The New Normal Is Life with COVID-19
Without immunity or effective approved treatments, COVID-19 will have a enduring effect on human interactions.
Governments and global agencies are starting to talk about road maps to re-opening locked down societies and enabling economic recovery. Most of these mention a vaccine. They outline steps that must be taken until a vaccine is available. What if we cannot develop an effective vaccine? Or, what if a vaccine takes longer than the optimistic predictions of 12–18 months to develop? Even if we can develop a vaccine, what is life going to be like until then?
SARS-CoV-2 is a pandemic virus. It is now circulating within the human population. For a virus with the infectious and disease-causing properties of SARS-CoV-2, this means that COVID-19 could be a disease that is an enduring part of human existence. In places where the virus was initially well controlled, the countries need to maintain vigilant testing, contract tracing, and isolation of new cases to ensure that travelers do not reintroduce the virus.
Testing, contact tracing, separating, and isolating
Without a safe, effective vaccine, the risk of recurrent local epidemic or pandemic spread of SARS-CoV-2 and COVID-19 remains high. This is why the road maps all include continued separation of people (social distancing), testing for previous exposure and possible immunity, testing for active infection, identifying contacts of those with active infection, and isolation of those actively infected or those who came in contact with an infected person. The US and many other countries are nowhere near ready to perform these tasks.
Effective tests for active infection exist, but these tests remain difficult to access for many people. Effective tests for previous exposure are still in the process of development and validation. Whether exposure is equivalent to immunity is unknown. Even once effective tests are developed, the reagents and supplies needed to administer these tests are not available at a scale needed for the US or most of the rest of the world. So, where does that leave us?
The New Normal: Social Distancing and Face Coverings
In the absence of approved effective treatments for COVID-19, the goals for most countries are to return the population to work while simultaneously limiting future outbreaks to avoid overwhelming the medical systems. In the US, I anticipate that this means continued social distancing through physical distancing, requiring face coverings in public spaces, and limiting the sizes of groups. Once a vaccine or effective treatments are available, then “pandemic” style life won’t be necessary, at least until the next pandemic of a new virus.
Socializing pandemic style
The decisions to shut down many regions and countries in response to COVID-19 and the media coverage of the places hit the hardest have created a certain amount of fear for many people. I predict that there will be two types of reactions to the reduction in stay-at-home orders.
One group of people will try to return to social life as if the pandemic never happened. They will get together in large groups. They will hug and shake hands. They will share food and drinks. These people will tend to trigger new outbreaks. Hopefully, the group that tries to return to the pre-COVID-19 “normal” will not cause outbreaks large enough that the government re-issues restrictive stay-at-home orders.
The other group of people will continue social distancing. They will start by seeing only one other set of people from one household. They will maintain a 3 – 6 foot distance. They will avoid touching. Some might even wear face coverings. For those that are very cautious, they may wait 14 days before seeing a different household of friends or relatives to make sure that they haven’t contracted COVID-19. This group will disinfect their homes after having friends over and will continue frequent handwashing. Friends and relatives may even inquire about contacts and habits before agreeing to visit.
Whether the cautious group expands its social gatherings will likely depend on whether outbreaks occur in their areas or whether they have family members or friends in the high-risk category for getting severe COVID-19.
Education and returning to school
Denmark is one of the first countries that instituted a lock down in response to COVID-19. The government shut down the economy and issued stay-at-home orders on March 11. They also have a very robust and effective socialized medical care system. On April 13, the Danish schools are set to re-open. However, the borders remain closed, travel restrictions remain in place, restaurants and bars remain closed, and gatherings of more than 10 people are banned. If Denmark finds that re-opening the schools does not result in an increase in infections, this could provide useful information for other countries about when it is safe to return children to school.
In the US, it seems unlikely that many school children will return to school before the fall. Some school systems have already made the decision not to re-open the schools for the 2019–2020 academic year. In case schools cannot be consistently open in the next academic school year, discussions of how to improve distance learning are happening in some US school districts.
A new normal
The bottom line is that many of us, especially in the US, have to think about life as fundamentally different.
Assuming SARS-CoV-2 does not mutate into something less virulent, there will be recurrent outbreaks of COVID-19. Hospitals will need to account for this in planning how much capacity is needed. People will need to be prepared for repeated periods of lock down or limited interactions.
In the US, people need to be prepared for persistent changes in how we shop, work, and play. They need to get used to wearing face coverings and social distancing in public. People need to be prepared to be unable to travel for pleasure or to hold large events, such as weddings, reunions, birthday parties, holiday parties, and funerals.
Hopefully, we will eventually understand SARS-CoV-2 and the immune response to the virus well enough and COVID-19 well enough to develop vaccines and have effective treatments for those who develop severe symptoms. Otherwise, we need to be prepared for recurrent outbreaks and high lethality from this new virus.
Even with a vaccine and treatment options, I predict that deaths from COVID-19 will will happen and contribute to overall mortality. Some proportion of the population will get viral pneumonia. SARS-CoV-2 will be one of the viruses that causes viral pneumonia. In some people, it will be fatal.
Until there is herd immunity (through exposure or vaccination), efforts will strive to limit spikes in infection to avoid overwhelming healthcare systems and ensure that the affected population can receive treatment or care without compromising the ability of other patients to receive treatment and care.
S. Gottlieb, National coronavirus response: A road map to reopening. American Enterprise Institute (29 March 2020). https://www.aei.org/research-products/report/national-coronavirus-response-a-road-map-to-reopening/
M. Buttler, C. Wienberg, N. Rigillo, Denmark attempts return from virus lockdown after early response. Bloomberg(6 April 2020) https://www.bloomberg.com/news/articles/2020-04-06/denmark-attempts-return-from-virus-lockdown-after-early-response
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