The Pandemic Will End: Part One.

The question of how the coronavirus pandemic ends and when people can return to normal activity is a complex one. It has been oversimplified in the public discourse with some suggesting we uniformly stop protective measures after a certain period of time while others argued we must permanently change lifestyles throughout in the world. I don’t believe either of these perspectives are correct, but we do need a thoughtful approach to how and when we normalize our daily lives. These decisions should have been discussed as soon as social restrictions were initiated, but that didn’t happen. It is crucial that it happen now to assure an orderly and rational exit. Over the next three days I will first to attempt outline the issues driving the risk/reward decision each individual makes as they leave social restriction, then tomorrow I will identify the medical and scientific information that we should use to help guide these individual’s decisions. On Friday I discuss what measures can be put in place to assure a successful exit of social restrictions in a way that prevents future damage to the health care system.

I must start my discussion today by expressing my incredible respect for the human race! Whenever I observed simulations of pandemic scenarios, social breakdown and disorder were significant consequences. In reality, the people of the world have done a remarkably good job of handling highly restrictive limitations on their lives with little social unrest. Everyone has made remarkable sacrifices that could forever change their lives, both economically and socially, and have done this in a positive and effective manner. If anyone needs reassurance about the state of humanity they can look at the efforts that people have made not only to limit their own activities but to try and keep everyone around them safe. It is a truly remarkable thing to observe.

Having said that, it is important that people understand the specific reason for the sacrifices they have made. This has not been clearly identified by the government or media. We took these acute measures, the so-called flattening of the curve, not to save lives, although that may happen in the short term. We instituted social isolation to save the healthcare system during this first, massive wave of the coronavirus infection.The real key was to reduce the number of sick and dying in this short period of time so that the hospitals and care providers did not get overwhelmed. Unfortunately, over the long term, highly susceptible individuals will continue to get infected and only drugs that can treat coronavirus infection will prevent death. 

Our goal to protect the health care system is extremely important given that a collapse from overwhelming number of infections would have social and medical consequences that make society untenable. When will we have achieved that goal and how do we mathematically and scientifically validate that accomplishment? One method is to look at hospital admissions and deaths from coronavirus. These numbers are easy to determine and it will tell us when a number of patients decreases to a point that’s manageable. Reductions in admissions initially will be dependent on social distancing, but importantly will be the result the increasing numbers of individuals who have already been infected and are immune to the virus so that the overall spread of coronavirus has slowed. Given this, one of the most important metrics will be identifying how many people have been infected are immune to coronavirus, which prevents them from spreading the infection. I will talk about the ways to do that tomorrow.

Another important concept to remember is that in a free society the decision to resume activities is a personal one. The job of health leadership and social institutions is to provide accurate information to individuals to inform the risk decisions they will make. We cannot overstate or underestimate the risk associated with coronavirus because people will sense these exaggerations and stop believing the guidance they receive. We also need to put trust into the decisions individuals make. Every day people make decisions to balance the human desire to participate in social interaction vs. the concerns about safety that result from those interactions. No aspect of our lives has zero risk, whether it be driving a car, participating in sports activities and or working with power tools. Coronavirus is no exception.  

Medical risk decisions are made daily by individuals. People did not stop having sex because of HIV disease, a concern that still exists, but most made accommodations to reduce the risks. HIV concerns are also tempered by the knowledge that there are drugs that can effectively treat the disease. Every year 500,000 individuals get hospitalized and an average of 50,000 people die from influenza but we have not forced people into pandemic isolation to control that infection. Unfortunately, despite knowing there is a risk of dying from influenza some refuse to take the vaccine that is available. Why is this? I believe that this decision is made because over time the perceived risk of influenza has become low enough that we have stopped trying to avoid the infection. We have grown immune to the risk of dying from influenza but not to the virus itself! As long as that perception has not overwhelmed the health care system we have argued against it but allowed it to persist. 

Also, it is important to remember that the personal risk from coronavirus varies greatly in different individuals. People who have been infected with coronavirus and are now immune have essentially no risk. Younger people have lower risk for severe illness and death from this virus then individuals over the age of 60. People who have less contact with other individuals during their daily lives due to job or social limitations might also feel that they are at less risk for developing the infection. These groups would likely be first to normalize their lives. This is in contrast to an elderly person with significant heart or lung disease that has a high likelihood of severe illness or death from coronavirus infection. That individual may wait until a drug is available to treat coronavirus before normalizing their activity. Others have argued that the elderly would be willing to sacrifice themselves to return to their normal lives. Regardless, the key to all of these decisions is that they cannot cause an increased number of infections that overwhelm the healthcare system. That would undo the benefits from all of the sacrifices that have been made.

Humans are social beings with an intense need for interaction. All of the major events of our lives-the ones we remember-are done in groups, from weddings, to graduations, concerts and sporting events. That drive for community will not, and should not, permanently change due to coronavirus. We need to provide a rational approach to how individuals can safely restart their lives based on their coronavirus risk and the risk to the healthcare system. Tomorrow I will outline the medical and scientific information that would facilitate this decision process.