We are not going back to normal

It is now widely accepted (even by Britain, finally) that each country must “flatten the curve”: impose social distancing to slow the spread of the virus so that the number of sick people at once does not cause the system health collapsing, as it threatens to do in Italy right now. This means that the pandemic must last, at a low level, until enough people have had Covid-19 to leave most safe (assuming immunity lasts for years, which we don’t know. not) or that there is a vaccine.

How long would that take and how draconian must the social restrictions be? Yesterday, President Donald Trump, announcing new guidelines such as a 10-person limit for rallies, said that “with several weeks of focused action we can get over it and turn it around quickly.” In China, six weeks of lockdown are starting to ease now that new cases have fallen in the net.

But it won’t stop there. As long as someone in the world has the virus, rashes can and will continue to recur without strict controls to contain them. In a report released yesterday (pdf), researchers at Imperial College London proposed one way to proceed: impose more extreme social distancing measures whenever admissions to intensive care units (ICUs) start to increase and relax them whenever admissions drop. Here’s what it looks like in a graph.

Periodic episodes of social distancing keep the pandemic under control.

Imperial College Covid-19 Response Team.

The orange line corresponds to intensive care admissions. Every time they cross a threshold, say 100 a week, the country will close all schools and most universities and embrace social distancing. When they drop below 50, those measures would be lifted, but people with symptoms or whose family members have symptoms would still be confined to their homes.

What counts as “social distancing”? Researchers define it as “All households reduce contact outside the home, school or workplace by 75%.” That doesn’t mean you hang out with your friends once a week instead of four times. This means that everyone is doing everything possible to minimize social contact, and overall the number of contacts decreases by 75%.

According to this model, the researchers conclude, social distancing and school closures should be in effect about two-thirds of the time – about two months and a month off – until a vaccine is available, which will take at least 18 months (if it works). They note that the results are “qualitatively similar for the United States”.

Eighteen months !? There must surely be other solutions. Why not just build more intensive care units and treat more people at once, for example?

Well, in the researchers’ model, that didn’t solve the problem. Without social distancing from the general population, they found that even the best mitigation strategy – which means isolating or quarantining the sick, the elderly and those who have been exposed, as well as school closures – would always lead to a wave of seriously ill people. eight times bigger that the US or UK system can handle. (This is the lowest blue curve in the graph below; the flat red line is the current number of intensive care beds.) Even if you set up factories to produce beds and ventilators and all other facilities and supplies, you would still need more nurses and doctors to take care of everyone.

A graph of occupied intensive care beds over time.
In all scenarios without widespread social distancing, the number of Covid cases overwhelms the healthcare system.

Imperial College Covid-19 Response Team

How about putting restrictions on a single batch of about five months? Not good – once the measures are lifted the pandemic breaks out again, but this time it’s winter, the worst time for overburdened health systems.

A graph showing the intensive care beds occupied over time for the deletion scenario.
If full social distancing and other measures are imposed for five months and then lifted, the pandemic returns.

Imperial College Covid-19 Response Team.

What if we decided to be brutal: setting the threshold number of ICU admissions to trigger much higher social distancing, accepting that many more patients would die? It turns out that makes little difference. Even in the least restrictive of Imperial College scenarios, we’re locked in more than half the time.

It is not a temporary disruption. It’s the start of a whole different way of life.

Living in a pandemic state

In the short term, this will be extremely damaging for businesses that depend on bringing people together in large numbers: restaurants, cafes, bars, nightclubs, gymnasiums, hotels, theaters, cinemas, art galleries, shopping centers, craft fairs, museums, etc. musicians. and other performers, sports venues (and sports teams), conference venues (and conference producers), cruise lines, airlines, public transport, private schools, daycares. That’s not to mention the stress parents go through for home schooling their children, people trying to care for elderly parents without exposing them to the virus, people trapped in abusive relationships, and anyone without a cushion. financial to cope with fluctuations in income.


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