Author’s note: I don’t want anyone to take this piece to suggest that things are not very bad, and will not remain very bad for a substantial period. This outbreak is not yet under control and won’t be fully under control until new medical therapies are available. Many people’s outlook on this outbreak remains too optimistic. My main point in this piece is that the suite of social measures we use to control this outbreak — which will be central to controlling the spread and limiting the death toll — can be expected to evolve over time as circumstances change and our institutions develop new competencies. Extreme social-distancing measures — including mass closures of workplaces and cessation of most social contacts outside families — may not be sustainable for as long as it takes to develop a vaccine. But they nonetheless are necessary now, will remain so for a significant period, and are likely to require periodic reimposition even after the acute outbreak recedes to the point they can be relaxed where you live.
The epidemiologist Neil Ferguson, the lead author of the Imperial College study that appears to have shifted U.S. and U.K. policy responses to treat the outbreak with much greater urgency, writes on Twitter: “I would comment that this is the time for innovative thinking about how we can practically maintain long-term suppression of transmission of this virus at a lower societal and economic cost than the world faces for the next few months. We still don’t know how successful measures adopted by China and Korea will be long term, but what happens in those countries will undoubtedly inform strategy elsewhere. Large scale readily available testing, combined with case isolation and contact tracing — perhaps assisted by technological solutions — may be key. But the first priority is to get case numbers down (R<1). There will then be a (limited) breathing space to assess less disruptive longer term solutions.”
The idea is setting in this week: We’re not going to be done with this coronavirus thing in a month or two. If you lock down society to beat the epidemic, and succeed in drastically slowing new infections, but then go back to what you were doing before, the epidemic can just come raging back. In that scenario, society would remain full of people without antibodies who remain vulnerable to COVID-19, and they would be engaging in the social contacts that allowed the virus to spread so rapidly in the first place. That beating this epidemic will not be a one-and-done thing is an important realization; it’s good that the president leveled with people on Monday in saying he expected disruptions to persist into July or August. People should be prepared to deal with a lot of change to their lives for a long time, with significant economic and social costs.
But, for the first time in a while, I think part of the coronavirus conventional wisdom has become too pessimistic. Yes, the fight to stop the spread of the virus is going to have to be ongoing unless, and until, we develop a vaccine or highly effective medical treatments, which is to say for at least several months. But the nature of the disruption does not have to stay constant. It is necessary now to close schools and businesses, and tell people to drastically reduce social contacts in a way that is economically devastating to many businesses and workers. But there is a trade-off: The better we get at interventions to identify and isolate specific people with the virus, the less we should need to rely on interventions that isolate the entire population. That’s a reason the ramp-up of widely available testing remains such an important goal for the U.S.: More testing should, in time, allow for more normal living.
We are seeing this already in other countries: South Korea and Singapore have been successfully addressing their coronavirus epidemics with less extensive social-distancing measures than are currently seen in Italy, France, and parts of the U.S., in part because of their effective testing and surveillance regimes. The Financial Times reports today on the town of Vò, Italy, which successfully stopped its local outbreak though a strategy that involved widespread testing of the population and isolation of those who tested positive, even as the rest of Northern Italy did not fare so well.
If an outbreak becomes widespread enough, it becomes impractical to conduct effective surveillance and isolation of an infected population that is simply too large to track. So my suggestion is not that if you dropped a massive testing capability into New York City today, it would be fine to reopen the Broadway theaters. But at some point, the massive shutdowns we are undertaking in much of the U.S. (and ought to be undertaking in more of it) should make it possible to sharply reduce the rate of new infections to a point where widespread testing and monitoring can become a cornerstone of a strategy to prevent uncontrolled outbreaks — if we actually have the capability to do such testing and monitoring. This would not mean a complete end to the need for social distancing measures, but it could allow for a reduction in their intensity.
It is also possible that effective antiviral treatments to treat the sick will be available much sooner than a vaccine that protects the healthy. This is partly because ongoing trials are testing whether already existing antiviral drugs, approved and on the market to fight other viruses, can reduce the severity of COVID-19 and save lives. Dr. Cyrus Shahpar, one of the public-health experts I spoke with for my story in our current print magazine, told me he thought widespread availability of effective antiviral drugs could come as early as late spring or early summer. This would be another important tool to save lives and reduce the burden on our hospitals, giving us additional space to rely less on societywide behavior changes.
The economic, social, and psychological effects of extended, societywide isolation measures are going to be severe, and I worry about the public’s long-run willingness to comply with them. Extensive testing, monitoring, and isolation related to specific coronavirus cases would not be a trivial imposition either, but it would be much less painful and disruptive. There is a reason the World Health Organization is pushing a mantra of “test, test, test.” Ramping up a more effective testing capability is likely to help us avoid the worst-case scenarios for the length and severity of coronavirus-related social disruptions, on the way to defeating the virus more soundly.
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