How long will social distancing last?
Social distancing is here. Social distancing will save us. So what will it take to kiss this social distancing nightmare goodbye?
Let there be no mistake: social distancing is the right thing. It's an emergency response to an emergency situation. It's slamming the door on the face of a viral pandemic. The problem is that the virus lurks for a terribly long time. It's not going anywhere fast.
So when will the emergency be over? When can we open our doors? When can we go back to our offices, cafes, clubs? To socialise? To be free? When will we see the light on the horizon?
And how will we recognise it when it comes?
EARLY DAYS, FIRST HOPE
Before we can relax, we have a mountain to crush.
We must know for certain that new cases of COVID-19 have been slowed to a point where our hospitals are coping well. Then we must know for certain that we can monitor a relaxed population for signs of inevitable exponential viral flare-ups.
Australia's early measures taken to "flatten the curve" may be starting to have an effect.
This means our hospitals may be able to cope with the inevitable emergency cases as they relentlessly roll in. And that means fewer Australians will die.
It also means we'll be fighting on the COVID19 battlefront - our couches and home offices - for months to come.
This is needed to keep the numbers needing intensive care beds at sustainable levels, and - eventually - for them to fall.
"For most of March, the total number of cases doubled in Australia every three to four days. That rate has now slowed to doubling every six to seven days," a report released Wednesday from the Grattan Institute reads.
If Australia had continued to see its case rate double every three days, every intensive care unit (ICU) bed in the country would have been filled by mid April. From that point, new cases would have to be triaged.
"Doubling or even tripling the number of ICU beds would have delayed the crunch by a week," the report reads.
The slowed rate of growth pushes that critical date out to early May.
"At the current doubling rate, of six to seven days, that crunch would hit in early May.
But the doubling rate is falling and so that crunch time will probably be pushed out even further."
The take home message: with luck, we may be getting close to "flattening" the pandemic's exponential growth.
"Over the past week the growth pattern has slowed and shifted from the exponential doubling to a linear trend with the number of new cases in Australia increasing by about 350 per day. If this rate continues, Australia's current ICU capacity will be able to cope."
But there's always a 'but'.
"But it is still early days. And our current testing regimen may not be shedding as much light on community transmission as we need. With limited community testing, and a disease which is asymptomatic or mild for many, we don't know how far infections have spread into the community and so we don't know the actual number of new cases each day."
HOW WILL WE KNOW?
What are the signs normalcy can begin to return? In a word: immunity.
"It will largely depend on being able to say who is safe from contracting the coronavirus," says University of Queensland research fellow Larisa Labzin.
We don't yet know that those who have had the disease are immune from catching it again. Which, the molecular bioscientist says, is why we must not only test for who has the virus, but also for those who have had it.
"An antibody test - which would identify those whose immune systems have already encountered the virus, as opposed to current tests that reveal the presence of the virus itself - will be an important part of efforts to track the true extent of the outbreak," Labzin writes.
Antibody tests: to get a grip on #COVID , we need to know who's already had it. Patients only make antibodies to COVID-19 7 to 12 days after they first become ill. Not for acute infection. But will aid understanding community spread. #COVID19Aus https://t.co/9vomNPVxb3— MJA Editor in Chief (@MJA_Editor) April 1, 2020
It's a different testing process to what is currently being applied. But Australia has ordered 1.5 million antibody test kits.
We need to confirm immune systems can recognise - and fight off - COVID19 after recovering from the virus.
"These kinds of tests will help clinicians and scientists measure exactly how soon after infection we develop antibodies, what levels are needed to be protective and how long these antibodies stay in our body," Labzin writes.
"But there is still a long way to go before we can test people's blood for antibodies against SARS-CoV-2 and confidently say it is safe for people to go back to work or into the community without getting sick," Labzin warns.
#COVID & personal protective equipment. I am being contacted by worried health staff. I know all stops are being pulled out. We will be OK. Secretary NSW Health instructed staff will NOT undertake or be required to undertake tasks requiring PPE if no PPE available. #COVID19au— MJA Editor in Chief (@MJA_Editor) April 1, 2020
With a vaccine still at least 18 months away, the recurring message is the need to test, test, test … and to keep the number of active cases down to levels the health care system can handle.
It's called disease surveillance. And it must be rigorously - and uniformly - applied.
It needs ample test kits. Ample applicators. Ample data. Ample analysts. Widespread tracking.
And it needs a health care system - fully stocked with masks, goggles, gowns and ventilators - ready to respond to inevitable flare-ups. Not to mention staffed by healthy doctors and nurses.
One group of Australian biosecurity experts are worried the current dip in the numbers is a false dawn, a temporary dip brought about by the introduction of new travel bans between March 5 and 10.
"It is too early yet to see an impact of social distancing, and lapses like the Ruby Princess cruise ship incident, together with lack of testing for asymptomatic high-risk people, may allow transmission to continue in the community," they write.
Some experts are urging governments and the general public to dramatically ramp-up the fight.
"We are concerned about the possibility of Australia losing control of the epidemic," write the UNSW's Raina MacIntyre, Louisa Jorm and Timothy Churches with Flinders University's Richard Nunes-Vaz.
"We may well exceed health system capacity, increase the number of cases, experience health and economic losses, and a longer time to societal recovery."
Social distancing, they say, isn't enough.
"So far, Australia has not contained the epidemic as well as it could have … A silent epidemic may be growing, driven by mild or asymptomatic infections of people who did not meet our testing criteria."
We cant be complacent. This virus will be with us and not much immunity for at least 18 months. Winter will be our biggest test. What we have done re closing borders, clubs, bars, quarantining, 2 meter social distancing etc appears to work effectively and must be continued. https://t.co/Uc1OZXbvqG— Peter Collignon (@CollignonPeter) April 1, 2020
As a result, the team says Australia faces a drawn-out struggle under current policies.
"It will leave us dealing with COVID-19 for much longer, with a slow trickle of new infections that keep feeding the epidemic. What's needed is a short, sharp lockdown for two to three incubation periods (four to six weeks), combined with scaled up testing capacity and expanded testing criteria."
With nobody to jump to, the virus will largely die out. It will, instead, be confined to small family units - and spread by those who break the rules.
It's tough. It's social distancing on steroids. It's a "shelter-in-place" quarantine.
And it must be endured and enforced for six weeks.
But, they argue, the end-state after six weeks will be the same as that projected in six to eight months under the current social distancing campaign: A dramatically reduced presence of the virus in our community. One that can be quickly identified, tracked and contained by available resources.
"This strategy, similar to South Korea's approach, would reduce the size of the epidemic substantially, spare the health system and give us a more manageable baseline from which to best protect Australia until a vaccine is available," they write.
Everything we do now is about buying time.
There is no other way to fight COVID-19 until a vaccine arrives.
Which is why the difference between social distancing and lockdown is such an important point.
Both approaches buy time to prepare our health workers, acquire more vital equipment, set up more beds, and engage in broader testing.
"The slow trickle approach, especially if schools remain open, may result in continued epidemic growth, potential failure of the health system, and a far longer road to recovery," The Conversation article argues.
Even once the light of hope breaks over the epidemic curve, there will remain a long struggle ahead.
Those who have recovered from the virus, who therefore have immunity, can be allowed back to work. The remainder will need constant testing.
The question remains: will our health care system - and medical supplies - still be up to the task?
"We need greatly expanded testing including asymptomatic, high risk people (contacts, evacuees and people in enclosed outbreaks such as cruise ships, aged care facilities, prisons). And we must allow doctors to use their clinical judgement to order a test.
"Without such an improvement in the public health response capacity, the coronavirus epidemic will almost certainly bounce back when even the current lockdown restrictions are lifted."
And that's the problem. COVID-19 will bounce back. And back again.
What's needed is a plan to get our health system through each viral peak.
"A short, sharp, complete lockdown of four to six weeks will improve Australia's control of the epidemic, reduce case numbers more rapidly and bring us to a more manageable baseline," the biosecurity experts argue.
"From there, we can start to phase in lifting of restrictions safely. Economic recovery can begin."
Jamie Seidel is a freelance writer | @JamieSeidel
Originally published as How long will social distancing last?