This crisis is not close to over, quite the reverse. The pandemic is only just getting started.
By Dr. William Hanage
The Guardian (4/16/20)
There has not been a lot of good news lately. But with the discharge of Boris Johnson from hospital on Sunday, and statements that the “peak” strain on the National Health Service would be over the Easter period, you might be under the impression that the storm is passing, and the Covid-19 pandemic will soon be a memory.
Fueling this mood are reports from studies of communities already hit by the pandemic. At long last we are beginning to see the results of work looking for signs that people have already been infected, through the presence of antibodies against Sars-CoV-2, the virus which causes Covid-19. Some of this data suggests strongly that many infections may have passed unnoticed, with the only symptoms being mild things such as loss of the ability to smell and taste, and that as a result, more people may be immune than had been thought. Surely this is a sign that communities around the world can breathe a sigh of relief and start getting back to work?
Unfortunately, it is nothing of the kind.
A mountain range, not a peak
Talk of the “peak” can be misleading, because it’s not clear whether you are talking about the Matterhorn or Table Mountain – both have a summit, but the peak is far more pronounced in one than the other. In countries such as Italy (unlike Wuhan) the initial surge in the Covid-19 pandemic has not evaporated quickly. There are multiple reasons for this but the most important is that the impact of physical distancing achieved in China has been hard to accomplish elsewhere, mostly because of the freedoms we correctly value in liberal democracies.
Worse, there may be a mountain range. In other words, what is happening right now could be just one peak – not the peak. And the reason for this is that despite all those positive signs from antibody testing, the huge majority of the population is not immune.
An editorial in the British Medical Journal has reported data from China suggesting that as many as four in five cases of Sars-CoV-2 infection could be asymptomatic. It then goes on to quote people from the Centre for Evidence-Based Medicine in Oxford, who say that if this is true “What the hell are we locking down for?” I wish those people would be brave enough to go and repeat that opinion in an ER in the Bronx right now, in which actual medicine is going on. Worrying about the exact rate of asymptomatic infection, or the currently unknown duration of immunity and a possible “second wave”, is like politely applauding the performance in a jazz club and murmuring “nice” while the building is demolished around you and the piano player gets decapitated. …
(Dr William Hanage is a professor of the evolution and epidemiology of infectious disease at Harvard University.)
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