Coronavirus: Getting Out of Lockdown

© CDC (Alissa Eckert)

The world currently has no alternative to suppressing the virus with strict lockdowns, but it cannot stay that way forever. How might we get out?

The “novel coronavirus” (officially named SARS-CoV-2 for “Severe Acute Respiratory Syndrome Coronavirus 2”—differentiating it from SARS-CoV, commonly known as just “SARS”) has swept the globe. At the time of writing, the case count was over 351,000, but insufficient testing means the count is surely much higher than that. The World Health Organization (WHO) estimated the mortality rate from the virus at 3.4% on March 6. The actual rate may be significantly lower because, in most places, only people showing symptoms severe enough to warrant testing are being tested and confirmed. In any case, the number is high enough to overwhelm hospitals’ capacity and cause heartbreaking loss of life. We must act in any way we can.

Mitigation vs. suppression

There are two ways to save lives: mitigation and suppression. Mitigation would rely on three pillars: 1) isolating those known to have the virus and enacting general hygiene measures, like hand washing and social distancing for the most vulnerable, 2) frequent testing of the general population and those with symptoms, and 3) treating those who test positive. This would cause minimal disruption to most people’s lives and the economy. As there is no vaccine and no real treatment for the disease, however, mitigation is not an option now. The death toll would be unacceptable.

This leaves suppression as the only viable course of action. Suppression means taking extreme measures to stop the virus’s spread, including extensive social distancing throughout the population, closing places people gather, including bars and restaurants, schools and universities, theaters and stadiums, offices and retail stores, and more. This requires big changes to most people’s lives and can have a high cost for mental health—humans are social animals and struggle to be happy without contact with others. The economic costs are staggering: With much of the economy shut down, unemployment will quickly surge well into the double digits without unprecedented government support—support that cannot continue forever.

A recent report by Imperial College London predicted that suppression would need to continue, on and off, for up to 18 months. This is because infections will bounce back quickly whenever suppression measures are eased as long as the population is not immune. Suppressing the virus’s spread means most of the population will not be exposed to the virus and hence remain unimmune. The only other way to spread immunity is through a vaccine, but the wait for a vaccine is estimated at 12 to 18 months, hence the Imperial team’s projections.

Getting out of lockdown

The economic damage 18 months of suppression would cause is almost only imaginable in nightmares. Fortunately, suppression with social distancing followed by suppression with a vaccine may not be the only way to combat the virus. Mitigation may be infeasible now, but two of its key pillars, testing and treatment, may become available in the coming months. There are at least six drugs* that may combat the virus. Mitigation efforts would then look like this: Everyone gets frequent tests to catch infections before symptoms show. Those with symptoms get tested immediately. Those with the virus get isolated and treated immediately. If COVID-19 treatments are effective enough to reduce its mortality rate to something like that of the common flu, those who test negative, and are not highly vulnerable, can return to work and their daily lives.

As long as testing and treatment for the coronavirus remain inadequate, suppression via extensive social distancing and hygiene measures remains a must. It is vital that everyone take the threat seriously to protect the most vulnerable. Government support for the jobless, the sick, and heavily affected industries will need to tide us over until treatment and testing become viable. In the meantime, we hunker down, stick together (virtually), and wait. With a little luck, hard work by the heroes of the pandemic (scientists and health care, grocery, and pharmacy workers, and delivery drivers, among others) will hopefully allow us to leave our homes and return to our lives before the end of summer. We can do it.

*Unfortunately, one of the seven drugs listed in the linked article in The Economist, Kaletra, has been shown to be ineffective. A small, non-controlled study of Chloroquine in France, however, has raised hopes.