The measures taken during the current global coronavirus pandemic will not last for a few more weeks. Instead, these measures may last forever.
This pandemic is unlike anything we have ever experienced before. Almost all aspects of our daily lives have been altered to sustain an almost unorthodox way of living. Society has successfully shifted from an open society to one where social distancing is the norm. We have profoundly changed the way we work, socialize, shop, exercise, and educate ourselves. Most of us want things to go back to normal in the coming few weeks or months. But the majority of us do not realize yet that some things will never go back to normal.
It is widely acknowledged that we need to flatten the curve to ensure the number of infected people at once does not collapse the health care system. Put differently, the pandemic needs to be kept at a ‘low level’ consistently until either enough people are immune or a working vaccine has been found.
Governments employ two fundamentally different strategies to counteract COVID-19 and thus flatten the curve:
Let R be the average number of secondary cases generated by each case (infected person). The aim here is to eliminate human-to-human transmission of the virus. In other words, we want to reduce R to below 1 and hence reduce the number of cases gradually. One of the main challenges of this strategy involves maintaining NPIs* for as long as the virus is circulating throughout the population or until there is a working vaccine.
By mitigation we want to use NPIs to reduce the speed at which the virus spreads throughout the population. These NPIs will specifically target risk-groups in the population (elderly, sick, etc.). We do this in order to build up immunity over time, which will eventually lead to a sudden rapid decline in cases and transmission.
The core difference between suppression and mitigation is thus that one aims at dropping R below 1 to stop the spread, whilst the other aims at keeping R just above 1 in order to build immunity.
A new approach
Note that, for the time being, as long as someone in the world suffers from COVID-19, breakouts can and will occur without the proper safety policies. In March, researchers at the Imperial College London have proposed a new approach to battle this pandemic. This new approach involves imposing strict social distancing** measures every time a breakout occurs and relaxing these measures when ICU (intensive care unit) admissions drop below a certain threshold.
Figure 1: According to computer simulations, alternating between periods of strict social distancing measures and relaxation of these policies keep the pandemic in control. Imperial College COVID-19 Response Team.
Under this approach, researchers expect that we need to adhere to the strict social distancing rules about two-thirds off the time until a vaccine becomes available (at least 12-18 months). In practice though, this approach may be difficult to follow.
Increasing ICU capacity
A lot of people have suggested that 12-18 months of this new approach is still a heavy burden on our social lives. So, they ask themselves the question: why don’t we increase the ICU capacity and choose the mitigation approach? Recall, that the mitigation approach involves social distancing of vulnerable individuals and closure of schools.
Figure 2: According to simulations, using the mitigation approach and at the same time increasing ICU capacity will result in way more casualties. Imperial College COVID-19 Response Team.
According to simulation results, this approach will likely result in a severe number of casualties since the health system, even with increased ICU capacity, will not able to cope with such a high number of cases.
However, a lot remains unclear, since these computer simulations do not take into account behavior that certain people exhibit when the number of cases starts decreasing. People may start going out more often as they hear ‘good’ news about the decrease in active cases, which may result in new peaks in ICU admissions. Therefore, it remains of utter importance that policy changes are made on an ongoing basis, based on daily data.
In the short term, the pandemic has been particularly harmful to businesses that depend on people coming together: airlines, hotels, clubs, cinemas, shopping malls, bars, cafes, public transportation, and many more. Some businesses managed to adapt to this ‘isolation economy’ by changing their offerings: fine dining restaurants have started delivering meals to their customers and gyms have started selling online training programs. But the disastrous consequences many businesses will be impossible to imagine and likely result in millions of bankruptcies throughout the world.
In the near future, we might see things going back to normal with certain awkward compromises. We might see that certain policies in restaurants and public spaces continue until the end of this pandemic.
Ultimately, however, we will restore the ability to socialize safely. Long-term changes will likely involve flagging potential breakouts before they might even happen. Israel’s largest healthcare system Maccabi Healthcare Services is already using AI to flag which of the 2.4 million people it covers are most at risk for COVID-19 complications during the current pandemic. Furthermore, ICU capacity is likely to be increased on a global scale, in order to cope with peaks in ICU admissions for potential future pandemics.
What is to come
After all, the complete eradication of COVID-19 requires profound solidarity amongst world nations. Countries should coordinate efforts to counteract the effects of this pandemic on the global health system and economy. It is in these tough times that through unity and agreement amongst the worlds’ citizens we will look at end of the COVID-19 pandemic as a great leap for the nation of peoples.
*NPIs or Non-pharmaceutical interventions are measures to reduce the transmission rate by reducing contact rates in the population. An example of an NPI during the ongoing coronavirus pandemic is social distancing.
**Note that NPIs and social distancing are used interchangeably throughout this article. They both refer to the same thing.
Disclaimer: This article is based on a report by the Imperial College COVID-19 Response Team on the 16th of March, 2020. The report can be found here: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
This article is written by Berke Aslan