At the start of the second week of April, hospitalizations are peaking in New York, the largest epicenter of the pandemic in the U.S. Meanwhile, there are just 9 known cases of the virus in Kent County, 10 in Talbot, and 16 in each of Queen Anne and Caroline counties. President Trump is talking about “reopening” the U.S. economy and sending people back to work. But don’t be misled. Many more people will get seriously ill in the months to come, and even if the virus seems to retreat in the warm summer months, it is likely to resurge in the fall and winter.
We don’t really know how widespread the virus is, because many of those infected show no symptoms, even though they can infect others. The only careful survey took place in Iceland, which tested 5 percent of its population and found that about 50 percent of those infected showed no symptoms. Applied to the U.S., that would mean at least 800,000 people have been infected, half of whom don’t know it and are likely infecting those around them. Consider also that in the period from December through February, when the virus was actively spreading in China, more than 750,000 people entered the U.S. from that country. So it is likely that the virus is far more widespread than we know.
Just consider what it means if an infected person spreads it to 2 others—then the next day those 2 infect 4 others, and so on—the definition of exponential growth. The math works out such that a single case could grow to over 200 million infected Americans within a single month. It’s easy to see how big cities such as New York quickly became hot spots of infection.
But cases are rising rapidly now even in small towns and remote rural communities—where a quarter of all hospitals have fragile finances even before the pandemic and are largely unprepared clinically for a surge of cases requiring ventilators. Testing is not widespread in rural areas, meaning we don’t really know the extent of the threat. And the virus has hardly been eliminated even in urban areas past their peak. So “opening up” the economy and sending people back to work anytime soon will simply launch a second wave of infections.
To open up safely will require massive testing—so we know who had already had the virus and is therefore immune and can’t affect others, so can be allowed to work—or waiting until 50 or 60 percent of the population becomes immune, enabling what is called “herd immunity.” That means it’s hard for the virus to spread, because those who are immune can’t pass it on. But letting the virus run free could still take several seasons of the virus to build up a herd immunity, and in the meantime would kill many of those who are most vulnerable—those over 70 or who have underlying health problems.
The current wave of testing identifies who is ill with the virus. To find those who have already had it and recovered requires a different kind of test—a so-called antibody test that identifies a specific protein in a person’s blood created by their immune system to fight the virus. The test requires only a finger prick of blood, results are available within a few minutes, and mass manufacture of the tests has begun. Still, it will likely take months and a coordinated national strategy to test every person working or who wants to go back to work, so that even a partial reopening of the economy safely is possible. Development of an effective vaccine will very likely happen within a year—but that means after the likely fall-winter resurgence of the virus. Until then, social distancing, working from home, and continued closure of non-essential businesses are the only effective tools.
Meanwhile, there is some good news on the vaccine front. The University of Pittsburgh School of Medicine (UPMC) just announced a potential vaccine for COVID-19. The team of scientists there did extensive research on earlier pandemic viruses: MERS in 2014 and SARS back in 2003. Both of those were also coronaviruses similar in the molecular structure to COVID-19. Their new vaccine research was just published in The Lancet, a leading medical journal. What’s unique about this vaccine is the delivery mechanism, which uses a small patch the size of a fingertip—like a small bandage—that has 400 very tiny micro-needles that painlessly deliver the vaccine over time, teaching the body how to produce antibodies to fight COVID-19.
This ease of use will help speed up adoption tremendously if the vaccine makes it to market. But clinical trials to confirm that the vaccine does no harm, even to vulnerable patients, and then to show that it really does protect people against infection, will take many months. For now, staying at home is the only “vaccine” that we have.
Al Hammond was trained as a scientist (Stanford, Harvard) but became a distinguished science journalist, reporting for Science and many other magazines and on a daily radio program for CBS. He subsequently founded and served as editor-in-chief for four national science-related publications as well as editor-in-chief for the United Nation’s bi-annual environmental report. Dr. Hammond makes his home in Chestertown on Maryland’s Eastern Shore.