Based on everything we know about epidemiology and about this virus, it is not safe to ease up on social distancing now.
The Johns Hopkins School of Public Health Guidance For Governors (updated April 17, 2020) recommends that governors should not back off social distancing rules or begin to allow people to resume normal activities until after the death rate from coronavirus in their state has declined for fourteen straight days, meaning that each day for 2 weeks, fewer people die than died the day before. There are no other published guidelines. However, the governors of many states are choosing to open beaches, restaurants, bowling alleys, and other non-essential businesses even though the death rates are not falling. The reason they are giving for this is that death rates have stabilized. This fails to recognize that death rates have stabilized because of social distancing. If social distancing is stopped, death rates will rise within weeks. At least half of people infected with COVID don’t feel sick, so if their state government says people who have no symptoms don’t have to do social distancing, why would they do it? You probably wouldn’t. But read on, I hope to change your mind.
Two important factors to consider in looking at an epidemic are how deadly the disease is, and how easily it is spread. The death rate from COVID in the US is about 3%, which is 30 times higher than from influenza (“flu”.)
Every person infected with COVID infects about 3 others. This may not seem like a lot, but if you do the math and assume the infection is passed on during the first week after becoming infected, when a person is most contagious, that means that after two months (9 weeks), infection from every person with COVID who is not social distancing will be passed on to 29,164 other people. (This is called exponential growth. If you find this hard to believe, send me an email and I’ll send you the calculation.) Of those 29,164 infected people, about 300 will die of COVID.
The best current predictions show that about 1 million US people will die of COVID within the next year. It’s hard to get our minds around numbers that large. By now you’ve heard the statistic that more Americans have died from COVID (60,000) than died in the Vietnam War (58,000). US involvement in the Vietnam War lasted 10 years. A million more deaths means COVID’s effect on the country would be like 17 more Vietnam Wars, only in one year instead of ten.
If we encourage people to go back to their normal activities before there is a two-week decline in the death rate in their area, we are inviting that explosion of deaths. Some argue that, with a return to normal activity, similar numbers might die, just over a longer period of time “so we might as well get it over with.” That is not true because, if we can spread the cases over a longer time, seriously ill people will have access to adequate medical care. If all the cases happen over the course of a
few months, the majority will not have access to intensive care. There are simply not that many beds in US hospital intensive care units.
In Italy and Spain, thousands of people died and more are still dying because they don’t have access to intensive level hospital care. If we don’t want that here, we have to keep things slowed down so the epidemic can be gradual rather than explosive.
I know the value of a paycheck and the pain of not having one. But consider – paycheck versus death? If you’re not there to spend it, it doesn’t do you much good.
Please, stay at home. Keep 10 feet away from everyone you don’t live with as much as you possibly can. We’ll take another look at this in a month.
Next time: herd immunity, the importance of testing, and lying leaders.
- Eva Hersh is a family physician. Send your comments and questions to her by email at firstname.lastname@example.org