Returning to normal – can we get there from here?

The COVID-19 pandemic has led to unprecedented levels of government action to slow its spread and to mitigate its effects.

The new coronavirus appears to cause death in one to two percent of cases compared to about one death in 1,000 cases for influenza. But unlike influenza, there is currently no preventive vaccine or proven antiviral treatment. The new coronavirus overwhelmed hospital capacity in parts of Italy and threatened to do so in New York City.

With a vaccine still a mere wish and a year away at best, might we hope for “herd immunity”? With COVID-19, that would require 50 percent to 80 percent of the population to be immune by infection or vaccination. Based on current data, we are less than one percent of the way there.

Extreme social distancing in spring has prevented hospitals from being overwhelmed, so we did flatten the curve. Let’s hear it for solidarity!

But when can we “reopen” society? When the disease does not threaten to overwhelm hospitals, and case counts are low enough to be identified and isolated, and their contacts are identified.

How will reopening progress? Per the 10th Amendment of the Constitution, decisions for reopening areas are made at the state level, perhaps at local levels in states that delegate this authority. Some have already begun gradual reopening using the three phase scheme recommended by the Centers for Disease Control (CDC) as a guide.

As reopening progresses, governors will be looking for

• Decreasing numbers of cases
• Sufficient hospital bed and intensive-care bed capacity
• Availability of personal protective equipment (PPE), particularly masks and gowns
• Readily available testing
• Sufficient public health investigative capacity

Expect incremental changes based on weighing risk of disease transmission against economic necessity. Activities might be allowed to recommence sequentially along these lines:

• Medical procedures, starting with the most urgent
• Businesses with minimal face-to-face customer interaction
• Other businesses
• Gatherings with moderate numbers of persons or face-to-face contact
• Larger gatherings and restaurants

COVID-19 may have catalyzed some permanent changes, speeding the adoption of telecommuting in businesses and distance learning for more college courses. Sick-leave policies and social mores may get more people to stay home while suffering from respiratory infections, and people may more consistently observe cough etiquette. Perhaps a greeting that transmits fewer viruses than handshaking will be adopted. And maybe we’ll wash our hands more frequently and stop touching our faces unthinkingly.

We could get lucky: the virus might be seasonal, so that it fades away during the summer without human effort; or researchers might demonstrate the effectiveness of an antiviral drug that reduces morbidity and mortality without extraordinary social-distancing edicts.

Fondly should we hope, fervently should we pray…

PAUL R. CIESLAK, M.D., is a member of the Catholic Medical Association and a public health official for the state of Oregon. He lives with his wife and family in northeast Portland.