COVID-19 WILL NOT COME BACK IN THE FALL
You heard me right! It will not come back in the fall. This is fake news spread by the current administration and picked up by the mass media.
WHAT? you ask. How can that be?
Well, it’s actually a trick question. The virus will not “come back”, because it will NOT GO AWAY!
It is astonishing to me that the conversation has evolved into whether the virus will come back in a big way, in isolated cases, or in something in the middle. The assumption is that it has to come back from a disappearance, and I simply do not see any evidence that the infection rate is decreasing in this country today, nor that anyone is modeling that it will decrease over the next few months. Quite the contrary, all of the models are showing an increase in the daily death rate over at least the next month, and based on the basic arithmetic that I have previously discussed, in which we looked at the facts that hospitalizations and deaths trail infections by several weeks, we can be certain that the daily death rates will maintain at rates at least as high as today, and most likely significantly higher through August.
What is inherently true is that as we loosen social distancing by providing people the opportunity to congregate on Main Street, in schools, in churches, at sporting events, on beaches and with friends, the odds that people will become infected will increase. This is not speculation, it is inevitability. And with increased rates of infection will come increases in hospitalization and deaths. No amount of wishing and hoping and rationalization will stem the spread of a virus that is highly contagious and easily spread.
But, you say, there are areas of the country, or of my state, that have low rates of infection. Shouldn’t we allow those people to go back out into society?
Sure.
But understand that the virus doesn’t read the newspapers; it has no eyes. It doesn’t listen to the talking heads; it has no ears. It doesn’t listen to reason; it has no brain. It only has tools to allow it to infect cells, reproduce and go back into the environment in larger amounts than it entered the body.
The evidence of its transmissibility is clear. Where people congregate, the virus spreads rapidly. Nursing homes, prisons, meat-packing plants, aircraft carriers, religious services, etc. The spread is not related to race, religion or sexual identity. If you go out into society because you need to work in an essential business, if you need to take public transportation, if you live in a compressed residential environment, if you do not take precautions, you will be infected.
Infection started in this country in isolated spots. Because this virus has the unusual characteristic that it can be transmitted between people for at least a week before the infected individual shows any symptoms at all (if they are among the 20% who actually do show symptoms), the virus spread through the population in those hot-spots before the professionals monitoring the population were aware of the problem. This allowed the infection to move to new areas.
The same is happening in those areas that have “very low” levels of infection. Those areas are not immune to this virus. Infections in those areas may have occurred weeks after areas like New Orleans, or New York. The infections will increase in those areas now, but we are just seeing a lag period. That is the simple explanation why we see about a third of the states with an increase in hospitalizations, about a third at the same rate as they have been for the past couple of weeks, and about a third are seeing a decrease.
Loosening social distancing will increase the spread. Not maybe - not a little - but a lot. I wish this was not the truth, but in order to fight this disease, we need to accept the truth.
In other words, this infection will spread from what is now probably 5% of the US population to at least double that amount, and probably much, much more during the summer. There will be no decrease, therefore there cannot be any “come back”.
So, what did we accomplish with social distancing? Actually, quite a lot. The American public, heeding the advice of the medical establishment and their local and state administrations stayed at home. They embraced Instacart, Curb-side pickup, Netflix, board games, Zoom, Facebook, etc. They wore masks when they went to the grocery store and, in general worked together to limit spread of the infection.
And what happened? You have seen the charts. I choose to marginalize the “confirmed infections” rate since it is influenced by the testing rate. More representative of the infection’s spread is the daily rate of hospitalizations and deaths. By these criteria, infection in this country has plateaued. The steep rise in hospitalizations and deaths has now peaked in many areas of the country and leveled off. While some states are showing decreasing hospitalizations, other are showing increasing rates. The net result is a curve that looks more like a “mesa” than a “bell”. And this achievement is exactly what was hoped for in “flattening the curve”. The effect of flattening the curve was not to eliminate the disease, but to stabilize the hospitalization rate to a point at which the healthcare system could cope with the severe cases.
Now what? The next step is to find therapeutics that will decrease the lethality of COVID-19 acquisition and infection. I am very optimistic that over the next few months treatments will be identified, drug combination regimens determined, and data collected that will dramatically shift the death rate numbers downward. The announcement this week that remdesivir showed a 30% decrease in length of hospital stays for severely ill patients was extremely important; however, the importance was NOT that remdesivir will offer a magic bullet treatment for the disease. As Dr. Fauci said, it was essential because it showed, significantly and importantly, that there WILL BE treatments that can stop viral infection. The eventual treatments may or may not include remdesivir. We will have clearer information at the end of June when a lot of the ongoing clinical trials begin to report their results.
When treatments are available which can prevent death in patients that need hospitalization, many people will begin to feel a little more comfortable taking the individual risk of venturing back out into the world. At least you will know that if you get infected, if you are one of the 20% who get ill, of the 10% that need hospitalization, that you will survive.
We can remain optimistic that a vaccine will be developed, that it will pass the safety and efficacy testing. Maybe the new mRNA strategy for vaccines will succeed. Maybe the protective effects of the vaccine will exceed 75%. Maybe we will figure out ways to grow or produce these vaccines in sufficient quantities to immunize 25% of the population. Maybe successful vaccines developed in one country will be licensed to other countries for their use. Maybe this will all occur in the next year. I remain optimistic. But if there are therapeutics that can manage the disease when you get ill, even if you are incapacitated for a month or more due to the severe effects of the virus, society can reopen and you can better determine your personal levels of risk: hug your grandchildren, go to a restaurant, go to a ballgame, try on a new pair of shoes, take an education class in person, go to a concert. That will be the true beginning of the end of this chapter in human history. Let us pray that we all memorize the chapter and remember it when the next pre-pandemic is identified.