by Michael Ainscough, MD, MPH
By the end of this week, 44 states will have initiated some degree of reopening for business. Gov. Pritzker has signaled that he is considering a regional approach to reopening Illinois. People want to go back to work… safely. We don’t have widespread testing to tell who is infected or who is immune, so returning to work will be something like a grand experiment.
We’ve not seen much disease in Washington County because of who we are and where we are. We are communities with strong family values and work ethic. We have made an earnest effort to social distance to minimize the spread of COVID-19. We live in a rural area away from the epicenters of disease in densely populated cities like St. Louis and Chicago.
Washington County has had few cases (14 as of May 4). It has been an island in a sea of virus moving all around us. Will the virus eventually be more prominent here? Probably. The 1918 Spanish influenza touched every city, large or small. When we relax our defenses, we will have cases. When people start traveling frequently again to St. Clair County and St. Louis, we will have cases. As of May 2, the St. Louis metro area had 6,676 positive cases and St. Clair County had 540 cases. Together these are equal to half of the total population of Washington County.
Do not be misled. When restrictions are relaxed, that will not mean that we are totally safe. It will mean that we are considered safe enough to resume some normal activities. When restrictions are eased to allow more interactions among people, it is likely that more virus will circulate in the community. More people, especially vulnerable groups, are likely to become infected.
When only China had the epidemic, Americans were not worried. When Italy and Spain’s medical systems were overwhelmed by the epidemic, our pendulum swung extremely in the other direction. We used traditional epidemiology responses of social distancing, quarantines, and closing businesses and schools. We slowed it down, but it has outlasted us. We can’t stay at home and out of work forever.
You can feel the pendulum moving back the other way now. We will come to a point in the middle where businesses will be open with some restrictions. We will try to balance health preservation with wealth preservation. The “80% people” who are at less risk of severe virus infections will resume a new normal of activities. The “20% people” who are at greatest risk of complications will still need to protect themselves, so they will continue to stay at home more, avoid large gatherings, and wear face coverings when out in public.
A report last week from public health experts (from the University of Minnesota, Harvard and Tulane University) said that the virus may be with us for two years, and outbreaks could continue in waves this year and into the next. Similarly, the 1918 Spanish influenza remained active for two years.
If the virus will be circulating for up to two years, and there is no vaccine, what can we expect? Epidemiologists say the worst case scenario is a large second wave approximately six months after the first peak, arriving next fall or winter. The 1918, 1957, and 2009 influenzas all had larger second waves. These precedents warn governments and health care systems to plan for a second wave. If the second wave is greater than the first, we would likely face stay-at-home orders, school closures, and business shut downs again.
Another possible scenario is a series of smaller waves which may occur as outbreaks in various geographic areas, depending on their levels of mitigation measures. If the waves are small enough, mitigation measures may not be needed. As herd immunity develops in future years, the virus will likely become less pathogenic and synchronize into a seasonal pattern like other respiratory viruses.
The virus will likely be with us until there is a vaccine. Without a vaccine, it would take 18-24 months to develop herd immunity, which means that over 70% of the population has had the infection and has immunity. A Johns Hopkins report recently calculated that at the current pace of 25,000 new confirmed cases a day, it would be well into 2021 before we would reach herd immunity. In that time frame, at the current daily death rate, over half a million Americans would die. We need a safe and effective vaccine to prevent those numbers.
COVID-19 doesn’t look like a “one-and-done” virus. We are likely in this for the long run. We should start developing a longer-term approach for how we will deal with it.
It is challenging to precisely predict the spread of COVID-19, but what we can control is our planning, preparedness, and our personal readiness. Our Washington County leadership team is doing the big picture planning and preparedness. What every individual, especially in the vulnerable 20%, can do is to continue the current guidance as much as possible. Avoid going to hot spots such as St. Louis and St. Clair County. Avoid socializing in groups outside of your family unit. Continue social distancing, wearing masks in public, and hand washing. We all need to do our part. Each needs the help of the others for all of us to get through this.
Michael Ainscough is a local retired physician who has contributed several articles on the coronavirus pandemic. He can be reached at firstname.lastname@example.org.