The odd thing about reporting on the coronavirus is that the nonexperts are supremely confident in their predictions, while epidemiologists keep telling me that they don’t really know much at all.
“This is a novel virus, new to humanity, and nobody knows what will happen,” said Anne Rimoin, a professor of epidemiology at U.C.L.A.
Some of that epidemiological humility should seep into public discourse.
Some conservatives scoffed that the coronavirus was like the flu, which was utterly wrong. Some liberals foresaw a disastrous outbreak when Jerry Falwell Jr. kept Liberty University open this spring, and that never happened. Viruses are complicated.
It has now been more than three weeks since Georgia started reopening, and there hasn’t been the abrupt statewide surge of infections that many had feared. That’s a good sign for reopening. But it’s early, and it’s in part because people in Georgia are still distancing to some degree on their own.
Texas opened up and lately has reported a spike of new infections, which is bad news. But that’s in part because Texas increased testing, and if you do more testing you find more infections.
We know that social distancing works, for China, Italy, Spain, Iran and New York all were hard-hit and eventually squelched horrifying outbreaks by imposing tough restrictions. Governors of Washington and California acted early and avoided such catastrophic outbreaks. One study reported in Health Affairs found that government restrictions collectively averted some 35 million infections in the United States by the end of April; if that’s true, those restrictions also saved an enormous number of lives.
Yet the same study found that school closures didn’t much help, and we still haven’t figured out the optimal level of restrictions to smother the virus’s spread without stifling citizens’ daily routines.
That’s not surprising, notes Michael Osterholm, an epidemiologist at the University of Minnesota, because we still haven’t figured out the 1918 pandemic. “In 1918, why did the spring wave go away, and then why did it come back in the fall?” Osterholm asked. “We don’t know.”
Epidemiology is full of puzzles. In 2003, the World Health Organization feared that SARS would return in a devastating wave that fall, but instead it was extinguished. In 2009, experts worried that the H1N1 flu would be a lion, but it turned out to be a kitten. Random luck shapes outcomes along with biology; some officials took reckless risks this year and got away with them, but that doesn’t make the actions prudent
“You’ve got to have a lot of humility with these viruses,” Professor Osterholm said. “I know less about viruses than I did 10 years ago.”
In the spirit of that humility, let me relay some advice from public health experts.
First, don’t swoon at every vaccine announcement. Remember that even when we get a vaccine that is proven both safe and effective, we will have to manufacture it on a huge scale — especially if each person requires more than one dose — and that will be a monumental task. Even if we make enough vaccine, we may be held back by shortages of syringes, needles and glass vials.
“It could take up to two years to produce enough vials for U.S. vaccine needs,” Rick Bright wrote in his whistle-blower complaint concerning his removal as a senior official for pandemic response.
Second, gather more data. In many places in America, there appears to be virtually no coronavirus, so those localities probably could safely reopen just about everything — if we could identify them and if we had rigorous surveillance so we could be ready to clamp down on an outbreak the moment it began.
Yet a majority of counties still don’t have a coronavirus testing site, and in some places the public isn’t using the testing capacity we have. So we should ramp up testing sewage for the coronavirus. Sewage often tests positive before human cases turn up, so it offers a critical early detection system. If Pakistan can conduct widespread virus testing of its sewage for polio, the United States can introduce widespread sewage testing for the coronavirus.
Third, cautiously open some schools. Not everyone agrees with this, but there’s some research and some practical evidence from the experience of Denmark, Australia and Taiwan that schools can open without adding much to risk.
Meanwhile, the cost of keeping schools closed — especially to disadvantaged children and to working parents — is enormous.
Fourth, be relentlessly empirical. There’s growing evidence that outdoor transmission is rare, so we should be more ready to open up parks and beaches. On the other hand, meatpacking plants, prisons and nursing homes have been particularly lethal, so they merit far greater care and oversight.
I find a gulf in perceptions between experts and nonexperts. Many Americans believe that we are now emerging from the pandemic and that, as President Trump says, we can see light at the end of the tunnel. Yet many epidemiologists, while acknowledging how little they know, are deeply apprehensive about a big second wave this fall, more brutal than anything we’ve endured so far.
That mix of humility and apprehensiveness seems the best guide as we devise policy to survive a plague. Hope for the best while preparing for the worst.
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