals, we have the potential to expose our doctors and nurses to the same thing that they’re going through now — which is basically a crisis. … So we need to make sure that the supply-chain problems have been sorted out before we begin to experiment with lifting social distancing.” — Pandemic expert Tom Inglesby to Scientific American
Lawmakers lack the competency and political will to pull off the best plans
“I’m not sure every government in the world has a clear end game in mind for its citizens. I haven’t seen any country that has articulated fully and transparently its specific strategy to get back to normality.” — Pandemic expert Steven Hoffman to CBC
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