USA TODAY International Edition
Why we can’t stop social distancing now
Coronavirus pandemic is still moving too fast
Prominent U. S. voices have been calling for a stop to social distancing soon, citing the rationale that the consequences of social distancing are worse than the impact of COVID- 19 itself. It’s worth looking very closely at that claim, where we are in the U. S. epidemic and what happens if we stop the social distancing efforts.
COVID- 19 has been spreading with exponential growth in the United States, and we’re just beginning to get an understanding of how extensively as testing has become more available. There are more than 82,000 U. S. cases confirmed as of Thursday evening and nearly 1,200 deaths. A few weeks ago, we had recognized 70 cases.
We shouldn’t be considering relaxing strong social distancing measures until we have drastically slowed the rate of spread, dealt with our dire shortages of supplies and diagnostic capacity, and prepared our health care system to deal with surges in patients.
Some hospitals in New York City have said publicly that within one to two weeks, they will not have ventilators to treat everyone. In terms of diagnostics, there are shortages of reagents and swabs. We still don’t have rapid diagnostic testing in place in many hospitals. We don’t have capacity to diagnose many COVID- 19 cases not sick enough to be in the hospital, so they aren’t yet recognized or counted in the trajectory of the epidemic.
How do we gain time to let hospitals get more supplies and prepare for high numbers of patients? How do we slow the spread of disease in America? How do we lower odds that intensive care units will run out of ventilators or space? The answer, for now, is large scale social distancing.
Measures take time to work
In Asia, we’ve seen these social distancing interventions, which in some places have been in place for two months, work to slow the pace of the epidemic. They’ve slowed the disease by slowing social interaction. Left to its own, this disease spreads from one person to about 2.5 people, and then each of those people spread to an average of 2.5 more and so on. For this disease to stop, we need to make it so that on average, one person spreads it to less than one other person.
These social distancing measures take time to work. The impact of big interventions in China took about three weeks to start to reverse things. In the USA, we’re only about 10 days into large scale social distancing.
To drop all these measures soon would be to accept that COVID- 19 patients will get sick in extraordinary numbers all over the country, far beyond what the U. S. health care system could bear. Many reputable models predict that systems will be completely overwhelmed by the peak of cases if social distancing is not maintained.
If hospitals become overwhelmed, they could struggle to provide even oxygen for some or many of the 15% of COVID- 19 cases expected to be “severely ill,” and the case fatality rate for COVID- 19 could far exceed 1%. Beleaguered hospitals also might not be able to provide care for other serious and life- threatening conditions.
Anyone advising the end of massive social distancing now needs to understand what the country would look like: COVID- 19 would spread widely, rapidly, terribly — and could kill millions in the year ahead with huge social and economic impacts.
Before considering changes, we should use all our energy to get to the strongest possible position for COVID- 19 response. We are not ready. We need rapid diagnostics in place. We need extraordinary quantities of personal protective equipment. We need more ventilators, and we need capacity to provide medical care to many more than we can now.
Encouraging progress
It’s encouraging that we are beginning to make progress. The Food and Drug Administration has provided recommendations for developers who may wish to develop serological tests, which can be used to identify who has been infected and recovered already, and to know how prevalent the disease is in the USA. Looking ahead, we will hopefully have therapies to treat at least the sickest patients.
Together, these measures will help reduce the number of cases to such a low level that we could do contact tracing and isolation of cases.
At that point, it will be a far less risky to pull back on social distancing. In the coming weeks, we will learn from the experience in Asia as leaders there begin to relax social distancing.
For now, we need to keep production lines for medical equipment running, doctors’ offices working, and groceries, pharmacies and banks open. It’s important to have science- informed dialogue about which businesses can stay open. These measures are painful and have bad economic consequences, but there would be no return to a normal society or economy now even if these measures were ended, given that COVID- 19 is rapidly spreading.
We need to press ahead with closed schools, mass telecommuting, no gatherings and staying home unless you need to go out. Generous economic programs can help those suffering. Through social distancing, we can slow this epidemic together.