How Long will this Pandemic Last?

The simple answer is, no one knows. And, I hate to tell you that you are very likely misunderstanding the President’s comments on this subject and misinterpreting those prediction models you are looking at.

Asked when the U.S. might expect to turn a corner in its efforts to rein in the virus, President Trump replied, “If we do a really good job, we’ll not only hold the death down to a level that is much lower than the other way, had we not done a good job, but people are talking about July, August, something like that.”

First of all, as a country, we have not done and are not now doing a really good job. In fact, we have missed many opportunities to have better responded to this virus. There are many things I can point to, but that is for a later blog post. Suffice it to say, the country is two month’s behind what would have been an optimal response. We are already seeing the consequences of that in the New York City metro area, California, and the western part of the state of Washington. And, watch, within 10 days, New Orleans will be at the breaking point that New York City is today and not far behind it will be parts of Michigan and Cook County in Illinois.

Also, note that “rein in” is not the same thing as this will all be over, which I fear is the way most people interpreted the President’s comments.

And those nice prediction models that you have been looking at – you know, the bell curves that seem to peak in April or May depending upon what part of the country you are in and then come back down to the baseline during the summer? I hate to tell you, but that is the first wave.

So, let me explain and propose what I think are the possible scenarios.

There are only two realistic circumstances under which this virus goes away. The first is that it mutates (viruses commonly do that) in a way that makes it less likely or unable to infect people. I am not betting on this. The second way is that we develop so-called “herd immunity.” Herd immunity is when enough of us become immune to the virus that it cannot efficiently spread, even to those few who are not immune. How many of us would have to be immune? We don’t know, but most experts I talk to think that number is at least 80 percent, perhaps higher. There are two ways that we can become immune. We can become infected, recover and develop protective antibodies, or we can develop antibodies in response to a vaccine instead of infection.

The vaccine is at least a year, perhaps a year and a half away, and that is if everything goes really well. What do I mean? Well, we are good at making influenza vaccines, but we haven’t always been successful in developing vaccines for some other viruses (note, e.g., HIV first began causing infections in the mid-1980s and we still don’t have a vaccine today.) This vaccine will be significantly different from the influenza vaccine, and in fact, uses a new methodology that we have never used before. Will it work? Will it be safe? Will it induce immunity? What dose is the right dose? How many shots does it take to create immunity? Is it effective in the very young and the elderly? How long does the immunity last? How long will it take for manufacturers to produce sufficient amounts of the vaccine? These are all questions we have to have answered. I very much doubt we have a vaccine ready for distribution before next summer, and then if we do, we still have to get it distributed all over the world and get a sufficient number of people immunized.

So, back to the question of this blog post. How long will this pandemic last?

Option 1. It goes away this summer. I doubt this and believe this is the least likely scenario. A lot of viruses do better in the cooler weather, and that certainly seems to be the case for this novel coronavirus (called SARS-CoV-2). Further, this SARS-CoV-2 virus appears to like lower humidity. So, this has led many to think that perhaps SARS-CoV-2 will be seasonal and go away during the summer.

Unfortunately, the fact that no one in the world is immune to this virus, other than those who have already been infected (we think), probably will ensure that this virus continues to be transmitted even during the summer, though I am optimistic that its transmission will not be as effective as it is right now (in other words, we will see new cases, but not at the same rate we are seeing them now). And, keep in mind, when we are having summer, those on the other side of the hemisphere are having their winter.

Option 2. The transmission and activity of the virus slows down over the summer and ramps up again next fall/winter. I think this is extremely likely. Thus, for all of you who have been studying predictive models and the curve we are on, that curve will take place and cases will come down over the summer, but then we will see another curve late fall/early winter. The next curve will likely be less severe, as perhaps 30 percent or more of our population becomes immune from the first curve and hopefully, we more readily accept social distancing and have altered our practices by not shaking hands, washing our hands frequently, covering our coughs and sneezes and decreasing our interactions at work.

Option 3. We have continuous spread until we achieve high levels of immunity approaching levels needed for herd immunity. This is certainly possible.

My guess is option 2, but that it continues to have these up and down curves of activity until we reach the levels of infection/vaccination needed to produce herd immunity, and I don’t think that will occur before fall of 2021.

Now, keep in mind that during this time (in fact, I think we are only a month or two away), we will develop therapeutic options. Some of these treatments might be to prevent infection, while others will be to treat infection to lessen its severity and the mortality rate from this infection. So, even if we continue to have significant amounts of disease, things will improve.

Once we have the vaccine, it is possible that this virus will be eradicated as we have eradicated some other diseases if there is excellent compliance with immunization world-wide and the virus does not mutate, or alternatively, it may be that the virus recurs, but we have an annual vaccine to protect people from it.

As I said at the beginning. When you ask the question, when will this pandemic end, no one can tell you the answer. However, I felt compelled to write this blog piece because I think many people are misled into thinking that this will all be over this summer. That seems very unlikely. I don’t write this to alarm you, because I don’t think this calls for alarm. It just means that we are going to likely have recurring cycles of isolating and social distancing, even while at the same time we are developing treatments for this disease. And, when we do have a vaccine that has been proven safe and effective, we are dependent upon as many people as possible getting vaccinated to protect those for whom the vaccine may not work, those who may have medical contraindications to taking the vaccine, or unfortunately, those who simply refuse to be vaccinated.