I’ve been covering the coronavirus pandemic since January. I’ve read a plethora of scientific research on the virus, watched governments’ differing responses, and talked with epidemiologists and doctors.
Friends and family have recently started asking me when things will go back to normal. Every time, I brace myself for their disappointed silence. I’m about to tell them what they don’t want to hear: I think we’ll be tiptoeing through this pandemic for at least the next two years.
The subsequent lockdowns we’re very likely to see may not be as stringent as this initial one, but the waves of death could get much worse — especially come fall.
Here’s what I’m expecting.
At least two years of on-and-off lockdowns
The streets of San Francisco are eerily empty a day after the city went into lockdown on March 16.
Josh Edelson/AFP via Getty
Absent a widely available vaccine, the coronavirus is not going to die out. The US — and much of the world — is far from the level of immunity its population would need to stifle the virus’ spread.
That means it will likely circulate for years. According to a recent analysis from infectious-disease researchers at Harvard, “a resurgence in contagion could be possible as late as 2024.” The researchers also found that on-and-off social distancing measures could be necessary through 2022 to avoid overwhelming hospitals.
So, for at least the next two years, public-health authorities will need to play a high-stakes game of cat and mouse.
States that proceed carefully will partially lift lockdowns, allowing some businesses to reopen and lifting some restrictions on people’s movements. They will closely monitor the virus’s spread, and attempt to limit it as much as possible. Local governments will test residents en masse, ideally including people who have no symptoms. Armies of contact tracers will try to track down anybody who was exposed to a coronavirus-positive person.
This, of course, is an optimistic future. In reality, things will likely get much worse in some parts of the country, because states will reopen without the right surveillance systems in place.
As we proceed, epidemiologists will do their best to model the virus as it spreads (though good data depends on widespread testing), watching its trajectory creep towards the maximum capacity of local critical-care systems. When enough people get infected that forecasters predict a caseload that nearly overwhelms hospitals, governments will drop the hammer once again, closing businesses and schools and ordering residents back into their homes.
“What happened in Wuhan could happen repeatedly to a city,” Dr. Ben Cowling, an epidemiologist at the University of Hong Kong who researches influenza transmission and control measures, told me in March. “They can shut down for a month, but then when they reopen, they’re still going to have an epidemic starting again.”
More overwhelmed hospitals and avoidable deaths
Dr. Anthony Leno, Director of Emergency Medicine, top center, assists nurses as they take in a patient from a nursing home showing symptoms of COVID-19, Monday, April 20, 2020, in Yonkers, New York.
Many states have already chosen to reopen without the widespread testing, contact tracing, and isolation policies they need to avoid a devastating second wave of infections. That will mean that in mere months, an unmonitored — and therefore largely unseen — wave of infections could overwhelm their emergency rooms, leading to thousands of unnecessary deaths.
Georgia could be the first state to suffer those consequences. Gyms, barbershops, hair and nail salons, spas, and tattoo parlors there resumed business on April 24. Theaters and restaurants followed three days later.
Epidemiologists and computer scientists at Harvard and MIT forecasted the virus’s spread through Georgia, as The Daily Beast reported on Tuesday. The models showed that if the state resumes 50% of pre-pandemic interpersonal contact, it could see 1,604 to 4,236 deaths by June 15. By contrast, if the state had left its lockdown in place, the models showed that the death count would have grown to between 1,004 and 2,922.
If Georgia resumes 100% of pre-pandemic activity, it could see 4,279 to 9,748 deaths by June 15, according to the forecast.
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A customer gets a manicure from Sally Le and pedicure from Tom Dinh at Nail Turbo, during the phased reopening of businesses and restaurants from COVID-19 restrictions, in Roswell, Georgia, April 24, 2020.
Other states are planning to follow Georgia’s lead. Texas allowed theaters, malls, and restaurants to reopen at limited capacity starting Friday, with more businesses to follow on May 18. Idaho and Montana are planning to open the doors to houses of worship. Oklahoma is reopening sports venues, among other businesses.
Dr. Ashish Jha, director of the Harvard Global Health Institute, has recommended the US conduct 500,000 to 700,000 tests per day nationwide before deeming it safe to reopen such businesses. That is the “bare minimum,” Jha recently told my colleague Dave Mosher. Other plans call for millions of tests per day.
“If we don’t do this, we’re going to basically find ourselves with large numbers of cases and having to shut down again in two to two-and-a-half months.” Jha said.
The COVID Tracking Project reported that 1.5 million tests were conducted nationwide last week, or just under 200,000 per day.
“The states have basically decided they can’t, for the next round, can’t count on the federal government to help lead this. So they’re all taking their own state-based approach,” Jha said. “It does make me worry a lot about what’s going to happen in Kentucky and what’s going to happen in Georgia and Alabama and a lot of places that are poorer and don’t have the same kind of singular focus on, ‘How do we get ready for the fall season?’”
Brace yourself for fall
Cots are set up at a possible COVID-19 treatment site in San Mateo, California, April 1, 2020.
Some evidence indicates the virus could come back with a vengeance in the fall. If it coincides with a bad flu season — which typically begins in October or November — that could spell disaster.
“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” Robert Redfield, director of the US Centers for Disease Control and Prevention, told The Washington Post. “We’re going to have the flu epidemic and the coronavirus epidemic at the same time.”
That one-two punch to the critical care system could lead to more preventable deaths and necessitate even harsher lockdowns.
“If we don’t get our act together, the chances that there will be another lockdown in the fall, and that it will be a long one, are very, very high,” Jha told The Atlantic.
The timeline depends on a vaccine — but it might never come
A pharmacist gives Jennifer Haller, left, the first shot in the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle.
Ted S. Warren/Associated Press
The real answer to my friends’ and family members’ question — when will this end? — hinges on the answer to another question: When will a vaccine be widely available?
COVID-19 vaccine efforts are moving forward at record speed. Over 100 potential vaccines are currently in development, according to the World Health Organization. Pharmaceutical companies Pfizer and BioNTech have already begun human trials, and say their vaccine could be available for emergency use by the fall. Johnson & Johnson hopes to have its own ready for emergency use in early 2021.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has estimated that the development and distribution of a vaccine will take 12 to 18 months.
Other experts say this timeline is too optimistic. The fastest vaccine ever developed, for mumps, took four years.
It’s also possible that there might never be an effective COVID-19 vaccine.
The UK’s Chief Medical Officer, Christopher Whitty, told a Parliamentary committee on April 24 that there was “concerning” evidence suggesting that it may be impossible to stimulate immunity to the virus.
“We cannot guarantee success,” Whitty said. “Vaccines are looked for, for every infectious disease. They are not found for all of them.”
No vaccine has ever been approved for use against any other coronavirus.
“If we could have a highly effective, very safe vaccine that is in plentiful supply, that we could give to everybody and everybody is immune, that would be amazing,” Dr. Lisa Winston, an epidemiologist at Zuckerberg San Francisco General Hospital, told me a couple weeks ago. “If a genie came out of the wall and I could wish for something, that’s what I would wish for. And I’d wish for it today. But that’s not when it’s coming.”
Dave Mosher contributed reporting.