After Sheltering in Place – What’s Next?

Alan Zendell, March 28, 2020

As one of the more vulnerable senior population, I’ve been thinking about what will happen after the corona virus pandemic runs its course, at least in its initial wave. One of the most challenging aspects of managing a pandemic is a lack of meaningful data. That occurs in two principal ways.

One is that much of what we think we know about the virus comes from past experience with other, similar ones. But as epidemiologists and virologists continually remind us, each virus is unique, and inferring the future behavior of this new one is risky.

There’s been a lot of speculation about a “second wave,” or a seasonal revival of COVID-19 next winter. That’s based on anecdotal evidence from previous epidemics like the Spanish Flu of 1918, in which the second and third waves killed most of the 675,000 Americans who perished from it. That number is huge, but we must keep in mind that medicine has advanced greatly in the last hundred years, and 1918 was the year of our greatest involvement in World War One. Many of our medical professionals were overseas and the constant movement of millions of troops in the United States and Europe made it impossible to slow the spread of the disease.

Will COVID-19 be as deadly? We don’t know. Initial data suggest a far lower fatality rate than the Spanish Flu, but possibly a higher rate of infection without quarantines, sheltering in place, and other distancing measures. That’s extremely significant since our population has more than tripled since 1918, and the population density of our urban centers has increased dramatically. We don’t really know what will happen next season or if COVID-19 will mutate into something either more or less dangerous than itself.

Another source of uncertainty is the number of reported active cases. Our data always lag reality. We won’t have an accurate timeline of how many people were infected until after the pandemic passes. Our country wasted so much valuable time in being able to test large numbers of people, we have no idea how many are infected.

As I write this my television screen tells me that nearly 112,000 Americans have tested positive for the virus. But that number could be low by orders of magnitude. Tens of millions have undoubtedly been exposed by now, but we probably won’t know definitively for years. CDC projections suggest that half our population, more than 160 million people may contract COVID-19. As Bill Gates said earlier this week, the only way to know for certain is to test every American.

Need a reality check? If COVID-19’s fatality rate in the United States is one percent and 160 million people are infected, that implies 1.6 million deaths.

My wife and I are sheltering in place, as directed by our governor. I’m guessing we may have to continue to do so until at least Memorial Day. After that, what will normal look like? Say the spread of the virus is reduced to zero by July. We end social distancing and start interacting with friends and family again. But half the population will already have the virus in their systems – viruses in our bodies never go away, they just become dormant. Will that pose a risk for people who followed the rules and remained virus-free?

Since I’m basically ignorant about everything medical, I consulted with a physician I trust (my daughter-in-law.) She assured me that even if I touch, hug, and kiss people who are still hosting the virus, I won’t catch it from them unless they are actively symptomatic. I have complete confidence in her, but there’s still the caveat that although we know that’s true for other viruses, we won’t be certain about this one until after the fact.

Another thing we discussed was “herd immunity,” which is a designation that is easily misinterpreted. Herd immunity occurs when so many members of a community have weathered the virus and developed individual immunity, there’s no place left for it to spread. From the point of view of people who haven’t been exposed, that means there’s no one left to catch it from. Big sigh of relief number two – except that this conclusion too is based on assuming that COVID-19 behaves the way previous viruses did.

All things considered, all of us elderly folks who continue to follow the rules and shelter in place, limiting the likelihood of exposure for the next few months can be reasonably assured that when life returns to something like normal next summer, we can hug each other without fear of dying. At least until the anticipated second wave hits, but I’m confident we’ll have a vaccine by then.

No one knows for sure, but life always has its uncertainties.

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