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Sketching Out a Worst-Case Scenario for the Coronavirus Pandemic

The medical staff of Severo Ochoa Hospital applaud in support for healthcare workers amid the COVID-19 coronavirus outbreak in Leganes, Spain, April 1, 2020. (Juan Medina/Reuters)
One good way to deal with a fear of the unknown is to attempt to envision it — to imagine what will happen if our luck gets even worse.

We fear the unknown, and right now there is still a great deal that we don’t know about the coronavirus. We don’t know how many asymptomatic people have it. We don’t know how many infected people will be able to fight it off, experiencing relatively mild symptoms, and how many will succumb. We don’t know why hydroxychloroquine and other drugs have successfully helped some patients recover and not others. We don’t know when a vaccine will be discovered and available to the general public. We don’t know when the unprecedented social-distancing rules, quarantine orders, curfews, and other restrictions upon our liberty will end. We don’t know when we can reopen our businesses and get our economies moving again. And we don’t know, with certainty, what made the virus jump to humans and set off this global pandemic.

One of the ways to deal with a fear of the unknown is to attempt to envision it — to think through the worst-case scenarios, imagining what will happen if our luck gets even worse, if Plan A and Plan B don’t work. In the wrong hands, such an exercise might turn into scaremongering, but if done responsibly it can also be useful preparation: Once we’re ready to deal with the worst, almost anything else we face will seem easier.

One giant question is whether human beings develop an immunity to SARS-CoV-2 once they’ve recovered from the initial infection. Once a person’s body detects an unwanted guest in the form of bacteria or a virus, it starts taking steps to get rid of that guest. (We sneeze, in part, because our bodies are trying to get something out of our noses.) Our white blood cells effectively “hack the code” of the interloper and get increasingly better at defeating it. And in the case of most viruses, the body remembers that code, meaning most subsequent exposures do little or no damage because the body fights them off so quickly.

Doctors strongly believed that the SARS-CoV-2 would be like most viruses in that critical sense, but we’re still not sure if it is. South Korean doctors have warned about cases that appear to be reinfection or perhaps a reignition of the virus — the virus is defeated enough for tests to come back negative, but at some point later, the body’s immune system falters and the virus flares back up again. This would be an enormous setback to the goal of “herd immunity” — reaching the point where the virus can no longer easily spread from person to person because so many people have developed immunity from a previous infection.

I won’t get into specific models or numbers, because one way or another, a lot of people in this country and around the world will have died from this pandemic before all’s said and done, and your perspective on just how devastating the losses are will probably be heavily influenced by whether or not people you know are among them. If the coronavirus kills three people you know personally, it will feel like a huge deal to you wherever the total death toll comes in relative to the official models; if the death toll outpaces the models but you don’t know any of the victims, it may feel like a far-off tragedy to you.

That said, the United States has endured close to 2,000 deaths a day for the past several days — we’re now experiencing something close to one new 9/11 every 36 hours. It is hard to imagine how anyone could look at that number of deaths and the prospect of tens of thousands more and construe it as anything less than an epic tragedy, one of the worst in our history.

The Chinese government claims to have gotten the virus largely under control, but the Chinese government lies a lot. So far, no country appears to have found the perfect way to mitigate the spread while keeping the economy operating normally, or even close to normally. The first coronavirus cases outside of China were in Thailand, Japan, and South Korea. By many measures, those countries are handling the outbreak relatively well, although none of them is close to out of the woods yet and Japan’s daily totals of fresh cases and deaths are starting to climb.

Although trying to flatten the curve, as those and many other countries have done, is the right strategy to ensure that hospitals are not overwhelmed, it also elongates the curve, meaning we will be dealing with the coronavirus as a fact of life for a more sustained stretch. Since the beginning of the epidemic, some have hoped that warmer weather would slow the spread of the virus or even stop it in its tracks. But a panel convened by the National Academies of Sciences has now warned us not to get our hopes up too high: “Given that countries currently in ‘summer’ climates, such as Australia and Iran, are experiencing rapid virus spread, a decrease in cases with increases in humidity and temperature elsewhere should not be assumed.”

We should expect additional waves of infection. The good news is that we should be better prepared for each subsequent wave, and it is less likely that we will see anything like long lines of revelers outside of bars on Saint Patrick’s Day, or Mardi Gras in New Orleans, or college students defying warnings by celebrating Spring Break on the beach — large gatherings that present an acute risk of spreading the virus further — in the near future. That said, with 80 percent of American counties under some sort of quarantine or social-distancing restrictions, when the reins are loosened, some will inevitably want to get together in large groups, whether or not health authorities recommend it. We’re a stir-crazy country and world right now, having missed out on at least a month’s worth of birthdays, parties, happy hours, concerts, sporting events, religious gatherings, weddings, and funerals. Some Americans will not have the patience to gradually ratchet up their social interactions once the government restrictions begin to be lifted.

Meanwhile, some percentage of those who fight the virus and defeat it may be far from back to “normal” for a long while. At least some patients who needed ventilators during treatment will take time to recover their lung capacity. Others who have spent time on ventilators for other respiratory ailments describe hallucinations and other lingering physical and psychological side effects. After the 2003 SARS outbreak, PTSD was not uncommon among survivors, especially health-care workers. A study of Toronto hospital workers found that professional burnout and symptoms of traumatic stress, anxiety, and depression remained somewhat elevated compared with colleagues elsewhere who hadn’t treated SARS patients. Doctors are generally smart and tough — but long shifts treating contagious patients can wear down even the most psychologically resilient people.

The other frightening question facing the country, of course, is the catastrophic impact on the economy, starting with the health-care sector. It may seem odd to find hospitals struggling to stay open during a major public-health crisis, but the preparations for the coronavirus have spurred most of them to postpone all other nonessential medical procedures — the very procedures on which they make most of their money. By one estimate, treating each coronavirus patient costs a hospital $40,000.

We are probably not out of the woods regarding the threat of disruptions to our national food supply, either. Four meat-packing plants in Pennsylvania temporarily shut down after a significant number of workers tested positive. A Smithfield Foods pork-processing plant in South Dakota is being temporarily closed for cleaning after more than 80 employees at the plant were confirmed to have the coronavirus. Americans will not starve, but they may find their supermarkets missing some products in the coming months, if they aren’t already.

In theory, once the threat of the virus is gone, the economy should rebound quickly. But the reality may be different. How much disposable income that once could and would have been used on vacations, hotel stays, flights, cruises, and meals out at restaurants has evaporated in the face of mass layoffs and business closures? On paper, the only thing holding back those industries are government rules barring people from going out and patronizing them. But as the shutdown of American life continues, the savings of those laid off will dwindle, and those who have their savings tied up in a small business will face ruin. The bonanza of spending from the Fed and Congress may mitigate the damage somewhat, but it may also be too late in coming. President Trump signed that massive relief package into law March 27. The first batch of payments wasn’t deposited by the IRS until Saturday, April 11, and paper checks aren’t due to start being mailed out until May 4.

The worst-case scenario is, in short, ugly: recurring waves of infections and quarantines, a year or more until we can have mass gatherings, an unbearable number of untimely deaths, some who survive having to live with serious lingering health complications, an exhausted health-care system full of burned-out doctors, nurses, and staffers, and more laid-off workers than resulted from the Great Recession. But even if the worst-case scenario doesn’t come to pass, this will have been — and indeed, already has been — a gut punch to humanity.

The good news is that we can get back up again, enduring and ultimately triumphing. In the end, we won’t have much choice; we’re not just going to lie down and die. We as a nation have survived the influenza pandemic of 1918, two World Wars, the Cold War, 9/11, earthquakes, hurricanes, wildfires, tornadoes, floods, and countless other calamities. The world has always thrown deadly challenges at us, and we have always found a way to meet them. In fact, we’re already working to find a way to meet this one: Human trials for a vaccine start next month.

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