- The toll of this pandemic has been horrific throughout the world.
- Remarkable sacrifices have been made that have limited its impact
- Moving forward we need to understand how many people have been infected
- If estimates are correct, we have significant immunity to COVID-19
- Immunity will allow us to move forward from this pandemic
Since both Passover and Easter are holidays of reflection and deliverance, I decided to reflect on the COVID-19 pandemic so far and discuss how we can be delivered beyond the time of coronavirus.
The impact of COVID–19 on the world and the United States has been horrific. Tens of thousands of people have become ill and died in a short period of time. Entire continents have been locked down and gripped by fear. These events serve as a stark reminder of the tenuous nature of life and the need to value every human being; important concepts that we might have been taking for granted.
Positives responses to the pandemic are often lost in the fever of the acute battle with the illness. Through remarkable sacrifices the pandemic was controlled in almost every country albeit at an enormous toll. This happened without violence or political upheaval and the vast majority of people tried to practice the public health initiatives that controlled the pandemic. This effort saved thousands of lives and that should not be forgotten moving forward.
So how do we move beyond the time of COVID-19. The raging debate about when and how to normalize activity, especially in United States, has led to widely opposing views even by knowledgeable individuals including former CDC and FDA directors. However, to make these decisions we need data. The biggest issue is that we don’t know what percentage of the population has been infected with COVID-19.
This number is crucial to moving forward. If a high percentage of the population is infected, it means significant herd immunity and indicates the case specific fatality rate is low. If a small percentage of the population has been infected, then the entire population is still at risk and the case-specific fatality rate is much higher. This potentially could make a second wave of the pandemic much worse.
An important aside, I disagree with those arguing immunity is of little value. Antibody testing simply identifies those who have had an immune response; it may not be important itself as protection against the virus. People seem to forget that it is memory cellular immunity that is really important for protection from a virus. Focusing on antibody mediated viral neutralization to protect from future virus exposure is problematic.
What follows comes from discussions I had this week with Dr. Eric Fearon, head of the University of Michigan’s Comprehensive Cancer Center.
One thing that is clear is this virus is very easily transmitted between people. Large amounts are in exhaled breath and many people who are infectious display no symptoms. Thus, many infections have occurred and most are asymptomatic. Given this, several of authoritative public health officials and biostatisticians have proposed the following scenario.
Assuming that the current University of Washington modeling estimates of 60,000 deaths in US for this first wave, and an estimated mortality of 0.06%, similar to the worst seen for influenza, these 60,000 deaths means 100M have been infected in the US. One hundred million people is roughly a third of the US population. Can this be right?
No one is sure, but a CDC study about community spread in early March and modeling from biostatisticians at Stanford (WSJ) argue that at least 3 million infected individuals were present in the US (1% of the population) around March 1.
With the doubling time of 3-4 days that was observe in testing in major cities for the two weeks prior to any significant social distancing, and the absence of social distancing in other parts of the country for many days more:
- If 3M (1%) infected on March 1
- 6M infected on March 5
- 12M infected on March 9
- 24M infected on March 13
- 48M infected on March 17
- 96M infected on March 24 (7-day doubling)
- 192M infected on April 8 (15-day doubling due to social distancing)
Thus, while it is possible that 30%+ of the entire US population is COVID-19 exposed, it is more of a certainly that 30% or higher have been infected in high incidence areas like NYC, SE Michigan, NJ, CT, MA and New Orleans.
Given this, our way forward beyond COVID is likely to be similar to the flu pandemic of 1918; based on our population immunity. If antibody numbers prove this out, we have a clearer and brighter future.