ANN ARBOR – From the data available today, it will be unwise for us to “ease up” on social distancing before the end of May (earliest) across the entire United States or to stop social distancing until the end of August. If we ease up earlier than this, then the opportunity for a rebound of the virus is very high. A rebound will cause us to have to refreeze and repeat an even more stringent social isolation program.
Currently we are in the early exponential growth phase of the COVID -19 epidemic in the U.S. If our social distancing efforts are effective, then this phase will peak in May and decline in June and July; we will regain control at the end of August and a return to “normalcy” with rolling prevention measures in September. Until we have more data, plan for this scenario.
If we do not maintain social distancing until the COVID-19 epidemic is in control, then we will likely achieve the peak case load earlier – at the end of April – but our mortality rates will be about 3x higher. Mortality is driven mostly from hospitals being overwhelmed. Under this ineffective lock-down scenario, we will be back to “normal” in May rather than September with the economy wounded but working. But we will be at an extreme risk of a COVID-19 rebound in November and another complete economic collapse at Thanksgiving.
Staying the social distancing course is critical – here is why.
COVID-19 is different from other epidemics like HIV, ebola, zika because
- COVID-19 is new. We have no immunity, no drugs and no vaccine for it and its rate of transmission is high. Social distancing is our only effective population-level intervention today. It will remain our first line of defense until an effective vaccine (or suppressive drug) is on the market at scale (likely 12 – 18 months).
- COVID-19 is diffuse. We do not have sufficient testing in place to know where to deploy a precise social distancing strategy.
- COVID-19 has a high transmission rate. It spreads human to human without direct contact (the worst scenario), and can be transmitted for a long time – up to 40 days of transmission per infected person. Now that it is established, it is growing exponentially.
These factors and our current under-sized testing infrastructure in the US means that it will be difficult for us to successfully deploy a pinpoint (hot spot only) social-distancing strategy throughout most of the US safely and certainly not in any of our densely populated economic centers that so desperately want to return to work.
There will be short term economic pressure as GDP declines 62% year-on-year and real unemployment reaches 42% under the general lock down required to control the virus with social distance policies through September. (see “Too Little, Too Late” Blog estimates – March 12 – 20 blog -“Best Guess” scenario). Unfortunately, we are unable to test and identify who and where to deploy pin point lock down strategies that allow people to return to work safely until the epidemic is under control. If lock down is successful, the epidemic will be in control in September.
Cancel your plans until September. Plan for the case-load on your medical community to peak in mid to late May. After peaking, the pressure on your medical infrastructure will drop as fast as it rose. Things will seem ready to start back up again. But wait until the medical community is treating one patient case at a time, rather than a whole population. This will take about 60 days after the case peak (end of July) is announced in non-hotspot areas and about 100 days (end of August) after the peak case load in hotspot communities. If you do not wait, the virus will likely bounce back and we have to start all over again. Plan to lock down through August if the virus maintains its current trajectory.
Continue to Social Distance. For all non-essential workers, the elderly, compromised patients, and student populations, while you are maintaining social distancing, continue to practice all of the pandemic management techniques of hand washing and sanitizing, disinfecting all surfaces, covering your mouth when coughing and remote working. Stay home. If you are sick, do not go out at all – maintain isolation in a separate room and bathroom that is sanitized regularly, have someone care for your pets, have any essentials and food delivered to your door without making any contact and wear a mask at any times that you are in the same room as another person. (see my first blog – Mar 2- 12)
Essential Workers. Reconfirm that your physical presence is really required for each activity. Check that the work cannot be delayed or transferred. Acquire network access and devices to work remotely as much as possible. Wear personal protection equipment at all times when working. . After each use, sanitize your vehicle, equipment and high-touch areas at work and home with a spray (preferable) or bleach wipes. If you live with others, disrobe outside, clear all other house occupants to the nearest shower prior to entering with a signal and shower with soap everywhere immediately. Wear gloves and a mask to load contaminated clothes into the laundry. You do not have to wash your laundry separately from others in the household – coronavirus will not survive in the washer.
Herd Immunity. If you contract COVID-19 and are confirmed clear of infection through a “no-detection” result of two PCR tests of nasal and oral cavities after a 24 hour period, then you are likely protected from additional infection for 12 to 18 months (This “herd immunity” data is from other Coronavirus studies. There have been isolated reports of COVID-19 reinfection and we do not know how long protection is conferred for COVID-19.) Many of you will get the virus and not know it. Antibody tests to determine this should be generally available in June. We believe that anyone with COVID-19 antibodies can return to normal life, but we need more data to ensure this.
Hotspots. Population level and density determines your community’s susceptibility to becoming a hotspot. All communities of over 100,000 people with a population density of over 2500 people per square mile are at high risk of becoming a hotspot. If you are living, working or visiting in any area (e.g., attend church, visit friends/family, attend an event, interact with crowds) within 100 miles of a population center of this size and density, then you are subject to community spread of the virus. Stay home and practice all pandemic prevention measures for at least 60 days after the peak case load is achieved in your greater community. Determination of peak case load must be conclusive and come directly from the CDC – Only use this source. https://www.cdc.gov/coronavirus/2019-ncov/index.html
The Economy. You may be put under pressure to return to the office and normal life. Try to stay home until end of August, unless the facts change. Testing and identifying who and where to deploy pin-point lock down strategies that allow you to return to work safely is not possible until the epidemic is in control in your community or we have increased testing by 5000x. August is 100 days after the peak case load in outbreak areas. Do not listen to how we controlled ebola or AIDS outbreaks in the past – this virus is different. Do not become a guinea pig in an economic or social experiment designed by non-experts. Unless your boss has a PhD in epidemiology, then use your judgement and obey the CDC guidelines in your community. Avoid “just this once” or “let’s try” requests that are not aligned with expert guidelines and do not break social distancing rules. Population mobility will make quarantining ineffective and the virus will resurge if social distancing is lifted too aggressively.
Resist temptation. We are unlikely to be able to lift social distancing and pandemic management practices safely before the end of August for this COVID-19 outbreak – especially if you are in a high risk group. Until we have more data, plan for September.
Calculate Your Community’s Likely Lock Down Time –
To see where you must maintain social distance measures, click the link below and navigate to the bottom of the document –
if you are within 100 miles of a blue circle on the map at the bottom of this document, then enforce your social distancing for the period through the peak case outbreak in your community PLUS
- at least 60 days (if you are young, uncompromised and in a non-hotspot) and
- up to 100 days (if your are elderly, compromised and/or in a hotspot)
If you are in the white areas of the map and are not exposed to people from denser population centers and are not in and do not have contact with the high risk population (over 65 or compromised patients), then it may be possible to relax some of your social distancing measures if you are in a well-served medical area that is regularly monitoring for viral outbreaks. I do not think such a community exists in the US today, but they will be possible to establish if we have an extended period before a vaccine or suppression drug for COVID-19 is on the market.
On the map, click on a circle to enlarge Texas – Dallas (already), Houston, San Antonio, Austin and El Paso greater metropolitan areas will (likely scenario) be hot spots with overwhelmed health systems. COVID19 cases will grow to a likely peak in mid to late May and a decline through August where we will have transmission break and can deploy a patient case-based strategy rather than a population strategy (IE, social distancing) to contain the virus. Continued rolling prevention measures will be required to avoid a rebound until a vaccine is available (likely in about 18 months). This would put Austin on a path to “normalcy” in September under an effective lock down scenario.
If I was forced to relax any social distancing restrictions in Texas (for example) – there are four possible areas where social distancing might be relaxed early because they are more than 100 miles from a population center over 100,000 people with a density of over 2500 people per square mile – along Big Bend along the Rio Grand, on the Oklahoma panhandle boarder, halfway between Dallas and Lubbock (but not too close to Abilene), and halfway between Beaumont and Shreveport LA in limited areas (in that order). The UP of Michigan may become another candidate for slightly earlier relaxation of social distancing under the right scenario.
Healthcare Expert Fred Brown is Chief Operating Officer of Fred Brown Management Consulting. To read his bio, click on https://www.linkedin.com/in/frederickwkbrown/