Covid-19: How will it end?
(as of May 2020)
I haven't heard visionary ideas of how the world can return to normal life,
especially since different parts of the world are experiencing different
stages of the epidemic.
Mostly, politicians like Trump are trying to avoid blame and blame someone else,
and they are just waiting for a miracle.
A lot of politicians discuss the best-case scenario: a vaccine will soon be
available; infections will not skyrocket; the virus will not mutate into something worse; there will be no other crisis at the same time; etc.
I have not heard any ideas about the worst-case scenario: the vaccine does not
arrive any time soon; infections and deaths skyrocket; the virus mutates into something deadlier; another crisis erupts at the same time (for example, a major war), etc. Ignoring the possibility that tens of millions of people will die is not a good way to prevent that possibility.
There is a serious possibility that the population of the USA and of Europe
will be decimated like it was in 1918.
An optimistic and realistic scenario is that we will soon have test kits that can be used at home, just like a pregnancy test. This will allow for everybody
to test anybody. Airports will be able to test passengers before issuing them
a boarding ticket. Offices will be able to test employees before letting them
in. And so on. Of course, this can happen only when we can make it widely
available and extremely cheap, ideally free.
Here is that California's governor listed
on April 14
as essential conditions to "reopen" the state:
- The ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those who are positive or exposed;
- The ability to prevent infection in people who are at risk for more severe COVID-19;
- The ability of the hospital and health systems to handle surges;
- The ability to develop therapeutics to meet the demand;
- The ability for businesses, schools, and child care facilities to support physical distancing; and
- The ability to determine when to reinstitute certain measures, such as the stay-at-home orders, if necessary.
In April 16 Trump announced a plan to reopen in phases that is surprisingly well thought out.
Here i loosely rephrase what Ross Douthat wrote in the New York Times, which is in turn based on a 15-page document by the American Enterprise Institute of March
( "National Coronavirus Response: A Road Map to Reopening").
Check also a roadmap to reopening for business prepared by experts of several universities.
- The model that the world is implementing, to various degrees, is a
"test, trace and contain" approach. We are forcing everybody to stay at home
because we don't know who has the virus and could spread it to others.
To be on the safe side, we keep everybody at home.
People who are found to be "positive" are quarantined, either in hospitals
or at home. But, de facto, we are quarantining the entire population.
- The first technological breakthrough will be quick ubiquitous testing,
just like we can easily test our blood pressure and our oxygen.
The covid equivalent of a pregnancy test.
This would allow people to know almost in real time whether they have been
infected and represent a threat to their family, friends, coworkers, fellow
shoppers, fellow moviegoers, fellow churchgoers, and so on.
If such a real-time test existed and was manufactured in millions of copies,
most activities could resume immediately. For example,
international air travel could resume with the caveat that airports wouldn't
only check luggage but also passengers.
- Unless a vaccine is developed quickly, we will need to come up with creative
ideas on how to quarantine millions of people. Locking them in the basement
is not an attractive option. Many of them don't have symptoms, i.e. look
perfectly healthy and are perfectly able to carry on normally.
Both governments and the hospitality industry may come up with
"covid resorts" and possibly entire "covid towns".
- Governments and scientists are waiting for the key event:
a sustained reduction in cases for at least two weeks.
That's what China achieved in March. That is the time when it is reasonable
to return to "partial normalcy": partial work, partial social life, partial schooling, partial outdoors.
It's a "normal" of widespread masking, of
more distance between tables at restaurants and libraries and classrooms;
and of limited number of people in shops, post offices and government offices;
and of online events replacing large-scale physical events such as games and concerts.
- To avoid a resurgence of infections and deaths, contact-tracing will be a key factor. That's what was missing at the beginning, and not for anyone's fault: we didn't know that asymptomatic people can spread the virus. About half of the infections happen before the person passing on the infection develops symptoms. Going forward, it becomes important to track down all the contacts of someone who is infected. More and more countries don't think that it is enough to interview people and ask them "whom did you see in the last few days?" It is indispensable to use devices that can, in a second, trace all contacts, i.e. electronic contact-tracing.
- Since different parts of the world are in different stages of the epidemics,
the transition from "lockdown" to "partial normalcy" will also take place
at different times. At any point in time there will be
"red zones" still in lockdown and "green zones" in partial normalcy,
and it will be a challenge how to protect the green zones from people
trying to leave the red zones. Will we see an exodus of people from
Arkansas, Iowa, Nebraska, North Dakota and South Dakota
to California if the curve "flattens" in California when it is still
rising in those states?
Until a vaccine is found, there will be red zones within the green zones:
the elderly will be in a permanent quarantine, regardless of how few cases
there are out there.
- Federal nations like Germany and the USA face an additional problem: that each state can decide its own response to a crisis like this one, a veritable patchwork of local ordinances. This could result in wildly different infection rates.
- The asynchrony between places poses the problem that China is already experiencing: most new cases are of people coming from areas that still have rising numbers (eg Chinese returning from Italy and Russia). Every place needs to have a strategy for the "second wave", and then the third wave, and so on until a vaccine becomes available. Each wave requires a new
cycle of "trace and contain" policies (restrictions on work hours and movement),
just like in states like California policies change daily based on pollution and fire hazard: today you can burn wood in your fireplace, tomorrow you can't; today
you can camp in the forest, tomorrow you can't.
- Some are toying with the idea of granting two kinds of certificates (possibly on smartphones).
If you had the virus and survived, you should get a "certificate of immunity":
you can go out and do anything. (Catch: we are actually not 100% sure that
people who survived it have become immune).
Some people don't know that they caught the virus, so it would be helpful to use antibody tests: if you have the antibodies, it
means that you were infected and your immune system did its job, and presumably
will keep doing a good job for a while.
(Catch: current antibody tests are not accurate).
Another certificate, a "certificate of temporary safety", should go to any
person who has not been in contact with any person who has the virus.
This certificate could also bear the degree of proximity to which it applies: you are a 1 if you had no contact with any infected person, you are a 2 if you had no contact with anybody who had no contact with any infected person, you are a 3 if you had no contact with anybody who had no contact with anybody who had no contact with any infected person, etc.
Initially the app would be able to issue only grade-1 certificates but over time
it would collect enough information to start issuing grade-2 certificates,
and so on.
You could safely hang out with other people who have the same certificate.
This would reopen most of the economy.
(Catch: you would have to carry the smartphone wherever you are and allow the
app to track every place where you go).
- At a minimum, all hospitals should start testing every patient. Almost every hospital in the USA routinely tests patients for sexually transmitted diseases. Even after a vaccine is found, hospitals should routinely test also for covid-19.
- It would certainly help to have biosensors that can measure the concentration of the virus in the environment (like this one developed by Jing Wang's team in Switzerland)
- These actions require thousands of workers that don't exist yet. At a minimum, states should hire enough workers to monitor all confirmed cases and their contacts.
- Normal life will return only once we have a vaccine and/or a treatment. However, being too optimistic about vaccines and treatments is a way to avoid discussing what we do in case they don't come, which is still the most likely short-term situation.
See also:
Back to FAQ/ Q&A about Covid-19,
Data on Covid-19 and selected sources,
Covid-19: How it may change the World,
The Clown & the Virus,
The Clown & the Virus - Part 2,
Trump's Virus,
Sinophobia & Covid-19,
Sinophobia & Covid-19 in US Media,
Was covid-19 made in the USA? in China?
TM, ®, Copyright © 2020 Piero Scaruffi All rights reserved.
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