It seems like it was only a week ago that Dr. Deborah Birx told us to expect 100,000 to 240,000 deaths from COVID-19. Yet here we are, with a total (as of this moment) of 10,493 deaths, hardly inconsequential, but hardly in the hundreds of thousands. Whether it was the product of exaggerated fears, a good response by government or the effectiveness of social distancing is a discussion best left to reddit, but two things happened to reflect a paradigm shift.
First, the Dow rose 7.73% yesterday, reflecting the market’s belief that the worst is in the past and we’re now looking forward. Second, the New York Times is now offering a ‘splainer about how we’ll know when it’s over. Playing the “experts say” game, the Times provides “four benchmarks.”
- Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care.
- A state needs to be able to test at least everyone who has symptoms.
- The state is able to conduct monitoring of confirmed cases and contacts.
- There must be a sustained reduction in cases for at least 14 days.
Notably, there’s no mention of a vaccine or a treatment, but rather a third leg to the pandemic. We started with containment, moved into mitigation and will then shift to suppression.
In suppression, cases will dwindle at an exponential fashion, just as they rose. It’s not possible to set a benchmark number for every state because the number of infections that will be manageable in any area depends on the local population and the public health system’s ability to handle sporadic cases.
Are we at the point where cases will “dwindle” because they’re no longer rising exponentially, as we were told they would? Is that good enough, or will letting down our guard give rise to the next wave of exponential increases while we still have no cure for the disease and no fix for getting infected. Or do we invest in mask futures?
And who decides whether we’ve reached these benchmarks?
“We wanted to suggest criteria that would allow locations to safely and thoughtfully begin to reopen, but what that looks like exactly will vary from state to state,” said Caitlin Rivers, another author of the report and an epidemiologist at the Johns Hopkins Center for Health Security. “We therefore included some flexibility for jurisdictions to tailor these criteria to their local context.”
Some jurisdictions may prove less concerned about reinfection than other issues, and accordingly flex their local muscles even if it means they become the next “hotspot.” What are you going to do when the person touching your tomatoes at the market just returned from such a place?
And then, there’s the curious question of how to deal with the “survivors”?
Gregg Gonsalves, a professor of epidemiology and law at Yale, said: “I’d feel better if we had serological testing, and could preferentially allow those who are antibody positive and no longer infectious to return to work first. The point is, though, that we are nowhere even near accomplishing any of these criteria. Opening up before then will be met with a resurgence of the virus.”
For people who have antibodies, having been unwittingly infected but were asymptomatic, the questions remain how they will know, but more importantly, how others will know they aren’t a threat. Maybe they can sew stylized gold stars to their garments?
A great many questions remain, but the sense that we’re all in a huge rush to get back to normal, to return to work before any of that sweet $2.2 trillion stimulus money shows its face, might push us to move forward with a foolish fearlessness. It was only a week ago that we were doomed. Is it over?
*Tuesday Talk rules apply.