COVID-19 is the worst pandemic since HIV-AIDS went global in the 1980s, and in certain ways it is already worse. It is quite infectious, can infect from a distance of 6 feet or more, can infect from an asymptomatic carrier, is clearly more fatal than the flu, and may cause long-lasting harm to multiple vital organs. Humans have no immunity to it, and it’s not clear what is required to gain immunity, or how long immunity might last. We have as yet no partial or complete vaccines, and no assurance that we will be able to develop them within any specific time frame, if ever. We have no proven antiviral treatments and no proven immune response management treatments. Under these circumstances, an uncontrolled outbreak can quickly overwhelm health care systems, thereby increasing the death toll.
These are the reasons why scientists urged governments around the world to take the drastic step of imposing a high degree of social distancing on their entire populations, with calamitous consequences for economic activity. Many of our complex just-in-time systems of production and distribution have been degraded, including those necessary to fight this pandemic.
As profound as these consequences are, we would be even worse off without them. Without such drastic reductions in the rate of infection, the virus could kill over 100 million people worldwide in short order, leaving many more with compromised health, and vast social and economic dislocation.
The current shutdown is not sustainable, but fortunately it does not have to be. Once it drives the rate of new infections low enough, we will be able to cautiously restore some degree of economic activity, with a wary eye on the virus’s ability to renew its exponential growth as restrictions are eased.
I believe we must engage in a marathon of changed behavior in order to minimize both the damage to our economies and the damage to our health. The initial social distancing shutdowns, if strong enough, will lower the prevalence of the virus enough for us to be able to control it while partially restoring economic activity. This new reality, of one foot on the gas and one on the brake to maximize economic activity while minimizing health risks, will buy time for all-out efforts to create vaccines to unfold. There’s perhaps a 20-25% chance (my guess) that one of the more than 80 current efforts to develop, test, scale, and deploy a complete or at least strong partial virus in the next two years or less will succeed. Even if that’s true, two years is a long time, and we may need to manage many cycles of virus resurgence and suppression to get through it. In the more likely case that the development of a vaccine takes longer–the average development time for a vaccine has historically been about 13 years–we’ll need to be able to operate our management system for a lot longer. My best guess is about 5 years, with perhaps a 20% chance of twice that long.
To control COVID-19 over this time frame will require that we develop a much better real-time understanding of the state of the battle between us and the virus that causes it. We will need to know, in each city, county, state and country, the level and distribution of active infection, day by day. We’ll need to get very good at increasing and decreasing social distancing at just the right times and in just the right ways. Achieving this will force us to accept some loss, for a while, of personal privacy and personal freedom of movement. It will decimate some sectors of the economy, favor others, and require changed procedures in all. It will drive unprecedented financial support from the Federal Government. Still, we will get better at it, clamping down less severely and less often, for shorter periods of time.As difficult as all this sounds, it’s an option that earlier generations did not have: we are not condemned to relive the 1918 Influenza pandemic, or the Plague pandemic of the mid-14th Century. We can do much, much better, but we must take it very seriously to succeed. We live in a new world now, and we need to work at making it better.