The Covid Pandemic Is Not Over: The Past May Be Prologue

(Posted on Tuesday, March 16, 2021)

Public health officials have told us that we are in a race between Covid-19 vaccines and the virus. But in order for us to win, we need a much longer track. With a slight decline in new infections—likely the result of a combination of the vaccine rollout and seasonal population immunity— and the advent of spring, there is a natural desire to return to regular business and social life after a brutal and desperate winter. But our public health officials are telling us differently. Theirs is a united message, “This is no time to relax!”

What do the experts see that we miss?

We need only look at our recent past to remind ourselves of the danger that lurks in our midst, ever ready to emerge and cause havoc. Look, as I do, each morning at the number of new Covid cases diagnosed the day before. You will see three waves of the pandemic, each touching more lives and killing more. After each peak, we reach a new plateau, first 20,000 new cases a day, then at 35,000 per day, and now what looks like our new plateau, 55,000.

Each time we rise to a new plateau, we develop a numbness to the new numbers, seemingly comfortable with our new and deadly status quo. We relax, jet off for fun in the sun, or celebrate our holidays. The rates begin to climb steeply, reaching ever new heights—not surprising given the high starting point. Each time we are reassured by the words “herd immunity,” which always seems just beyond our grasp—beyond our grasp because, as I have argued before, the concept will never apply to Covid no matter how many are vaccinated or infected. If we are lucky, our vaccines will give us seasonal “herd” immunity, a temporary reprieve from a spate of new infections but a reprieve that will need to be renewed each year via vaccination and vigilance.

Last winter and spring, we saw our future in Italy. Let’s look to that unfortunate country again to see a glimpse of what may await us. This time last year, Italy experienced its first Covid wave, peaking at 6,200 new cases in one day. Based on population size, the US equivalent of that level of infection would be 34,000 new cases a day. Italy’s path was an important foreshadowing of our future. Less than three weeks after Italy hit its peak in the first wave, we hit ours with 33,473 new cases in a single day on April 10, 2020.

Through the spring and summer, infections dropped in Italy, not to zero but to around 300 new cases per day, an equivalent of around 1,640 cases in the US. But we were never able to get our numbers down that low. Instead, we averaged 20,000 during the same period. Come fall, Covid cases in Italy spiked again to a high of 40,000 cases per day, or the equivalent of around 215,0000 cases in the US. But because we had never managed to control our outbreak our second wave was much worse than it should have been—we reached a peak of more than 300,000 new case in early January.

That is what happens when we don’t control our pandemic.

In January, as we reached our peak, Italy went into partial lockdown. In January and February, daily cases plateaued around 12,000, which is equivalent to around what our current plateau is today at 55,000 daily cases. When Italy reached its plateau it started lifting restrictions. Did Italy’s numbers stay level? Not in the least. As I write, Italy is headed back into lockdown, with cases having peaked again at just over 26,000, an equivalent of roughly 146,000 cases per day in the US.

Italy is no anomaly. A third wave is sweeping across Europe, even among countries who had managed to control their outbreaks better than we did throughout the warmer months of 2020. Look at the new peaks these countries are reaching and what they say about the numbers we here in the US could reach – are we really ready for 463,000 new infections per day, which is the US equivalent of the spike in cases in the Czech Republic?

There is another path though. Consider Australia, a country which reached a peak of 715 cases in August (equivalent to 9,135 cases in the US) but brought those numbers down to near zero and kept it there, through constant vigilance and exhaustive testing, tracing and quarantine measures. Today, the country is inching ever closer to pre-pandemic life, with small weddings allowed, bigger sporting events, and even dancing in clubs.

Which will be our future?

If we want the parties and the dancing, Spring Break is not the time to do it. We need to hold the line, maintain our vigilance, and continue to drive down new infections. There will be time for a party, but that time is not now. First let’s take advantage of the warmer weather to reinforce mask wearing, social distancing and outdoor gatherings only to bring down new infections closer to zero—at least under a couple thousand. Then, and only then, can we start thinking about the plan needed to restart the party: widespread testing through rapid inexpensive home tests, comprehensive contact tracing, and assisted mandatory isolation where everyone known to be exposed to Covid-19 is monitored through quarantine and given support so they do not risk their jobs, their income, or their ability to look after the children in their care.

Past is prologue. If we don’t act now, expect a new peak, higher than our last.

This article was originally posted on Forbes on March 16, 2021.