WE’LL MEET AGAIN
DON’T KNOW WHERE
DON’T KNOW WHEN
(Quarantine Essay #7)
The Atlantic (formerly The Atlantic Monthly) is providing some of our best coronavirus journalism. Recent articles by Ed Yong (“How will the Coronavirus end?) and Joe Pinsker (“When will the Coronavirus end?”) look forward to the end of this crisis.
Both articles are sobering and only for the sober-minded.
Yong offers us a lot of “ifs”: “If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it won’t be quick.”
That is a lot of ifs. Note that there are challenges with each one. Trump is typically wavering from day to day, perhaps hour to hour. He represents an archetypal case of a leader unequal to the moment.
We also have inconsistent adherence to social distancing. In Chicago this week when the spring weather exceeded fifty, thousands went to the lakeshore parks. The Mayor chose to close the parks as a consequence. In some facets we are doing well with social distancing. In others not so good.
Testing has lagged, but is speeding up across the country. There are regional efforts (as in our local Northshore Hospital here in Evanston, Illinois) which are succeeding.
There are increased efforts at mask production. 3M’s mask production plant in Aberdeen, SD has shifted to “surge capacity”. In one month they have doubled production to a million a month. They are not alone.
In the areas of factory production (masks, ventilators, temporary hospitals) we have a good chance of ramping up quickly. But being so far behind is our disadvantage.
The weaknesses are in both the federal government’s vacillation and the consequent inconsistency among the populace. Clear federal leadership would probably have a dramatic impact on lax populations . But we have little basis for hoping that will ever come.
Thus, the poignancy of Yong’s analysis. Even in the best case scenario, with all the ifs going from yellow to green, we are in a protracted struggle. Yong outlines three possible scenarios:
1. The first is that everyone everywhere manages to suppress the virus everywhere at the same time like the global community did with SARS in 2003.
2. The second is the virus does what past flu pandemics have done: it “burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts.” This is the herd-immunity strategy. Quick but costly. This strategy would kill millions and devastate our health systems, but would end the crisis soonest.
3. Yong offers the third option as our best: playing a protracted, global game of whack-a-mole. Suppressing outbreaks repeatedly over a long and complicated time until a vaccine can be produced.
The coronavirus will now be a “lingering part of American life” for at least a year, and perhaps longer. But every time we try to get back to normal, the virus will too. Thus Yong concludes that we need to expect multiple periods of flare-ups and social distancing for quite some time.
Joe Pinsker has a similar take. His article describes the goal we are seeking as both simple but unsatisfying. We have to have enough of the population’s resistance to the disease spread from person to person. Pinker’s estimate based on interviews with leading researchers is 60-80 percent. With that rate we will be able to deal with the periodic flare-ups of the disease. But how long that spread will take we don’t know.
There are two ways this might happen according to Pinsker. We either develop a vaccine; or the virus works through the entire population killing many, but making others immune (Yong’s burn-through scenario).
The challenge with both scenarios is that they will take over a year or more. We can’t maintain shelter-in-place rules for an entire year. Can we?
So we may shudder at President Trump’s suggestion of getting back to work by Easter Sunday (April 12); but his impulse is actually inevitable. At some point we will have to relax our current restrictions and begin to experiment with new norms.
Pinkster, based upon his interviews, offers us four possible timelines:
Timeline One: 1-2 Months
The most unlikely scenario is the shortest one. It is the “burn-through” effect described above. Our health systems simply won’t be able to cope, and COVID-19 runs rampant both increasing our herd immunity and killing the vulnerable.
Timeline Two: 3-4 Months
In this timeline there is increased testing that gives scientists more information on the nature of the virus. The more we learn about how it behaves the more we can loosen restrictions upon the least vulnerable among the population. We might have developed treatments for COVID-19, but not cures. But still, this is a likelier scenario than the drama (and tragedy) of the first one.
Timeline Three: 4-12 Months
As summer emerges we are going to learn if the virus is seasonal or not. In either scenario (it is or it isn’t) we can probably relax some of restrictions of social distancing. But not all.
If coronavirus is seasonal, then summer is going to be more tolerable for us than the spring. We could increase outdoor activities, reopen bars and restaurants. But large gatherings would probably still not be a good idea. “No Lollapalooza, no Major League Baseball, no crowded beaches.” Stores might still limit the number of customers inside at one time.
But this means that an autumn resurgence of the disease is a real possibility. We might have to return to stricter norms of social distancing then. Back to digital classrooms and church online.
However, if we use the summer to continue ramping up PPE and ventilator production then when the “fall wave” comes we’ll be better prepared.
But if it isn’t seasonal and we see no decrease in cases come mid-June, then we may have to continue with some form of the present severe social distancing. Not identical perhaps, but not as loose as we could hope.
Timeline Four: 12-18 Months (or longer)
Spring 2021 is about the earliest anyone expects there to be a COVID-19 virus. If we can get the vaccine right (and this isn’t as easy as producing face masks at surge levels) then we can gradually return to “normal” life.
Pinsker concludes with a best-case scenario. Even without a vaccine subsequent outbreaks of COVID-19 will not be as bad as this first one. But it’s going to threaten us for a long time to come. “This wouldn’t be ideal,” Pinsker writes, “but by then, life would be back to normal—though at the same time, completely changed.”
Research like this helps me deal with our current social restrictions. If I can get a conception of how long we might be doing this, what a possible endgame might be; then I can adjust my expectations accordingly.
In sum, this is a major global crisis and not merely the hysteria of the media or partisan politicians. It’s going to be a long struggle over several months if not more than a year. We are going to have to practice social distancing for far longer than any of us we will want to.
The more troubling questions are not actually medical. At least for me. These are questions about the impact this experience is going to have on all of us. We are undergoing a global trauma unlike any we have ever seen. The shock waves are just beginning. The social, economic, political, and psychic destruction about to happen to us and among us unforeseeable. I don’t write that to scare anyone. It’s simply a fact.
In the Christian Bible there is an admonition during times of social upheaval to “strengthen the things that remain.” We certainly have to meet this current crisis with great intensity and determination. But we are in for the long haul.
We may meet again on the other side. But we will all be changed.
March 28, 2020