Recent spikes in COVID-19 cases in the south and west have primarily involved people in their 20’s and 30’s. The governors of those states have stated that such spikes are of less concern because they are predominantly among young people. Younger people have a much lower risk of hospitalization and death than people over 65 or those with underlying conditions. Although hospitalizations have risen in most of these states, hospital capacity has not been exceeded. Governors and health departments have admonished young people to be more careful about mask wearing and social distancing, but see no reason to not continue relaxing restrictions. Not to worry, right?
I don’t think so. It is very likely that this pattern of infection among younger people went on for weeks in places like New York City and New Jersey. We did not detect this pattern there because the shortage of tests at the beginning of the pandemic meant that we were only able to test people sick enough to be hospitalized.
There is no way to know for sure if this pattern among younger people preceded the terrible illness and death rate in New York City and New Jersey, but what we now know about how SARS-COV-2 spreads makes this very likely. Antibody testing in New York City suggested that as much as 20% of the population had been infected with SARS-COV-2.
It is clear that community spread was happening silently for weeks or months before people started coming to emergency departments in the northeast. We now know that from 30% to 50% of people who have COVID-19 have no symptoms, but can spread the virus to others.
As the people with no or mild symptoms interacted with the more vulnerable populations, hospitalizations, ICU admissions and deaths went through the roof. New York City hospitals just barely managed to avoid the situation that is now happening in India, where the health system and hospitals are completely overwhelmed and turning sick people away because there are no ICU beds or ventilators.
Could this happen in states like Florida, Texas, Arkansas, Mississippi and California? Unfortunately, I think the answer is yes. All of these states have large vulnerable populations. Many of these live in rural areas with small hospitals that would be overwhelmed by only a few very sick COVID-19 patients.
There are two things that might mitigate or prevent this impending disaster. It is probably too late to do one of them, but the other is still possible.
- Contact tracing for cases with isolation of cases and contacts. This is doable if the number of new cases is reasonably small. The maximum number of new cases where this will be feasible is 1-500 per month. In places like Florida, Arizona and Texas where new cases are exceeding 1000 per day, this approach will not be feasible.
- Universal mask wearing in public and maintaining at least 6 feet social distancing. We know this works to limit community transmission. Unfortunately, there is growing resistance to these measures.
People are emotionally and economically traumatized by the initial draconian measures that were necessary to get virus community transmission down to a manageable level. They just want to forget about the virus and get back to normal life.
Unfortunately, SARS-COV-2 has gone nowhere. It is still among us and will reproduce itself in any human host where it gains access through mouth, nose or eyes.
People who are upset and angry about not being able to return to normal life should listen to an old Rolling Stones song. The lyrics go “You can’t always get what you want. You can’t always get what you want. But if you try, sometimes you get what you need.”
What we need is to learn to live with mask wearing and social distancing for a long time to come. We also have to learn to live without sports, concerts or any other venue that requires large gatherings of people indoors. Outdoor gatherings may be possible, but only with mask wearing and social distancing.
We may have an effective vaccine that will provide long enough immunity that we can return to Pre-COVID life. There is no guarantee of that and if it does happen it is very likely to be next summer or later.
That’s all the good news I have for today! Hopefully my next post can be more upbeat. It would be especially wonderful if my predictions are wrong.