The new coronavirus has brought our society to the minimum possible. He's shut down businesses, he's canceling big meetings, and he's keeping us all at home. Everyone is asking the same thing: when will there be a return to normal?
The answer is very simple: when a sufficient part of the population (between 60 and 80% of people) will be immunized against COVID-19 and / or able to curb the spread of the disease from person to person. This is the ultimate goal, although nobody knows exactly how long it will take to get there. The scenarios for exiting this coronavirus nightmare, on the other hand, are different.
The long road and the short road
Esistono due percorsi realistici e brutali per raggiungere la famosa “immunità di gregge”. Uno è lo sviluppo di un vaccino. L’altro è che la malattia si faccia strada, uccidendo sicuramente molti, ma lasciando anche molti altri immuni. Questa è la tesi “inglese” (cambiata poi in buona parte). Not yet knowing whether recovery from the disease confers immunity, not to mention permanent immunity, I wouldn't consider it a first choice.
Unfortunately, both of these coronavirus scenarios may be a year or two long, but in the meantime, degrees of normalcy will likely be regained. Absolutely not at Easter, as Renzi would like or Trump. But this summer, for example, we could find restaurants open but no concerts, open offices but no crowded beaches, bars with spaces spaced between the seats.
Imagining patterns of returning to everyday life would be easier if the authorities had a complete view of who is infected, cured, immune or susceptible. Information that would emerge from widespread tests, which the world is very slow to deploy.
For this the strategy adopted is that of self-isolation. It can slow the spread of the virus, saving as much as possible catastrophic overload of patients in hospitals across the country. This unfortunately entails the cost of freezing daily life.
Epidemiologists have pointed out that they have no idea when life will be "thawed", but here and there a number of possible scenarios are shown on how we could resume some activities after (or even during) the coronavirus. Below are a few breakthrough points to keep an eye on in the coming weeks, months and years.
Scenarios from 1 to 2 months
Devo notare che gli esperti pensano che questa tempistica sia altamente improbabile. Ma molte misure di distanziamento sociale potrebbero terminare in un mese o due se il coronavirus si rivelasse “improvvisamente un patogeno meno serio”. È quanto ad esempio ha affermato William Hanage, professore di epidemiologia presso la Harvard T. H. Chan School of Public Health. “Gli infetti di secondo e terzo grado potrebbero manifestare una malattia molto lieve e sviluppare rapidamente una immunità.” Questa circostanza ipotetica sarebbe certamente fantastica. Ma produrrebbe anche “un sacco di grattacapi” tra gli esperti di sanità pubblica, per la difficoltà estrema di individuare con precisione questa presunta immunità per zone, età, tipologia di soggetti.
Another path to a short-term resolution is much simpler: less social distancing would produce what Andrew Noymer, a professor of public health at the University of California, defines a "big, short, acute shock". In other words: many infections in the coming months, health system overwhelmed and death of many people. After such a catastrophe many people are assumed to immunize themselves.
Both these events would do well to stay in the drawer for at least two more months, for better or for worse. By then, public health experts will have learned more about the virus by then. In a month or two, the authorities and public health researchers will probably also have a clearer idea of the immunity acquired by the healed, and if so, for how long. This information will be useful for containment efforts.
Scenarios from 3 to 4 months
This scenario can occur in the hypothesis in which the capillary development (and the use) of rapid or very rapid tests makes us discover that we already have a substantial mass immunity to this virus.
In this sense, the development of two types of tests is important: one that detects the presence of the virus itself and one that detects the antibodies that people develop when they are immune to it.
With this new information, Hanage said, it would be possible to isolate contagious or more vulnerable people, while much of the population returns to something reminiscent of normal life.
"There would be fewer tables in a restaurant, or fewer people in a bar"he said. In the meantime, if some places have a much higher incidence of disease than others, people in those regions or cities may leave home earlier or during different periods than people in other parts of the country.
Michael Stoto, professor of administration of health systems and population health at Georgetown University, defines three variables that determine the spread of a disease:
- How many infected people or contacts on contaminated surfaces on average meet in one day;
- How many possibilities of virus transmission are there in these situations;
If more targeted tests started to provide a more complete picture of the spread of the virus, health authorities could choose to focus on one variable more than another.
Ad esempio, se i dati dei test indicassero che serve ridurre il numero di incontri delle persone, forse i ristoranti e le piccole imprese riaprirebbero, ma eventi grandi e affollati verrebbero cancellati. Insomma, una “normalità” ad assetto variabile.
In three or four months, researchers may have identified a treatment for COVID-19. Maybe not a cure, but something that could relieve symptoms quickly and reliably, avoiding death. This would not eliminate the continuing need for social distancing, as large-scale outbreaks would still be possible, but it could reduce the risk of overburdening the country's hospitals if an outbreak occurs.
For Hanage, this timeline is more likely than shorter coronavirus scenarios.
Scenarios from 4 to 12 months
A big unresolved question about COVID-19 is whether, like the flu, its spread will slow down substantially over the summer.
Researchers have some theories as to why summer is a flu season: higher temperatures and increased UV radiation are lethal to some viruses. Schools are closed and the crucial fertile ground is being removed from the virus. But it is not yet known whether one of these theories can be applied to coronavirus.
Qui gli scenari possibili diventano due: in uno, il coronavirus si ritira in estate. Nell’altro no. In entrambi, almeno alcune delle misure di allontanamento sociale attualmente in atto continueranno anche nella seconda metà dell’anno.
In the first case, the virus recedes in the summer. L’estate sarebbe un po’ più divertente rispetto alla primavera, almeno nell’emisfero settentrionale. Probabilmente sarebbero ammesse attività all’aperto in piccoli gruppi. Forse riaprirebbero bar e ristoranti. Ma probabilmente ci sarebbe un freno a grandi incontri. Niente stadi, niente concerti, niente spiagge, ancora niente cinema (se non magari all’aperto e con distanze giuste).
The championships could resume in the summer but without an audience, TV programs would continue to give up the studio audience. In the meantime, stores may continue to limit the number of authorized buyers. Forget the big crowds for a while, but on a small scale there would be fewer limits and life would certainly return to more acceptable levels.
Potrebbe anche essere (relativamente) sicuro spostarsi per vedere i propri cari. Se la probabilità di essere infettati si riduce e si diffonde ovunque, sotto casa come altrove, le restrizioni di viaggio avrebbero poco senso. Sicuramente però stazioni ed aeroporti avrebbero accessi contingentati.
L’aspetto negativo di questa estate più vicina a quella “normale” è che ci sarebbe una forte possibilità (anche se comunque non una certezza) di una ripresa della malattia enteo sei mesi. Questa “ricaduta” di infezioni potrebbe tornare a partire da ottobre, reintroducendo la necessità del distanziamento sociale.
This social distancing could be equal to the current one, or slightly lightened: at that point, many people could have developed a possible immunity and theoretically they could go out without risking the infection. And we would know even more about the virus. If for the autumn we had full certainty that children have strong resistance to getting infected, but above all to spreading it, schools could even reopen.
Within three to four monthscountries will still be in a better position to absorb another wave of infections. Summer would be a good time to produce more respirators, increase the ICU seats. The store of protective equipment that healthcare workers wear to prevent infection would increase.
If we used the summer break to strengthen our response in the fall, in short, with the right reinforcement, social distancing could be further reduced.
And we come to the second of the "sub-scenarios": the one in which the coronavirus does not retire even in summer. L’attuale picco si ridurrebbe per le misure di isolamento adottate ora, ma il rischio di una ripresa rimarrebbe elevato nei mesi più caldi. Se il numero di casi non diminuisse in modo significativo entro l’inizio di metà giugno, ha detto Noymer, sapremmo che il virus non è stagionale.
At that point, social distancing measures could be changed according to the situation. With the ever-present possibility of more waves of infections, quarantine could continue just as it does now. If the hospitals were better equipped, however, the social distancing could be reduced. There may be more work outside the home and a slight increase in sociability, but it would still be a world with rigorous hand washes, choked sneezing, and generous amounts of hand sanitizer. In all likelihood, people who can work remotely or order food via delivery would still do so instead of leaving the house.
Scenarios from 12 to 18 months (and beyond)
Spring 2021 is the time everyone is waiting to see a vaccine. "Any faster timing would be world record, it would be speed of light", dice Noymer. Se si tratta di un progetto approssimativo da perfezionare richiederà ancora più tempo, probabilmente altri sei mesi o un anno dopo la prossima primavera.
The vaccines, as I wrote here, they take so long because they are difficult to perfect. A series of methodical tests are conducted to ensure that they do not harm healthy people, that they generate the desired antibodies and that those antibodies actually defend against the disease. They are not excessive bureaucratic safeguards: if you have to inject something (or put in the mouth) hundreds of millions, probably billions, of people, you need to study it well.
And if it works, normal life will resume, but not immediately. The logistics of vaccinating millions of people is no small feat. And even assuming that not everything comes in one large batch, a sort of system will be needed to determine who gets the first few doses. The most vulnerable people to the disease? Health workers?
In examining all the scenarios of the coronavirus, then, do not want to, it is also possible that no one is able to develop a safe and effective vaccine. It would be a disappointment, but even in this case at 12-18 months we would be well on our way to immunity at the population level, certainly reaching it by the autumn of 2021. And until then we probably would not have been locked up for more than a year. Even in a world without vaccines, achieving immunity at the population level means that future outbreaks of COVID-19 would be much less harmful than the current one. The virus could remain threatening and continue to circulate, infecting people like and more than colds or the flu do.