Friday, February 26

When will the coronavirus pandemic and social distancing end?

As the gears of the modern world
grind to a near halt, one question is likely on the mind of many: When will the
coronavirus pandemic — and social distancing — end? 

No one knows for sure, but it’s probably not
any time soon. Here’s what we do know about when it may be safe to come out of
our homes and resume normal life.

It will almost certainly take herd immunity to end the pandemic.

Most experts say we’re past the
point of containing the virus, like we did with SARS and MERS. That means that
COVID-19 is here to stay, and the pandemic will end only with herd immunity.

Herd immunity describes what
proportion of a population has to be immune to a disease for the population as
a whole to be protected from outbreaks. The exact threshold depends on the
infectiousness of the disease, represented by the basic reproduction number, called
R0 (pronounced “R naught”).

When a new virus emerges, no one is
immune. A highly transmissible virus, like the coronavirus behind the current
pandemic, can spread like wildfire, quickly burning through the dry kindling of
a totally naive population. But once enough people are immune, the virus runs
into walls of immunity, and the pandemic peters out instead of raging ahead.
Scientists call that the herd immunity threshold.

Up to two-thirds of a population would need to be infected to reach that threshold.

Current estimates put the coronavirus’s R0 between two or
three, meaning anyone with COVID-19 tends, on average, to infect two or three
other people. While this number can change based on our behavior, researchers
estimate that the herd immunity threshold for COVID-19 is about one-third to two-thirds
of any given population. Worldwide, that means anywhere from 2.5 billion to 5
billion people.

Scientists aren’t yet sure how long
people infected with COVID-19 remain immune, but so far it seems that they aren’t readily reinfected (SN: 3/4/20).

Letting the virus burn through the population would be the fastest approach.

People acquire immunity against a virus
in two ways: Either they have been infected and recovered — gaining some level
of antibody protection — or they get a vaccine against the virus.

Since a vaccine is at least 12 to 18 months from being available (SN: 2/21/20), the fastest way to herd immunity would be to let the virus burn through the world’s population unimpeded. According to a March 16 report released by researchers at Imperial College London, in the United States, the pandemic would peak in about three months under that scenario.


The costs of such a strategy would
be overwhelming. Upward
of 2 million Americans would die from infection alone,
according to the same report. Roughly 81 percent of the U.S. population would
get infected, the team estimates.

The elderly and those with
underlying health conditions would be hardest hit, but younger people, too, can
experience severe illness (SN:
). And the critical care capacity of U.S. hospitals would be
exceeded as early as the second week of April, and eventually require 30 times
as many critical care beds as currently exist, the team estimates. While there
is much still unknown about the virus, most experts agree with this overall

The costs of delaying action any
further to slow the virus’ spread could be catastrophic, the researchers
conclude. That’s why countries around the world are trying various strategies
to quell the surge in cases, in effect flattening the
exponential curve of the pandemic and lessening the strain on hospitals. Those
measures primarily consist of aggressive social distancing, such as closing schools, cancelling large public events
and encouraging people to work from home if possible (SN: 3/13/20).

Social distancing reduces deaths but delays herd immunity.

The necessary flipside of successful social
distancing is that achieving herd immunity gets delayed as cases decrease, says Michael Mina, an epidemiologist at Harvard
University’s T.H. Chan School of Public Health in Boston. Even if collectively we
prevent a surge in the coming weeks, he says, the virus could reemerge as soon
restrictions are lifted.

“In the absence of robust herd immunity at the population level, we have
some risk of a second wave of the epidemic,” Mina says. 

Social distancing will need to last 1 to 3 months at minimum, potentially longer.

Society could keep a lid on such a resurgence
by maintaining broad social distancing. The Trump administration on March 16 called for significant social
distancing for at least the following 15 days. But most experts expect such
measures will need to be in place in the United States for one to three months,
at minimum, to keep hospitals from being overwhelmed.

We could get a big
break if the virus’ spread slows with warmer weather, though so far there’s no
indication that will happen. “That would be a great stroke of luck,” says
Maciej Boni, an epidemiologist at Penn State University, and may allow more
people to return to work once the number of new cases begins to fall.

Keeping schools closed and encouraging people to generally stay home could suppress the pandemic after five months, according to the Imperial College London report. But once such restrictions are lifted the virus would, in all probability, come roaring back. Until a vaccine becomes available, potentially in 12 to 18 months, the report argues that major, society-wide social distancing measures are necessary. 

But such drastic changes to daily
life may be difficult to sustain, Boni says. “It’s like you’re holding back a
wave of infections with Saran Wrap.” 

More widespread diagnostic testing could ease the need for extensive social distancing.

Whether such strict isolation could
be maintained for months on end is unknown. “We’ve never faced anything like
this before,” says Caitlin Rivers, an
epidemiologist at the Johns Hopkins Center for Health Security. The economic
costs would be enormous, especially for the most vulnerable members of society.

“But I’m not ready to give up on the lessons
from places like South Korea and Taiwan,” Rivers says. “They’ve shown the virus
can be [locally] contained through general social distancing coupled with
extensive testing, case isolation and contact tracing.” South Korea, for
instance,  reported its highest number of new
cases, 909
on February 29. Since then, the number has steadily decreased. On March 24, only 76 new cases were

While the United States is ramping up testing,
it currently cannot test as widely
as many other countries (SN: 3/6/20), allowing
the virus to spread undetected widely across the country. Until that capacity increases
significantly, the only tool the United States has to slow the virus’ spread is
blunt, widespread social distancing.

As staying home hopefully dampens the epidemic,
Boni, Rivers and Mina all say it’s key to use the coming months to rapidly expand testing infrastructure, while also
bolstering health care systems. 

Testing allows public health
officials to identify new cases and isolate them, while tracing and testing
their contacts as quickly as possible. Testing and isolating potential contacts
before they develop symptoms is crucial, since the pandemic seems to be driven by
people who don’t know they’re sick (SN: 3/17/20).

It would be “as though we’re back
at the beginning of the outbreak and taking targeted approaches,” Mina
says. With some luck, such an approach could keep outbreaks from spreading
until a vaccine creates herd immunity.

The feasibility of such a program
depends on many unknown variables. Firstly, it would require vastly more testing
than is currently available. It also requires rigorous and rapid contact
tracing after a positive case, which is no small task. Some countries have used
cell phone tracking data to aid this process.

A big unknown: Are all these efforts sustainable?

At this point, there are still too
many unknowns to know how — and when — we will reach herd immunity. In the
coming weeks, epidemiologists will be closely tracking the number of new U.S. cases
as well as the total number of tests to get a sense of whether social
distancing is working in a particular region.

“It’s been amazing to see the swing in society over the past week,” Mina says. “Nearly everyone has gotten on board.” But he worries about the sustainability of such strict measures as the weeks wear on. “Societal forces may end up overwhelming the science.”