If these epidemiologists are right, we are facing 18 more months of isolation

Less than a week ago, White House coronavirus response coordinator Deborah Birx, introduced the US to the 15 Days to Slow the Spread campaign. 

The initiative was an official reaction to a comprehensive modeling study of  likely US and UK outcomes regarding the development of the COVID-19 pandemic.

The report, published by a team of epidemiologists at the Imperial College of London, was made available to the public yesterday morning. Assuming no major interventions effectively flatten or suppress the exponential growth curve, government officials are anticipating 18 more months of isolation measures and economic downturn.

According to Maciej Boni, PhD, of the Center for Infectious Disease Dynamics at Pennsylvania State University, the report depicts the most likely outbreak narrative.

“This has been trickling out to the public since [the] last week of February. Now the public is ready to hear that 1 to 2 million people could die, which is what we [epidemiologists] have said for 3 weeks,” Boni said in a media release. “We’re not as successful at finding antivirals as antibiotics or antimalarials. I’m not holding up hope for antivirals.”

There are lingering variables that are contributing to this stark prognosis, just as there are promising measures on the horizon that may very well repudiate it. The relief efforts subsume viral antibody research, basic economic stimulus bills, and consumer curfews.

“The global impact of COVID-19 has been profound, and the public health threat it represents is the most serious seen in a respiratory virus since the 1918 H1N1 influenza pandemic,” the authors wrote in the paper. Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely. “

Initial reports, branding the novel coronavirus responsible for Covid-19 as the “old people’s disease” might have played a punitive role in diminishing civilian precaution. Additionally, an incubation period that spans four to 14 days not only led many officials to believe that there were fewer cases than there actually were, but it also exposed asymptomatic carriers to dense communities. 

In the time since various forms of social distancing have appeared in more and more populations alongside academic efforts to mitigate the surging outbreak. There are many demographics, namely the old and the immunocompromised who are diprotitantly affected by the communal spread. And corporate and consumer ecosystems will likely be inhaling debris for the remainder of the year at least. 

Collectively we have two viable routes ahead of us. Thankfully  we don’t have to choose between one or the other.

Flattening the curve and outbreak suppression 

Flattening the curve, which has been adopted by most of the US, works by slowing the rate of virus transmission so the number of cases never exceeds the number of hospitals available to facilitate these cases.

The second option, suppression, attempts to reverse the pandemic through extreme shelter-in-place measures and home quarantines to achieve a reproduction number of less than one.

For perspective,  the Imperial College team, led by Neil Ferguson, OBE, ran a model based on three scenarios; each surveying intervention efforts against mortality, transmission and hospitalization rates. 

Zero intervention (businesses operate with normal employee density and schools remain open) would result in 81% of the US population contracting the disease. Of those 264 million people, 2.2 million would die. Before the end of April, the demand for critical care beds would be 30 times greater than the actual supply.

If officials employ a combination of case surveillance, home quarantine, and social distancing of vulnerable subjects, we could slash the peak critical care demand by 60% and the death toll by roughly half. 

“In order to suppress the pandemic to an R0 of below one, a country would need to combine case isolation, social distancing of the entire population, and either household quarantine or school and university closure, the authors found. These measures “are assumed to be in place for a 5-month duration,” the authors concluded. 

The success of either method is further determined by proper coverage and managerial assessment

Pandemic events of this magnitude at once illuminate societal fractures and binds its denizens under a common cause. Economic patriotism, an increased interest in local politics, medical austerity and altruism  have already begun to eclipse 2021’s corrosive potential.

As pointed out by the latest report, it’s important to remain alert when the horizon becomes visible again,  

“Once interventions are relaxed, infections begin to rise, resulting in a predicted peak epidemic later in the year. The more successful a strategy is at temporary suppression, the larger the later epidemic is predicted to be in the absence of vaccination, due to lesser build-up of herd immunity,” the report concludes.

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