This is very real: an update

Less than two weeks ago I sent out the original email to my family on COVID-19. As the month has progressed, it’s become even clearer that we are in a real crisis so I am updating my original assessment to capture recent developments.

How bad is this going to be?

A reporter asked me how concerned I was on a scale of 1-10. I defined 1 as the start of a regular flu season and 10 as a pandemic that throws the entire world back at least several hundred years. The level of concern I have with the COVID-19 pandemic is 6-7. This is a true global emergency. It will have a tremendous impact on all aspects of our lives across the globe. However, it will not end our world as we know it. Governments will still function. The lights will stay on. Water from the tap will still be drinkable. Food will be available. Schools will still exist.

What is going to happen?

I believe the following will happen unless we implement significant interventions now:

• Deaths in the tens of millions across the globe.
• Healthcare providers will have to refuse care to anyone over a certain age or with pre-existing conditions in order to save the ones who have a better chance of surviving. (This is already happening in the Lombardy region of Italy: see reports from Jason Van Schoor and Silvia Stringhini.)
• A global recession.
• Shortages in all aspects of life, particularly of medical supplies.
• Businesses that rely on travelers, conferences, or other in-person interactions may go bankrupt. Workers will lose their jobs.

People who are lower income will suffer more from COVID-19 infections and economic impacts than those with more social and financial resources.

What can we do?

We need a vaccine. Realistically that is the only thing that can stop this pandemic but we don’t have one and won’t have one for at least 6 months (most likely 12-24 months).

Until a vaccine is available and widely distributed, we need interventions that slow down transmission of the virus and minimize the impact on our healthcare systems. If fewer people have COVID-19 at any one time, then fewer people will be very sick at any one time. If fewer people are sick, more people will be available to do the daily work needed to keep the world running and our healthcare system will be less burdened. The more daily work that can be done, the less the world as a whole will be impacted. The less burdened our healthcare system is, the more sick people will survive because they can get sufficient medical care. When you see the term #flattenthecurve, this is what people are thinking of.

How do we do this?

Slow down transmission

The most effective tool we have at the moment is social distancing - limiting the amount of contact everyone has with other people. COVID-19 is primarily an airborne virus. While hand washing and cleaning surfaces will help somewhat, social distancing is far more important so that people are not sharing airspace. China has probably been able to control COVID-19 because they implemented very strict social distancing measures. Italy is trying to do this now. The sooner we implement strict social distancing, the more effective it will be.

There is substantial evidence that we all (worldwide) need to implement social distancing as much as possible starting immediately and keep it up for months. This is where public health experts will clash with everyone else. Doing what China did worldwide for 6-12 months would have devastating effects on our lives. Given that we don’t want to destroy the world in order to save it, we have to find a realistic and effective middle ground.

Separately from whether your local government has ordered closures or event cancellations, consider the following for every activity in your life and re-evaluate regularly (even weekly):

• How necessary is it? (Work is necessary. School is necessary. Going to the movies is not. Hanging out with friends might be necessary for your mental health, but going to a crowded club to hang out is not.)
• How risky is it in terms of exposing yourself and exposing others? (Are you or the people around you in a high risk group? How much does the activity involve sharing space or physical contact with others?)
• What are the alternatives? (Is teleworking an option? Can you meet friends for walks outside instead of going to coffee shops?)
• How could you decrease the risks? (Avoid handshakes and hugs. Stagger work schedules so people don’t overlap in the same space. Have online/virtual dates.)

This is not just about your personal risk. If you are young and healthy, you can still get COVID-19 and pass it on to others. If you are older, a decision to not embrace social distancing also puts others at risk: people you come in contact with and the healthcare workers who will care for you. We all need to implement social distancing to flatten the curve.

Support healthcare systems

Our healthcare systems will be severely taxed by COVID-19. We need to minimize our use of healthcare for other things and ensure as much capacity as possible is available for COVID-19 and the health emergencies that will continue to happen (heart attacks, stroke, etc.) Here’s what you need to do:

• Do not purchase or use masks or other medical supplies unless you have been told to by a medical or public health provider. Otherwise leave masks and medical supplies for healthcare providers.
• Cancel or postpone any elective clinic visits, procedures, or other health care activities.
• If you need to see a provider for any reason, call them first. Telehealth appointments may be an option and many illnesses can be treated effectively that way (including most cases of COVID-19).
• Only go to the emergency room if it is truly an emergency. For anything less than a true emergency, call your primary care provider.
• Above all, if you have cold or flu-like symptoms, stay home unless your symptoms are severe enough to need emergency medical care.

Don’t forget to take care of yourself and support others

In addition to logistic and economic impacts, social distancing can have significant impacts on our mental and physical health. For this to work, we need to make social distancing sustainable.

To manage the impacts on your personal life, consider this: for every thing that you stop doing, add an activity that meets a similar need and is consistent with social distancing. Can’t meet your friend for dinner? Go for a walk with them instead. Unable to see your partner in person? Do a video date. Cuddle with pets. Go for a walk or run outside instead of the gym. Weed your garden. Do spring cleaning. Write letters to people you’ve lost touch with. Look for things that make you happy.

For those who are healthy and able to risk more contact with the world, consider activities that support your community: Volunteer at a food pantry. Donate blood. Go shopping for an elderly neighbor who is avoiding stores. Watch your friend’s kids so they can still work while the schools are closed. Apply to work for the 2020 census. Help do the things that will keep the world running.

How long is this going to last?

We don’t yet know for sure, but many experts estimate that we will need to maintain these measures for 6-24 months. The world is going to be very different for a while. It will be hard and scary much of the time, especially at the beginning, and some people’s lives will change forever. This is also something that humanity has survived before - 1918 flu, SARS, Ebola. We know what to do and we are all responsible for doing it.