On Monday, Donald Trump announced he would seek to “reopen large sections of the country” by Easter with the aim of easing Covid-19’s economic impact, a move public health experts say would risk escalating the pandemic. What is the worst-case scenario if physical restrictions are loosened, and why is it mistaken to think the cure is worse than the disease?
Would it be possible to ‘reopen’ the country in two weeks’ time?
Dr Greogry Poland: We won’t reopen in April. The number of new cases we’re seeing now in the United States is increasing by almost 50% every day. We are on the steepest part of the curve right now. What we’re seeing is a reflection of transmission two to four weeks ago, which means whatever you’re seeing now, it will be significantly higher and worse in a few weeks.
Dr Robert J Kim-Farley: We want to avoid what I call the second wave. It would occur if we prematurely dropped our guard – this physical distancing – too soon.
It’s possible we might be able to be more nuanced in our approach to physical distancing, and that once we have more extensive testing, and we can truly ensure that [certain] areas do not have community transmission occurring, then those people could potentially go back to work. But [they’d need to be] under a microscope. Public health officials would need to frequently test to ensure there is no introduction into that community.
But in our densely populated areas, like Los Angeles or New York, places that have already seen major spiking of the epidemic, it would just not be appropriate epidemiologically, from a public health viewpoint, to begin to relax any of the physical distancing measures while we’re still seeing an uptick of the outbreak.
If we did reopen, what could happen?
Poland: It doesn’t make any sense to loosen restrictions during an epidemic. You’re fundamentally choosing economics over our lives. Let’s say you live in a community with a 200-bed hospital. They have five to 10 ICU beds, half of which are used for heart attacks and everything else. So maybe they have five beds and five ventilators. If you admit one person a week, you can give great medical care. If you admit 20, 50, or 100, mortality rates shoot up.
It means your hospitals are overrun. People are on carts in the hallways, and they die in the hallway waiting for medical care. There aren’t enough ventilators, IV fluids, doctors and nurses. It’s a scenario you never want to see. So if everybody goes back to work, people start dying in droves.
How many cases might we see without significant interventions?
Poland: The CDC has released what they think would be a worst-case scenario: 160 to 210 million people infected by December, 1 million hospitalized, and somewhere between 200,000 and 1.7 million dying. Imperial Medical College has really come up with some very dire projections. One is that they’re projecting an eightfold demand higher than what can be met by the medical system.
When can we start to relax physical distancing?
Kim-Farley: We’re going to have to have robust testing, so we truly know what is happening in the community – not just those who are getting [sick], but even what’s happening silently. Once we think we have a good understanding of who is getting the disease, we could isolate those persons and their close contacts. Once we get to a point where we think we can contain the disease, then I think it would be the appropriate time to start taking off the physical distance controls.
What do you say to people who think the cure – physical distancing and business closures – is worse than the disease?
Kim-Farley: We have to err on the side of protecting human life. So we should not rush back to business as usual, at the expense of a second wave. That indeed could be a tsunami that would endanger many more lives.
Poland: I tell them to go on the internet. Go look at the South African Olympic gold medalist swimmer [Cameron van der Burgh], who says he has never been hit as hard with something in his life. Look at the pictures of the young people on ventilators or who have already died as a result of this.
You’re playing the odds. Put it this way. If I have a gun with 100 chambers and one bullet, are you willing to play? Are you willing to let me hold it to your sister, your wife, your mom’s head?
Dr Robert J Kim-Farley, professor with joint appointments in the Departments of Epidemiology and Community Health Sciences at the UCLA Fielding School of Public Health
Dr Gregory Poland, vaccine expert and internal medicine physician at the Mayo Clinic