The most honest, direct answer from experts is ‘we really don’t know’

After announcing an “initial 15-day period” of social distancing on March 16, President Donald Trump told the nation on Monday that he’s “extending our guidelines to April 30 to slow the spread” of the coronavirus that causes Covid-19. The extension is exactly what many infectious disease experts expected or advocated for.

In op-eds and interviews, experts such as Aaron Carroll, MD, a professor of pediatrics at Indiana University, and Marc Lipsitch, DPhil, director of Harvard University’s Center for Communicable Disease Dynamics, have warned that lifting restrictions too early could undo any progress made in trying to slow the disease. Former FDA commissioner Scott Gottlieb has suggested it might be late summer before the nation can start “coming back to some element of our normal lives.”

But there’s still confusion over what people can and can’t do during this 30-day extension — and after it ends. When Trump announced the initial 15-day period, his advice wasn’t overly specific: “We’re asking everyone to work at home, if possible, postpone unnecessary travel, and limit social gatherings to no more than 10 people.” He also sounded hopeful that the slowdown wouldn’t last long. “We’ll see what happens after that,” he said on March 16. “If we do this right, our country — and the world, frankly — but our country can be rolling again pretty quickly.”

It’s clear now the world won’t get rolling again pretty quickly — projections about the viruses’ peak vary by state and extend to mid-May. There are signs that social distancing is helping some areas slow the spread. But it’s less clear what day-to-day life will be like for a while. Elemental spoke with two infectious disease experts to get a better sense of this next phase of bunkering down and social distancing.

Until you can be sure you’ve had no symptoms 14 days from any interactions with the last person who might have been sick … you can’t be sure you aren’t part of an infection chain.

Why was the initial period 15 days, and why is the new one 30 days?

The length of effective social distancing periods depends on the coronavirus’s incubation period — how much time elapses between when a person gets infected and when their symptoms show up, explains Dawn Nolt, MD, MPH, an associate professor of pediatric infectious diseases at Oregon Health & Science University’s Doernbecher Children’s Hospital.

The average incubation period of Covid-19 is five days, but it can be up to 14 days — or possibly longer, she says.

“The time of physical distancing needs to be over multiple incubations of the virus,” Nolt says. If you encounter someone who’s infectious, it could take up to 14 days before you show symptoms and know whether you have Covid-19, she explained. If you don’t show symptoms, then that potential “chain of infection” from that person is broken.

But what if you encountered another infectious person halfway through the first 14 days you were waiting out? The clock has to start over. Until you can be sure you’ve had no symptoms 14 days from any interactions with the last person who might have been sick — even if they didn’t know it yet — you can’t be sure you aren’t part of an infection chain. “One person may encounter multiple infected persons during a period of time, and so multiple chains need to be broken,” Nolt says. And while it’s fairly unlikely you’ll become infected while running errands (assuming you keep your six-foot distance and are being careful), every time you leave the house, you do risk exposure. Which means the clock starts over basically every time.

The original 15-day directive was overly optimistic, Nolt says, but it’s not clear 30 days will be enough either.

“In previous pandemics, the shortest amount of time that a large population needed to maintain physical distancing was six to eight weeks, but in other populations during the same pandemic, it took months of physical distancing to flatten the curve,” Nolt says. “Once the curve seems to flatten, then small measures of physical distancing may be relaxed,” such as returning to school, returning to work, going to grocery stores regularly, and similar activities.

But stopping too early will land us right back where we started.

“If the physical distancing is relaxed too quickly because there were, in fact, still existing chains of infection, the population may see a rebound in cases,” Nolt says.

So how long is this really going to last?

The most honest, direct answer from experts is “we really don’t know.” That’s obviously not very satisfying, but it’s hard to determine because there are so many factors involved. Some experts suggest that life can “return to normal” only when 60%–80% of the population is resistant to Covid-19, either because they’ve had it and developed immunity or because of a vaccine.

But that could take years. In the meantime, the strictest measures are needed to flatten the curve so that hospitals can manage cases without — ideally — being as overwhelmed as the ones in major cities are right now.

“The time it takes for the number of new cases to decrease will depend on several factors: on how densely packed the population is, whether there are vulnerable people who may pick up the infection more quickly, how many measures are taken (only school closures versus locking down a state), and when in the outbreak these measures were taken — if the outbreak is already established, it may take more measures and a longer time to control,” Nolt says. “The earlier and more drastic the measures, the quicker the outbreak is controlled.”

But it also depends on how well everyone follows the rules of social distancing, explains Tara C. Smith, PhD, a professor of epidemiology at Kent State University. Several stories have already revealed the danger of throwing caution to the wind, such as the 28 students at the University of Texas at Austin who spent on spring break in Mexico and tested positive for Covid-19 after they returned. It really will take a nationwide effort from everyone.

“The more people that do this very strictly, the fewer cases we will have and the more quickly we could potentially relax these measures,” Smith says.

What can I do? Just groceries and absolutely essential errands that can’t be put off?

Basically, do as little as you can in public or around other people.

“Persons with mild infections may still be able to get on with their lives, but cough and sneeze and thus may contaminate the six-foot area around them,” Nolt says. They may not realize they’re sick yet and could end up contaminating multiple areas.

“To reduce your contact with ill persons and avoid zones of possible contamination, you should minimize your time in public areas,” Nolt said. “Physical distancing gives some reassurance that that unexpected sneeze or cough won’t land on you.”

So yes, that means doing just the essentials. You need food, so shop for food, or order takeout (yes, it’s safe). Pick up drugs at the pharmacy — the drive-through if you can — and try to get as many things at once to minimize multiple trips. Only schedule and go to medical appointments that your health care provider tells you are necessary.

“If everyone did that, it would slow the spread more rapidly and potentially mean we have to do social distancing for a shorter period of time,” Smith says. Places that do social distancing well will eventually start to see cases flattening out, though increased testing may not make it look that way at first, she says.

“The issue with smaller towns and rural areas is that we lack testing almost completely, so while people in NYC know the virus is there, many of us don’t.”

I’m going out of my head! Can I get together with one other family for games or dinner or to share childcare?

It’s hard to tell people to avoid absolutely everyone outside your household, even though that’s the safest advice. If there’s another family you want to share childcare with, and you can be absolutely sure they are taking the same precautions you are in limiting shopping to the necessities and avoiding the public, it’s an individual risk calculation you have to make. But the stricter you can be, the safer you and your family — and their family — will be, experts say.

“You don’t really know how well those others have adhered to strict social distancing, and they could be incubating the infection without realizing it,” Smith says. “The best practices are to stick with stricter social distancing methods as much as possible.”

If I live in a small town with a small population, can I relax a bit more than people in New York City or Seattle?

Unfortunately, no. Covid-19 is now in every single state, but testing scarcity has prevented us from knowing just how many cases there are and where they are.

“Even if it’s more sparsely populated, anyone could be exposed to this out in public. It only takes one person,” Smith said. “In large cities with known outbreaks like NYC and Seattle, obviously I would be even more strict, but the issue with smaller towns and rural areas is that we lack testing almost completely, so while people in NYC know the virus is there, many of us don’t. I think some have a false sense of security because of this.”

An example of how deadly that false security can be is what happened to a state choir in Skagit County, Washington. When they held their choir practice on March 10, the Skagit Valley Chorale board of directors had not heard of any cases in their area. But despite the lack of reported cases and the 56 attendees taking care to maintain social distancing in a large room and using hand sanitizer, nearly four dozen of the singers became ill with Covid-19, and two have died.

How do I wrap my head around all this?

It’s okay to feel off-balance and frightened right now.

“Our society has gone through rough patches like this before, but that doesn’t mean every individual pulled through,” Smith said. “Many are genuinely scared because they or those they love are in a risk group, and the fear and stress they are experiencing are understandable.”

But it’s heartening to see reports of compassion, generosity, and kindness right now and to experience loved ones and strangers alike being a bit more thoughtful about everyday activities and interactions, such as giving an extra nod and smile to a fellow shopper in the grocery store.

“I hope we use this to come together, to check on our friends and neighbors, even if it’s a call or text rather than in person, to give generously when you can, be it financial or just with praise, thanks or time donated to a cause,” Smith said. “I think we all just need to dig deep and find patience and kindness as much as we’re able and understanding for those who are having a really tough time now.”


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