Health Care

Four Assumptions about the Coronavirus

An employee wearing a protective mask and face shield walks inside a Railink train after the government eased restrictions following the COVID-19 coronavirus outbreak in Jakarta, Indonesia, July 2, 2020. (Willy Kurniawan/Reuters)
We are a long way from done with this fight.

Where do we stand in our fight against the coronavirus? Here are three safe — but not entirely certain — assumptions about this pandemic, and a fourth that follows from the first three.

1. The most common strain of SARS-CoV-2 in the United States right now is extremely contagious and will prove difficult to contain even with wider and more consistent adoption of best practices.

A study released last month by the Scripps Research Institute concluded that the strains of the virus spreading so quickly in Europe and the U.S. have a mutated S “spike” protein that makes them about ten times as infectious as the strain that was initially identified in Asia. If it seems like the United States is having a tougher time controlling the spread of the coronavirus than Asian countries did in winter and early spring, that’s partially because this version of the virus is tougher to stop from spreading.

More and more researchers are contending that SARS-CoV-2 is airborne, meaning that it is not merely being dispersed by the bodily fluids of those who have it, but also floating about in aerosolized form. It is also possible that the virus is not truly aerosolized, but that it is floating in tiny droplets which are so small and so light that they can easily be carried long distances by air currents. The European Centre for Disease Prevention and World Health Organization are now taking the former possibility seriously, and with good reason: An aerosolized virus would mean that most of our current pandemic-control practices, such as remaining six feet apart, were not enough by themselves to prevent contraction of the virus.

The scale and complexity of the problem should not be understated. The country enacted unprecedented, sweeping lockdowns that kept most Americans at home, at great cost to the economy. These lockdowns slowed the spread of the virus, but did not stop it. Preventing more infections is not just a matter of convincing the president to wear a mask consistently, or shutting down beaches or subways, or requiring quarantines for those who travel between states. At every level of government, the response to the virus has met with mixed success. But it’s important to recognize that no one is ignoring any simple or easy solutions, because such solutions don’t exist. At this point, there is no known method of completely halting the virus’s spread.

2. The death rate for those who catch the virus is extremely low, but with millions upon millions of Americans infected, a low death rate will still add up to a horrific loss of life.

Early on in the pandemic, people argued about whether the death rate associated with the virus was worse than that associated with the flu (roughly .01 percent, though even the accuracy of that oft-cited figure can be debated.) So far, everything we’ve learned through our study of SARS-CoV-2 suggests that it’s been more deadly than the typical seasonal flu. The CDC currently estimates the death rate at between .6 and .7 percent, while a new study puts it between .5 and .8 percent. As of this writing, Worldometers has the United States at 3,642,907 confirmed cases and 140,460 deaths, for a death rate of just under 4 percent.

Some observers will look at the above figures and note that because some infected with coronavirus are asymptomatic, and are less likely to be tested, many more people should be in the sum of total cases, bringing the case-fatality percentage down even further. But even if the “true” fatality rate is as low as 0.2 percent, the highly contagious nature of SARS-CoV-2 means that it represents serious danger for a country with 328 million people. According to the Census Bureau, roughly 252 million Americans are over age 18. If half of those adults — 126 million people — catch the virus before herd immunity kicks in or a vaccine becomes widely available, a 0.2 percent fatality rate would still mean 252,000 deaths.

For a while, optimists could point to a steady decline in the number of Americans dying from the virus. In mid April, the U.S. was seeing 2,500 new deaths per day. By mid June, that had declined to under 1,000 per day. Thereafter, it kept declining until roughly Independence Day weekend, falling as low as 500 to 600 deaths per day. Now, has started to creep up toward 1,000 again.

In theory, more cases of infection do not necessarily mean more deaths, if the newly infected are young and healthy enough and treatment methods continue to improve. But realistically, those young and healthy infected patients will sooner or later interact with older and less healthy people and spread the virus to them, causing the death toll to creep back up. Doctors and medical experts have been warning about this for weeks, and the daily data are now proving them right.

The elderly and those with preexisting health conditions remain at greatest risk of succumbing to SARS-CoV-2, but we will also continue to see tragic and troubling cases of seemingly healthy, not-so-old people dying from the virus. In addition to age and health, the ability of the infected to fight off the virus is likely influenced by genetic factors that will take much more research to identify. There is, for example, a striking, odd disparity in the blood types of those infected.

3. A vaccine is coming as fast as anyone could hope for, but still probably won’t arrive until late 2020 or early 2021.

We continue to hear good news from the hunt for a vaccine. The University of Oxford vaccine candidate might be done with human trials by September, and “AstraZeneca has agreed to sell the vaccine on a not-for-profit basis during the crisis if it proves effective and has lined up deals with multiple manufacturers to produce more than 2 billion doses.” A candidate vaccine developed by the federal government and Moderna appears to be safe and to trigger an immune response, and is entering the final stage of testing trials. The Food and Drug Administration has also fast-tracked two experimental vaccines jointly developed by German biotech firm BioNTech and Pfizer, according to CNBC.

What does this all mean for the timing of a vaccine? An unidentified “senior administration official” told CNBC that U.S. health officials and pharmaceutical companies expect to start producing potential vaccine doses by the end of the summer, and that drug-makers are buying equipment, securing the manufacturing sites and, in some cases, acquiring the raw materials.

Of course, there are reasons to temper our optimism. Once a reliable vaccine is identified, it still will need to be produced and distributed on a truly massive scale. CNBC’s “senior administration official” said the aim is to “deliver 300 million doses of a vaccine for Covid-19 by early 2021.” Health and Human Services secretary Alex Azar said recently that the country could have “tens of millions, even 100 million doses of vaccine, this fall, and many hundreds of millions of doses by early next year.” Even if the administration’s wildest dreams come true, though, that timeline suggests that when 2020 ends and 2021 begins, most Americans will still not be vaccinated.

What’s more, the development and distribution of a vaccine are only half the battle. Almost all of the vaccine candidates require two doses administered separately, probably a month or two apart, and the immunity to SARS-CoV-2 may not last, because viruses mutate. Coronavirus vaccinations might turn into something akin to annual flu shots, or they might need to be administered every two to three years. Plus which, there will of course be Americans who refuse to be vaccinated.

4. Our battle with the coronavirus will almost certainly last until at least the end of the year, and could very well last for several more years.

All indications are that Americans should hunker down, because this fight is far from over. If we’re lucky, something resembling normal life will return sometime in early-to-mid 2021. But even after we’ve all been vaccinated, we’ll still be living with the lingering economic, geopolitical, social, educational, and psychological consequences of the virus. Certain industries — tourism, air travel, cruise lines — may never return to their pre-pandemic levels; certain others — casinos, movie theaters, amusement parks, and less popular spectator sports — may be slow to recover.

Once the world is on its way to recovery, one final problem will remain: figuring out how to prevent a similar crisis from happening in the future. We must be aware that the conditions that facilitated the virus’s migration from a bat to the still-unidentified Patient Zero in Wuhan will be almost entirely unchanged when the pandemic ends. We don’t know exactly how that migration happened, but illegal animal poaching and smuggling will continue around the globe, the so-called wet markets in China will remain open, and we will still have to take it on faith that most countries conduct their biological research into contagious diseases safely.

Hopefully, we will never experience something like this ever again. But there are no guarantees.

Editor’s Note: This article originally identified the U.S. COVID fatality rate as 0.4 percent. In fact it is 4 percent. The underlying numbers remain correct.

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