This is the most confusing aspect of this outbreak. What is the end game of our respective governments.
China: has locked up their population, and is squeezing the virus out of existence. They are only having 20 ish cases per day. But they are importing 80 cases per day. As soon as the restrictions on movement comes off, it will begin again, albeit with a much larger hospital capacity to deal with the sick. Their approach is not sustainable in a globally connected world.
South Korea: they went all out for identifying infected and isolating them from the general population. They put together a plan to test more people per day than the virus could find new hosts in a day. They have been incredibly successful, testing 20,000 people per day, and through this incredible feat they have got the virus under control, and case numbers are dropping. They will have to maintain this vigilant screen for months (years), due to the global nature of this virus.
USA: who knows what our approach is or will be. We have now tested the same amount of people in 8 weeks that South Korea tests in a single day. The US response is a shamble. We literally have 10s to 100s of thousands of people infected. We just don’t have the leadership to get our house in order. To follow the South Korean model, we need to be testing 40,000+ people a day to keep the infected numbers under a million US citizens. Because we are not doing this, we are now required to follow China’s approach of isolating people. This approach is not sustainable in the long term. But it will be our future for at least the next month.
The end game is simple we either drive this virus out of existence or we come to live with this virus by treating the sick with drugs, or by creating community immunity (herd immunity).
Eradication: We have lost the chance for eradication. That ship sailed.
Medication: There are many treatments being trialled. Basically, repurposing old drugs. Some drugs appear useful, but from what I have seen there is no magic bullet to treat the infected, yet.
Herd immunity: The long term goal is to have enough people with immunity to the virus in our community that the virus has a very difficult time finding a host. The huge caveat being we don’t know if long-term immunity is achieved after infection. But let’s just hope immunity to this virus is possible, to gain that immunity there are only two approaches; immunity provided by a vaccine or immunity acquired through natural infection.
Vaccines: there are so many of them under development and being trialled, but the reality is it’s at least 12 months away. Why not sooner? Safety and efficacy. I can’t shake the image of the “I am legend” movie. Rush out a vaccine, and turn the citizenry into flesh-eating zombies. Obviously, that is not going to happen... but there are real risks to not testing a vaccine before widespread adoption.
Natural infection: So this is what we are left with, natural infection and recovery to drive the virus out of our life. How many people need to be infected and recover for herd immunity to provide protection to our most susceptible. This estimate is based on the reproductive number of the virus (How many people does an infected person infect). The estimate for this virus‘s reproductive number (R naught) is somewhere between 2 and 4. So if we are working on a R0=2 we have to get 50% of our population infected-recovered-immune: R0 = 3 we need 66% immune: R0=4 we need 75% of our population to be infected-recovered-immune. These percentages are just to get our infection numbers stable. If we want to drive it out of existence, we need a higher immune %.
So here is the conundrum. We can lock ourself away, and not give the virus a home, let medication research and vaccine Research catch up. But those advances are months, potentially years, away. This is not a sustainable plan. I have no desire to be locked away in my house for months. But it’s all we have right now.
We can test, test, test and get the infected identified and isolated to slow the virus‘s spread down. But does every country have that capability? Even if we get ahead of it by doing 100,000 of tests per day, we will just keep importing cases from around the globe. Will this be a new customs screening requirement?
What we really need is for the young, the healthy in our population, to get infected, recover, and develop immunity. Let those people, under 40 (or 50) somehow protected by youth, get the community immunity threshold above that all important % needed to drive the virus out of circulation. However, to engineer an experiment where we are actively infecting the young in the hope of protecting the immune compromised and the elderly in our society, is more of a plot found in a b-rated SciFi movie.
But what are we going to do?
My expectation is that we will be doing a hybrid response. We need to restrict our movements to flatten the curve and allow our health care system to prepare for what may come. I expect the restriction of movement and activities to be in place for at least a month. We are going to lose more freedoms in the coming weeks as the government scrambles to catch up.
We need to get our testing capability up. It’s coming, but we are possibly a week or two away from testing 20,000 people a day, and longer to get the capacity we need. Testing means identifying and isolating the infected and slowing the spread.
But do not be surprised that if in the coming month(s) they lift the restriction on school
closings and kids sports. Let the virus percolate through the young and healthy, causing little impact on the healthcare system, but creating that needed community immunity. One last thought, let’s drop the word social distancing, and adopt the idea of personal space instead. Isolation from family and friends is not the goal, just create a personal space buffer between people so the virus can’t jump. So get mates together for a bike ride (go in different cars), go to the park and kick a ball around, play baseball, cricket, go for a surf, horseback riding, all these activities can be done while keeping personal space between people, but maintaining friendships. I’d love to hear other ideas that allow friends to gather but don’t foster the spread of this virus.
Be nice!
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