If someone had suggested five months ago that we would see more than 3 million cases and 135,000 deaths from COVID-19 in the US in mid-July, they would not have believed it.
But it is now clearly possible that within five months, half of all Americans could have been infected with SARS-CoV-2, and more than 800,000 Americans could die in this extraordinary outbreak. That is what many of our leading public health experts expect now.
Could your projection models be off base? Perhaps. But don’t count on it. Despite the health consequences, disruptions, restrictions, and fear of the past five months, things could get much worse.
Acute spikes in COVID-19 cases, hospitalizations, and deaths are now reported in many states, including Texas, Arizona, California, and Florida. And we’re still a long way from where we should be at this point in the availability of reliable coronavirus testing and effective contact tracking.
Meanwhile, NIH chief infectious diseases chief Anthony Fauci recently told a panel of Congress that if the coronavirus trajectory spreads at its current rate, we could soon see 100,000 new confirmed cases per day in the U.S. And Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, cautions that the count of nationally confirmed tests accounts for no more than 10 percent of actual cases. That means there could actually be a million news cases every day by the end of the year.
And according to epidemiologist Jeffrey Shaman of Columbia University, “From the first studies of the new virus, we knew that without control, the virus would be able to infect 50 percent or more of Americans.” Why? Because a highly transmissible virus like SARS-CoV-2 spreads exponentially. That means that if three people become infected, within a few days, without proper controls, each will potentially infect three others. Then each of those nine newly infected people will infect three more, and each of those 27 people, and so on until we have a massive outbreak. These were precisely the assumptions made by Marc Lipsitch at Harvard, Michael Osterholmother at the University of Minnesota, and other public health experts.
So let’s do the math.
If half of us get some form of infection, from essentially no symptoms to very serious results, that would mean at least 160 million Americans infected with coronavirus. The best estimates are that about 15 percent will need hospital care. And even if significantly less than 1 percent of people infected with COVID-19 don’t survive, we could see at least 800,000 deaths from the outbreak.
Some states, such as California, have just announced that they will stop reopening and even reverse the relaxation of some of the current restrictions. Other states, like Florida, continue to reopen businesses and relax restrictions, as if the news had not reached Governor Ron DeSantis that COVID-19 is totally out of control in the entire solar belt.
So what do we do? It should be understood that it is not a simple binary choice between moving forward with the reopening or moving to more draconian national protocols to gain control of the wildfire pandemic. Experts suggest that wearing proper facial covering and social distancing are important in controlling outbreaks. But given the new explosive explosion of COVID-19 in so many states, it may be too little, too late for such measures alone.
There is growing concern that in addition to the spread of SARS-CoV-2 through large respiratory droplets and contaminated surfaces, transmission may also occur through small droplets, called aerosols, exhaled in normal respiration. About 240 esteemed scientists from around the world recently expressed concern about this alternative route of transmission to the World Health Organization. In effect, these microdrops can go beyond the recommended six feet apart, sneak around the edges of the masks that most members of the public wear, and remain airborne. This is a real concern, especially for susceptible people in small interior spaces like an elevator or office.
The truth is that until we have effective and safe medications, a proven vaccine and better tests, our best option to control COVID-19 would be to close again bars, indoor restaurants, gyms, beauty salons and hairdressers, and continue to ban sports, entertainment and live political events.
But the question about the reopening of schools in September remains particularly tense. Staggered school hours, reduced classroom time, and more remote learning can be helpful in reducing the spread of the virus, but these same proposals create an unmanageable and difficult challenge for many parents who work and need their children in regular school. full-time or find some way to find and pay for the right daycare.
So depending on the emerging case and mortality trends in the coming weeks, don’t be surprised if there is another round of ‘shelter-in-place’ across the board, along with the mandate that masks be kept and social distancing when we need to. leave. Doors Non-essential workers would have to stay home and continue zooming.
At the other extreme, we could basically continue the process of “reopening” and pretend that we are returning to some sort of normal state, more or less after the president’s delusional misrepresentation of the pandemic reality that lessened the effect of governor closings. and put ourselves in this situation first. If we do that, we will have to be prepared for millions of new patients, increasing deaths and a wide range of unexpected diseases and complications related to COVID-19.
But wouldn’t that number decrease if, as we are already seeing, the age of people infected with the coronavirus is actually decreasing, averaging around 40 years, compared to 55 years just four months ago? Perhaps. But there are still millions of older and vulnerable people in the population who would be susceptible to becoming seriously ill, infected by countless “disease spreaders,” people who have avoided masks and physical separation as a matter of principle or, worse, as a way to show support for Donald Trump.
Some have suggested that a “targeted” approach to stricter restrictions be considered. In states or regions where an outbreak is significant, why not limit yourself in these communities? That is neither practical nor acceptable to most Americans. I suppose most of us would not tolerate the kind of draconian restrictions on all travel and movement that China imposed on Hubei province last March when the COVID-19 outbreak was in full swing.
It is true that hundreds of laboratories around the world are working on medicines to treat SARS-CoV-2. But the most likely effective candidates will be directed at the sickest ICU patients and ventilators.
As for a vaccine, you can bet that Donald Trump’s “October surprise” will include an announcement that a new vaccine will be ready for the public by the end of the year. But here’s why you should be skeptical.
While there may be innovative technologies to produce a coronavirus vaccine, there are simply no shortcuts in time to prove the efficacy, and especially the safety, of any new vaccine. Initial testing will be done with young, healthy volunteers, not those at higher risk. The vaccines themselves can produce serious side effects and we have no idea how long the protective properties will last, or whether it is possible to develop and manufacture sufficient quantities, and to distribute a new vaccine in the short term.
Maybe there is a middle ground. If we could manage to create the tools (accurate, ubiquitous evidence and effective follow-up of contacts) and rules, including the constant use of masks and social separation, and, if necessary, return to take refuge in place, at least in some places, we could have a chance to control the United States outbreak.
Unfortunately, if Donald Trump reopens in January 2021, all bets are off.
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