States are beginning to partially reopen. Both Republican and Democratic governors have begun to explore ways in which to incrementally send Americans back to work, while mitigating the risk for new outbreaks. Last week, it was Georgia, Tennessee and South Carolina. This week it is Texas, Florida, Colorado and localities within New York and California, among others. As we move forward, there are multiple unknowns to consider.
First, we need to understand the nature of immunity: How long it lasts, and how many people have it. If herd immunity is reached when approximately 60% of the population has contracted and developed immunity to the virus, then we need about 195 million Americans to develop immunity. This is important when considering the purpose of our testing, which is not intended to prevent everyone from infection but instead to prevent outbreaks by identifying hotspots. The majority of Americans are expected to contract the virus and recover. The question is which comes first: Herd immunity or a vaccine.
Because our testing is primitive, we don’t know how many Americans have had the virus and recovered, nor do we know whether or not they are immune, for how long immunity lasts and if they’ve since been re-infected. Further, we have no guarantee that a vaccine will be developed in a timely fashion or at all. This all means that we’re banking on a summer slowdown.
If viral spread slows amid the heat and humidity of the summer months, then one thing is true and another thing needs to be: First, we will have a second wave of infections in the fall. Second, we have to use the summer to increase our medical capacity: More ICU beds, ventilators and PPE (how much of each remains debatable). By ensuring that we’re more prepared for a second wave than the first, we can prevent unnecessary deaths and economic suffering concomitantly.
The problem is that we don’t know how the virus will respond to the heat. What is true for influenza and the common cold is not necessarily true for COVID-19. If the virus does respond to the summer weather as some epidemiologists predict, then there will be a second wave in the fall, though it doesn’t have to be worse than the first.
If the summer weather doesn’t kill the virus, then you can be almost certain that herd immunity is coming before a vaccine. The elderly and immunocompromised will stay home safely, while younger, lower-risk Americans will resume life in a manner somewhat approximating normalcy, becoming infected and presumably developing immunity. If the summer weather does kill the virus, then we use the warmer months to build our medical capacity in preparation for the new flu and COVID-19 season.
Regardless of whether or not there is a second wave, there will be more infections as a result of lockdown. The government closing schools and shutting down nonessential businesses has been effective in areas with high population density – like New York City – and should continue in those particular locations. But because we have kept younger, healthy Americans home instead of allowing them to develop immunity, not only are they going to be infected as we reopen, but now we’re several months behind in the pursuit of herd immunity.
As we reopen the country incrementally, it is important to avoid overwhelming a healthcare system which hasn’t yet had the summer to build capacity. But we don’t need to remain shut down indefinitely, nor is that the best solution. As we proceed, we should prepare for these two possibilities, both of which entail more infections.
Perhaps in the fall, locations with higher population densities should be locked down again. This is where our testing is important. By using contact tracing to identify hotspots, we can prevent outbreaks emanating from areas like New York City without needing to shut down the entirety of the country.
Irrespective of which possibility becomes reality, we need to continue reopening with caution, as well as with the understanding that more infections are imminent as the result of our initial strategy. One way or another, we’re heading toward herd immunity. The final question for now is how quickly our action allows us to get there and how long it lasts. This, we may know in short time.
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Kevin Catapano is a weekly columnist for The Daily Campus. He can be reached via email at email@example.com.