*Covid-19 is new and it is a disease being spread currently throughout the world. Researchers and scientists are still finding out information about the disease. Therefore, some facts researched in this post can be modified or new findings could be added as the novel coronavirus spreads more throughout the world in this pandemic. In addition, government policies and measures can be changed or varied based on regions and their situations as the pandemic unfolds.
With the coronavirus pandemic in our lives, we are going through a difficult and different time right now. Many places in the world have travel restrictions, social distancing measures, self-isolating or quarantine rules. Currently, 93% of the world’s population live in countries with travel restrictions. A third of the global population is under some form of restriction due to the coronvirus. Government and health officials are urging people to stay home. We are experiencing a shortage of normal daily life supplies such as toilet paper, hand sanitizers or disinfectant wipes. There are shortages of personal protective equipment, ventilators and medical supplies. Medical professionals and healthcare workers have to treat patients and save lives with no available vaccine or antiviral treatment. Social distancing measures also leave many businesses and people with no or reduced income resulting in financial difficulty. Stock markets have also been plunging in record levels around the world. As of April 3, 2020, Italy reports total deaths in the hundreds per day. The coronavirus death toll passed 10,000 in Spain on Apr. 4. New York State in US alone recorded 630 deaths in a single day on April 4. Now over 1 million people around the world are infected with about 60,000 deaths. When would this pandemic end? How long will social distancing last? In this post, I share with you my findings from research what experts are saying how long this pandemic and social distancing will last.
How Long Have Past Pandemics Lasted?
Covid-19 is new and we do not fully understand the disease such as true transmission risks or mortality rates. Currently, we are still finding about the disease and we do not have a vaccine or treatment. When something is unknown or new, we can try to relate current events to a past experience and predict, assume or guess what may happen in the future. However, each pandemic can have unique characteristics on its own, different from other pandemics. In addition, we live in different times with a larger population, globalization, advanced technology and science as well. Although the Covid-19 pandemic can unfold totally different from past pandemics, I thought it may be interesting to see what a pandemic looks like. There have been many pandemics in history but I picked one that happened not too long ago and one that was the deadliest in recent history.
According to The Centers For Disease Control And Prevention (CDC), in 2009, the H1N1 influenza virus (Swine flu) caused the first global flu pandemic in 40 years. It started in April 2009. The World Health Organization (WHO) declared the H1N1 influenza pandemic in June 2009 and announced the end of the pandemic in Aug 2010. CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) from April 12, 2009 to April 10, 2010 in the United States. They also estimated that 151,700-575,400 people worldwide died from the H1N1 virus infection during the first year the virus circulated. The virus infected about 1.4 billion around the world. 80% of the deaths were in people younger than 65. By November 19, 2009, doses of vaccine had been distributed in over 16 countries. Estimated overall effectiveness of all pandemic H1N1 vaccines was about 56% according to a 2011 study from the US Flu Vaccine Effectiveness Network. According to a CDC study released in 2013, the vaccine saved about 300 lives and prevented about 1 million illnesses in the US. Measures such as travel precautions, closing schools, quarantining, staying home were used to control the infection during the pandemic.
Another Pandemic, Spanish Flu lasted from January 1918 to December 1920. This was the most severe pandemic. About 500 million people were infected (one-third of the world’s population) and at least 50 million deaths occurred worldwide. About 675,000 people died in the United States. Uniquely, there was a high mortality in young and healthy people including 20-40 years old. There was no vaccine to protect against infection and no drugs that treated the flu so many doctors prescribed medication that they felt would help symptoms. Aspirin therapy was officially recommended. In the second wave of this pandemic, the death rate was the highest from October to December of 1918. One hypothesis suggests that aspirin poisoning contributed to higher number of deaths. Patients were advised to take aspirin up to 30 grams per day which is a toxic amount. Aspirin poisoning can cause hyperventilation and pulmonary edema, or the buildup of fluids in the lungs. Today, above 4 grams are considered toxic. Isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings were used to control the spread. The pandemic eventually came to an end in US by the summer of 1919 because people who were infected either died or developed immunity.
How Can We End The Covid-19 Pandemic?
There are two ways we can make SARS-CoV-2 which causes coronavirus disease 2019 (COVID-19) go away: vaccine or herd immunity. One is to come up with a vaccine to treat and prevent infection of SARS-CoV-2. Currently, there is no antiviral treatment or vaccine available for Covid-19. The disease is new and we are still finding out about the disease. Healthcare workers and researchers are working very hard every day to find ways to treat and save patient’s lives. After a vaccine and treatments are available, we can be safe from getting infected and our lives can go back to normal. However, a development of vaccine is not something that happens within weeks or a few months. It can take a while. It is possible that the pandemic will have peaked and declined before a vaccine is available.
Secondly, spreading of the coronavirus can also retreat when we have lots of people who are infected of the coronavirus recover from the infection and have immunity. This is called herd immunity when the infectious virus is not transmitted fast because there are enough people in the community who already have an immunity. Experts say that about 60% of population need to be immune in order to have herd immunity. Herd immunity can be reached by widespread vaccination or through natural infection. However, reaching herd immunity though natural infection can be disastrous if we do not mitigate the spread of the virus.
How Long Will It Take To Develop A Coronavirus Vaccine?
Then how long will it take to develop a coronavirus vaccine? Currently, there are over 40 coronavirus vaccine candidates being developed around the world. There’s no vaccine and no specific antiviral medicine to prevent or treat COVID-19 at this time. As of April 1, 2020, the US FDA has not approved any preventive or therapeutic coronavirus vaccines to be used against the SARS, MERS or the SARS-CoV-2 coronaviruses according to the CoronaVirusToday. Vaccine development takes time, it’s not something that normally happens over a few months. Normally, a vaccine development process could take 5-7 years until a vaccine is approved and distributed. However, due to the urgency and need of a vaccine and treatment, the process of getting approved and distributed is likely to be faster than normal.
In order to make sure the vaccine candidates are safe and effective, they have to go through clinical trials. Clinical trials usually have three phases before drug approval. Currently, only three vaccine candidates have entered ‘Phase I’ of clinical trials. The first phase involves testing on a few dozen healthy volunteers, the second involves several hundred people, and the third involves several thousand people. They are essential steps to ensure safety and effectiveness so there is no risk of adverse effects or enhanced disease. Most vaccinologists don’t think the vaccine will be ready before 18 months assuming everything goes smoothly according to Annelies Wilder-Smith, professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine. After that, the vaccine will have to be manufactured in large quantities. After manufacturing, there is another challenge of prioritizing and distributing to the public. Healthcare personnels and professionals who are combatting the coronavirus on the front lines and the most vulnerable population such as seniors, pregnant women may get access to the vaccine first. Politics and purchasing power of countries play a role too. Some countries may decide to treat their own population before exporting the vaccine to other countries.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the U.S. House Oversight and Reform Committee on March 12, 2020 that a vaccine would not be available for use in the broader public for another 12 to 18 months. He said it will take this amount of time to really know if a vaccine works. Currently, the vaccine called mRNA-1273 developed by NIAID scientists and their collaborators at the biotechnology company Moderna, Inc. started the Phase 1 clinical trial. The recruiting of healthy 45 volunteers has been completed on March 19, 2020. The first participant received the trial vaccine on Mar. 16, 2020. CanSino Biologics is also registered for a Phase 1 clinical trial and currently recruiting participants. The University of Oxford is also enrolled in a Phase 1 clinical trial and their recruitment of participants is underway. Medicago is developing a plant-based COVID-19 vaccine and they expect to begin human testing in July or August of 2020. The company said if their vaccine is successful, it could be available for the wider public use by November 2021. There are also 40 other companies with a Covid-19 vaccine candidate which are currently under investigation.
Could We Just Achieve Herd Immunity Through Natural Infection?
Previously, the United Kingdom government was considering to achieve herd immunity by allowing the virus to spread instead of suppressing the spread using mitigation measures such as self-quarantine or social distancing. Experts calculated that over 47 million people in the UK would need to be infected (70% of UK population) and then recover to achieve herd immunity. However, they also estimated that this will result in the deaths of more than a million people with a further eight million severe infections that are requiring critical care. Now, the UK government has reconsidered a plan and has changed their strategy. They have social distancing measures in place now to slow down the spread.
Herd immunity can be obtained by vaccination or people who get infected recovers and build an immunity against the virus. Harvard University epidemiologist Marc Lipsitch told experts “The rate of spread of this virus is similar to the pandemic flu of 1918, and it implies that the end of this epidemic is going to require nearly 50% of the population to be immune, either from a vaccine, which is not on the immediate horizon, or from natural infection,” Also, Prof Willem van Schaik, Professor of Microbiology and Infection, University of Birmingham, said we will only reach herd immunity to Covid-19 when approximately 60% of the population is immune. There is no vaccine currently and it may take about 18 months before a vaccine is available. Therefore, herd immunity without a vaccine won’t be achieved unless about 50-60 % of population get infected and recover.
However, achieving herd immunity through natural infection is certainly not the goal we are trying to achieve. If we allow the spread of the virus without any mitigation, the virus can spread fast and that we can have a sudden surge of infected people. As a result, it will be too overwhelming for the healthcare system to meet the demands. If the healthcare system fails to meet the medical attention needed by severe or critical patients, people can die. Therefore, now we have mitigation measures placed in our daily lives. In this way, we can avoid a sudden surge of the number of people infected. We can avoid overwhelming our hospitals and health care workers. We can also buy more time to acquire more health workers, medical supplies, personal protective equipments, medicines and figure out the shortage crisis. When we have measures such as social distancing, quarantining or travel restrictions in place and if people follow these measures, fewer people will get infected. The number of total deaths and critical conditions can also be mitigated until treatments or a vaccine is available. It will probably take a longer time to have enough people with an immunity against the virus this way. However, we can save more lives.
Why Do We Need Social Distancing?
The goal of social distancing is to prevent the surge of the infected so that our healthcare system can take care of the seriously sick and minimize deaths. Right now, many places have limited hospital beds, ventilators, protective medical supplies such as masks and health care workers. Effected countries are trying to flatten the curve so that spreading of this disease and critical cases are manageable. Government measures and restrictions such as social distancing is needed during this time in order to slow down the spread of the virus. The goal is for us to save as many lives as possible and stay as healthy as possible until vaccines are available.
In the new projections by Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, and Deborah Birx, the State Department immunologist advising Vice President Mike Pence, up to 200,000 Americans might die if US fails to reduce the spread of the virus. Another Covid -19 Projection Model which is designed by the Institute for Health Metrics and Evaluation, says that peak hospital resource use will be on April 16, 2020. It also says US will be short of 84,671 beds and short of 18,905 ICU beds on this peak date. This model assumes continued social distancing until the end of May 2020. As of April 1, 2020, 2,607 COVID-19 deaths per day is projected on April 16, 2020. Currently, Total of 93,765 COVID-19 deaths in US projected to August 4, 2020. [Update April 14, 2020 This number went down to 60,308 as of April 14, 2020 with social distancing measures. The number of hospital bed and ICU bed shortages all went down.] That is the estimate for the next 4 months. Deaths could be higher if governments don’t have the social distancing measures in place and people do not follow them. White House said that measures working to mitigate the spread of the virus are the only hope for keeping the total death numbers to 100,000 from going higher. Dr Deborah Birx, the White House coronavirus task force response coordinator, said the models showed between 100,000 and 240,000 Americans could die with measures in place. Without the measures, the coronavirus can result in 1.5 million to 2.2 million total deaths in the US. In addition, the Imperial College COVID-19 Response Team said on March 26 report that 40 million could have died worldwide if there was no global action against the coronavirus pandemic. This shows how important it is for people to stay home and limit contact with others.
Social distancing does work in saving lives. In the 1918 The Spanish flu pandemic which killed up to 50 million people, cities that cancelled public events and practiced social distancing had a far fewer deaths than the cities that didn’t do social distancing. Philadelphia had a parade with 200,000 people marching at the World War I event. 4,500 people died at the end of the week from the Spanish flu. On contrary, St. Louis restricted public buildings and transit. Their death rate was half of Philadelphia’s.
It is too early to conclude but we are seeing some signs of flattening the curve in some states in the US. However, according to an April 1 article by CNN, there are some places that are showing improved signs. Despite the high numbers in US, places like New York (state’s average of day-over-day case rate is improved), North Carolina, Washington State’s Kings county are showing some improvements. One of the Canadian provinces, British Columbia released data on March 27th that its hospital systems would likely be able to cope with the demand. They have put the social distancing measures in place early on.
[Update April 8, 2020] As of April 8, an influential University of Washington model now predicts less people will die in US and less hospital beds will be needed compared to last week. It estimates 60,000 people in US will be killed and about 16,000 hospital beds will be short next four months. Mitigation efforts are resulting in 33,000 fewer deaths and 168,000 fewer hospital beds projections. This is assuming social distancing measures will continue until August.
Also on April 6, New York Governor Andrew Cuomo said hospitalizations, admissions to intensive care units and the number of patients put on ventilators had all declined. Their curve may possibly be flattening. On April 7, New York reported total of 731 deaths (worst day of total new deaths for one day) for April 6. However, Governor Cuomo said new admissions to intensive care was the lowest in two weeks.
How Long Will Social Distancing Last?
So then how long will social distancing last? Social distancing can suppress the spread of the virus but it is not an easy thing to do for a long time. Social distancing not only restricts the normal daily lives of people but it also hurts the economy. Many businesses had to close their physical location due to social distancing, they suffered a revenue loss and their business put on hold. They still have to pay for living expenses while paying rent for their business. Some companies are badly effected and they may have to close down. The Government has announced financial relief packages to help individuals and businesses. However, many businesses will still be affected badly if the social distancing goes on for a long time. There are also other concerns with lives of the vulnerable population such as the homeless, low income or the physically challenged.
At this point, no one really knows exactly when this will all end and when we can go back to our normal lives. However, we can reference projections and timelines presented by the government or experts. A third of the world is currently under some form of lockdown according to the Business Insider. The US federal plan to fight the Covid-19 Pandemic warned policy makers that this pandemic will last 18 months or longer. The 100-page federal plan also said the pandemic could include multiple waves. It also indicated that there could be potentially a critical shortages of diagnostics, medical supplies including personal protective equipment and pharmaceuticals, and staffing in some locations. So far President Trump has announced social distancing measures are extended until at least April 30.
The Canadian government is also indicating this pandemic and social distancing is not short term. According to a government document obtained by the National Post., it said “Current GoC [Government Operations Centre] modelling suggests as a best case scenario that current measures continue until at least July.” Canada’s deputy chief public health officer, Dr. Howard Njoo, also told reporters that Canadians will be in it “for the long haul.” Canada’s chief public health officer, Dr. Theresa Tam, also said, “This virus is going to be with us for some time. It will not be eradicated from the world in months,” A study from Imperial College in London predicts social distancing could continue for 12 to 18 months.
Social distancing will most likely be needed until the infection significantly slows down, the number of deaths declines, and hospitals no longer have to worry about a shortage of beds, masks, personal protective equipment, and ventilators. Lifting social distancing measures too early can result in another spike of coronavirus infections and deaths. Therefore, it is important for the government not to lift the measures too early. Researchers at Imperial College of London proposed that more extreme social distancing measures can take place every time admissions to intensive care units (ICUs) start to spike. These measures can be loosened each time admissions fall as well according to their report. So it may be possible that social distancing measures can be done by tightening and loosening the measures throughout the year.
The US Centers for Disease Control and Prevention recommends communities be evaluated for four consecutive weeks and require them to demonstrate a decrease in cases and deaths; a decrease in Covid-19 associated hospitalizations while keeping the capacity to care for the sick; and the public health capacity to investigate and control the virus according to CNN. Other guidelines included “no new cases for 14 days” and “the ability to detect new clusters” before some of certain restrictions can be lifted. The World Health Organization does not want to see countries end up in a cycle of lockdowns followed by a release, followed by another lockdown, followed by release. Dr. Mike Ryan, executive director of the WHO’s health emergencies program said we need a transition strategy that gets us back into more control of the virus rather than going back and forth between lockdowns. According to an Imperial College of London report, “To avoid a rebound in transmission, these policies will need to be maintained until large stocks of vaccine are available to immunize the population,” which could be 18 months or more. The virus will continue to be a threat until a vaccine is developed or many people recover from infection and build an immunity. How much we can slow down the spread and how many lives we can save will depend on how well people follow the current restrictions for social distancing and do their part. How government officials will make decisions on lifting measures will also depend on how everyone’s effort of social distancing reduces the spread and deaths.
[Update April 6, 2020] At the briefing on April 6, when the ABC News correspondent Jon Karl asked, “Will we truly get back to normal in this country before there’s an actual vaccine that’s available to everybody, and how do you start lifting the restrictions without a vaccine?”, the White House coronavirus task force, Dr. Anthony Fauci said “If ‘back to normal’ means acting like there never was a coronavirus problem, I don’t think that’s going to happen until we do have a situation where you can completely protect the population…But you’re absolutely right. If you want to get back to pre-coronavirus, that might not ever happen in the sense that the threat is there. But I believe that with the therapies that will be coming online, and the fact that I feel confident that over a period of time we will get a good vaccine, that we will never have to get back to where we are right now.” according to an article by Business Insider on April 6, 2020.
[Update April 9, 2020] Canada’s Prime Minister, Justin Trudeau told Canadians, “We will not be coming back to our former normal situation; we can’t do that until we have developed a vaccine and that could take 12 to 18 months.”
[Update April 17, 2020] WHO released guidelines on when to start relaxing the lockdown. There are six criteria to meet before countries can start lifting measures: the disease transmission is under control; health systems are able to detect, test, isolate and treat every case and trace every contact; hot spot risks are minimized in vulnerable places, such as nursing homes; preventive measures are put in place in schools and workplaces; the risk of importing new cases can be managed; communities are fully educated, engaged and empowered to adjust to the new normal.
President Donald Trump also announced a 3 phase plan to re-open the US economy. The states must meet criteria listed before starting to lift the lockdown. Each state governor can decide when to relax the restrictions and this guidance can be implemented on a statewide or county-by-county basis. The states must have a downward trajectory of influenza-like illnesses and COVID-19 cases reported and documented within a 14 day period. Hospitals should also be able to treat all patients without crisis care. They should also have a robust testing program that includes antibody testing in place for healthcare workers.
The novel coronavirus will remain a risk until either a vaccine is developed or we have a herd immunity. At this point, no one really knows for sure how long it will take to have a vaccine available for everyone or build enough immunity in our community. We can only estimate and make projections through models built by experts. However, we can mitigate the situation and try to avoid the sudden surge of infection spreading that results in hospital and medical equipment shortages. If mitigated successfully, we may reduce the number of people who are in severe or in critical condition due to the Covid-19. New York Governor Andrew Cuomo said on April 2, 2020 that currently New York state has 2,200 ventilators in its stockpile, enough to last six days at the current burn rate. Without ventilators, some patients will die since they will not be able to breathe on their own. In order to lessen the severity of the coronavirus spread, everyone should do their part to stay home and practice social distancing. Until effective treatments and vaccines are developed, the government measures will need to be in place and social distancing, restrictions and quarantining will exist. Even if spreading of the virus slows down, there is always a potential for another wave of infections. Therefore, the lockdown can’t be lifted too early.
Many businesses, on the other hand, will not be able to maintain their business and end up closing due to a lack of income and cashflow during the time of social distancing. Some people may not be able to survive without an income for a period of time even with the government’s financial relief and assistance. The Crime rate could go up during this difficult time. Depending on how everyone complies with social distancing and how much we can slow spreading of the virus, the government may be able to loosen the measures in place. The Canadian Prime Minister, Justin Trudeau said, “There are a wide range of projections depending on how Canadians are behaving.” He said, “Canadians were in control of the crisis and could reduce the amount of time restrictive measures in place by staying home, washing their hands and limiting trips outside”. With the mitigation effort and compliance, the outcome may be different from projected numbers of the models. However, some form of restrictive measures will be needed until a vaccine or antiviral treatment is available. We may need social distancing until we have other ways to mitigate. Right now it is the only way. We could have multiple waves and measures before going back to normal life, and this may take a while. How restrictive social distancing will remain and how many lives we can save really depends on how everyone does with the social distancing measures. We all have the responsibility and power to make this better or worse. Stay home and stay safe.
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