Relaxing COVID-19 sheltering too fast will kill people
Our national and regional reaction to the COVID-19 crisis reminds me of when I practiced medicine. Patients would come to the hospital extremely ill, possibly new diabetes out of control. After intense medical treatment and severe behavioral changes, a few weeks later the patient would be back in the clinic doing better.
Invariably, there would be the question, “When will I be able to go back to my normal diet and activity?” The real answer is never. The more nuanced answer is that the diabetes will not go away. It is a lifetime illness. This is the opportunity to create a new normal that is healthier for the rest of your life. Do not stop the treatment, embrace it.
Similarly, COVID-19 will never go away and we will never return to the old normal. That is not the way pandemics work. This is a unique pandemic, unlike any event in history. However, there are some basic realities of spreading infections that can help us to project the future. Fundamentally, viruses are sophisticated parasites that use their host organism for reproduction and shelter. Once they move into a species, they do not go away. They meld into the DNA of the host.
After the flu pandemic of 1918, the flu did not go away. We learned to deal with it. Every year, we develop a slightly different vaccine for the flu. However, about 40,000 people in the United States still die from the illness yearly. Medically, the coronavirus will stay around just like other viruses. In time, we will be better able to deal with it. But we are not there yet.
For COVID-19, shelter-inplace is currently the only effective way to treat the pandemic. It is helping, but it is not a cure. The shelter orders will change; however, the effects of the COVID-19 pandemic will be permanent.
Locally, the spread of COVID-19 has decreased in the Bay Area since we started sheltering in March. Yet, we are clearly not in a safe place. A second spike in cases and deaths is almost inevitable and may be worse than previously thought. Moving too fast to relax sheltering right now will kill more people.
Like my diabetes patient, people are anxious for the crisis to be over completely. Some people believe that we, as a society, can end sheltering and return to a world that will be like the comfortable past. Sadly, that is not possible.
The change, biologically and socioeconomically, related to this pandemic has just begun. The world has been profoundly changed already, and there is much more to come. We are nowhere near the end of the crisis.
Using another analogy, we are in the second inning of the last game of the World Series. We are a couple runs ahead of the opponent, but they have a strong team. The result of the game will rewrite history. We cannot lose. We are not at the point when we can relax and put in the second-string team. We are confident that we will win, but we are not assured of victory.
It is neither time to despair nor to celebrate. It is time to create a new normal that is safe and prosperous for everyone. We cannot buy into the false choice between physical safety or economic security. Both can be accomplished. We can avoid the second spike in COVID-19 and rebuild the economy. Yet, we must be careful and vigilant. We must take small thoughtful steps.