When Will Isolation End? An Epidemiologist Explains What Needs To Happen Before We Socialize Again
Americans are adjusting to life without social interactions.
It’s been more than two weeks since bars, restaurants, and schools closed in Ohio.
We still don’t know how long it will be before non-essential businesses can reopen and residents travel freely.
President Donald Trump recently extended his stay-at-home recommendations through the end of April.
"I don't think we can make any concrete plans for a particular date," she said.
"Dr. Tony Fauci, who is leading the White House response team, initially suggested eight weeks, and I think it will be at least that long, potentially more."
"There are so many unknowns right now regarding how effective social distancing will be and the behavior of the virus."
For example, Smith said it's not clear if warm weather will slow the spread of the coronavirus.
"The consensus in the virology community is that warm weather will likely not significantly reduce transmission of the virus, but we're still holding out hope that it will."
Researchers at Harvard are saying that one long isolation period won't be enough, that we will need many shorter lockdowns until a vaccine is widely available. Smith said that's going to be a hard sell.
"I think it will depend on what people are willing to accept," she said.
"If we end up relaxing this lockdown sometime after April and then let people get back to normal, how difficult is it going to be to then say, 'Okay, we're stopping that now, and we're going back into lockdown?'"
"I think that will be difficult psychologically on everyone."
Back to normal, Chinese style
Life is slowly going back to normal in the epicenter of the coronavirus outbreak. Chinese officials say around three-fourths of shops have reopened in Wuhan where COVID-19 was first detected.
But Smith said that normalcy is possible because of the extraordinary containment measures in China.
"They basically opened up entire hospitals just for people with coronavirus, not just for the extremely ill, but even those who had a fever were immediately isolated."
In the U.S., we're not even testing the majority of suspected coronavirus patients, she said.
"China has massive testing, so they can pretty much keep the population under control while still allowing people to start going back to work."
Another concern in China and the U.S. is the possibility of a second wave of infections.
"The virus is not going away so even if we keep things shut down for several months, it's still going to be there in the population at low levels," Smith said.
"So once you have everybody mixing again, you have the potential to spread it back to the population at large and spark additional outbreaks."
According to Smith, what we need is a plan for transitioning out of total lockdown into surveillance mode. That plan needs to include mechanisms that can trigger a shutdown in specific locations if certain disease thresholds are detected, she said.
"You can do that a little more surgically than locking down the entire state," she said.
"So we could go to contact tracing, where you test the person, and if they're sick, they go into isolation," she said. "Then their contacts go into quarantine. This strategy is different from the current one that has everyone in a community staying at home.
"We don't have the capacity to do that," Smith said, identifying this as a problem. We don't have the ability in terms of large-scale coordination, personal protective gear, or testing protocols, which she said prevents us from using more surgical interventions rather than a broad scale lockdown.
Waiting for the plan
Shortages don't prevent health officials from planning. But Smith hasn't seen many signs of it yet, at least at the highest levels.
"It seems like federally, everything is just touch and go," she said.
But she believes Ohio Department of Health Director Dr. Amy Acton and Gov. Mike DeWine are likely working on what it will take to lift the stay-at-home order.
"They've been so forward thinking on the rest of this that I can't imagine they would not be planning those types of things," Smith said.
She said the eventual lifting of the stay-at-home order will likely include information on what comes next in terms of containment. Recurring infections may still trigger localized lockdowns and that's likely to be our new reality until a vaccine is ready, and we've achieved herd immunity, she said.
Both will take time. Herd immunity requires at least 60% of the population to be immune to the disease, and she's not optimistic about the widely circulated 12-18 month timeline for the vaccine.
"It's more likely to be around 24 months before it's widely available," she said.
"What people need most right now are answers, and unfortunately, we can't supply them."