In some places — New York, Washington, California — the pandemic has stabilized, with number of new cases, hospitalizations, and deaths either flattening or declining. This is obviously good news, better than the alternative.
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But that news is only emerging from a few early hot spots, after a month or more of total lockdown.
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Nationally, deaths are still higher each day than the last, despite the fact that the country is now weeks into shutdown (and longer into a state of aggressive social distancing).
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And though there is good news coming out of those hotspots, it is incredibly limited food news, for two big reasons.
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The first applies to the hotspots themselves: we have turned the corner, or reached this plateau, only through massively disruptive isolation policies.
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These trends will not continue pst any degree of “opening up,” even very limited forms of it.
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Of course, there are policies we can deploy to dampen the spread far below its “natural” exponential rate—social distancing, large scale testing.
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But even in the best of circumstances, the spread won’t be nearly as controlled as it has been for the past month. How could it be? We’ve essentially eliminated the vast majority of opportunities for the virus to spread...
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...and even a very limited opening, monitored by mass testing, will multiply those opportunities many times over from where we are now.
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The second big reason the good news from hotspots is only very limited good news is that it probably reflects control over only, at most, 5% of the ultimate shape of the pandemic. We haven’t gotten it under control; we’ve only gotten 5% of it under control.
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That’s because probably only 5% of the public has been exposed, to this point, and conceivably a lot less.
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Even in the Bay Area, where we’d expect considerably more exposure than the country as a whole, a new study found only 2-4% of the population with antibodies—and that finding has already been called into question as too high.
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For the pandemic to truly end will require one of three things: a vaccine, probably a year away, a “cure,” whose timeline is murkier but probably about as long, or herd immunity, which requires 60% exposure—at least twelve times the current level.
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That means twelve times as many infections, and roughly that many hospitalizations and deaths (though treatments will likely improve even before we get to a cure).
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And we could be considerably farther from that herd immunity endgame, if less than five percent is exposed, or if we need eighty percent exposure to achieve immunity. Conceivably, we could be only one eightieth through the pandemic.
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Over the last few weeks, we have heard a lot about mass testing—and it is essential. But it won’t bring about the end of the pandemic, only allow us to live somewhat more comfortably and openly through it.
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That period of moderated fear will end only with a vaccine, a cure, or herd immunity. And of those three, the only one we can count on is immunity.
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Or—we think we can count on it. Because we don't yet know how many people who survive carry antibodies, or how long the immunity of those that do carry them lasts. On herd immunity, too, we are flying somewhat blind, and the trip to there from here is very long indeed. (x/x)
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