What Lies Ahead in the Pandemic?

The first great wave of the COVID-19 pandemic is either peaking or past its peak in China, parts of Asia, Europe and the U.S.  What lies ahead?

What does it mean when people say, ‘the worst is over’?  It means that the explosive growth of the pandemic in a particular city or nation is over, that the healthcare system is no longer stretched beyond capacity, that the number of new cases each day is not getting larger.

But it does not mean that the contagion has stopped spreading.  There may still be more new cases each day than cases that have been resolved.  New people will go into the hospital.  New people will need intubation.  New people will die.  There will still be large numbers of people who walk the streets in either a pre-symptomatic or asymptomatic state.

The only way to completely stop the spread of COVID-19 before a vaccine is available is to test universally and constantly, and track and quarantine all infections, efforts that very few countries will be willing or able to mount.

But there is no doubt that human beings will attempt to return to a more normal life and be willing to take on a certain level of risk to ensure that total economic collapse and all of its attendant consequences do not occur.

So, what will life be like in this interim period, before vaccination but after total shutdown orders have been lifted?  Knowing that there are still significant numbers of infected people in public, will people be willing to fly on airplanes?  Will they go to bars and restaurants?  Will they attend sporting events, concerts, plays or theater?

This will partly depend on the level of contagion in any specific area.  And that level will probably ebb and flow much like the tides and any other cyclical phenomena.  COVID-19 is highly contagious, so if the social distancing measures are completely abandoned it will return with a vengeance. 

Will a more relaxed social distancing policy, with people generally wearing masks in public and trying to keep their distance from others, be enough to keep the virus at bay?  Will the mortality rate be lower if we keep the contagion at a lower level and allow our healthcare providers to work in an optimal manner?

The unpredictable nature of the COVID-19 sickness may have a sobering effect.  Even young, healthy adults can end up on a ventilator and ultimately die.  Will this fact cause much more conservative behavior, or will people be willing to take that relatively small risk and resume their normal lives?

Clearly, elderly people and those with pre-existing health problems will be very reluctant to risk exposure as long as there is a significant level of contagion present.  This is a growing portion of our population and a group that contributes heavily to our economy.  Their isolation and sheltering will certainly be a brake on any real recovery until there is a vaccination available.

One possible short-term aid would be the development of a treatment that stops or significantly reduces the so-called ‘cytokine storm’, the medical event that seems to herald the rapid demise of patients and is responsible for the death of young and healthy victims.

It is impossible at this point to accurately predict the future of this contagion.  But I believe there is enough evidence to support the argument that any true return to normalcy is many months away.  There may be an improvement in economic activity once the strictest shelter-in-place restrictions are lifted, but it is likely we will endure many months of a seesaw response.  We will simply have to do our best to adapt to each new situation and, most importantly, avoid desperate moves that pit state against state, country against country, rich against poor.  Our humanity is being tested; we must all do our part to meet the challenge.