There Is Something In Between
Let me start with a serious disclaimer that the following article does not include any recommendation on what to do in the face of the COVID-19 outbreak, neither individually nor policy-wise.
As such, its sole purpose is to make an explanatory attempt to truly understand the effects of the now widely acknowledged coping strategies in qualitative terms (no numbers or percentages will be given), and from there, to forecast how the world will probably behave in practice within the next 12 months.
According to Imperial College COVID-19 Response Team’s report released on 16 March 2020, we can identify two extremal strategies to cope with the COVID-19 outbreak: (A) Mitigation with case isolation alone, or just Mitigation for simplicity, and (B) Suppression. In the present account, we don’t consider doing nothing even as an option as it is not possible for the obvious moral and practical reasons. These two strategies establish two extremes, in between which lies a spectrum of designed and actual operating points. Designed operating points are ordered as a function of added policy measures (or non-pharmaceutical interventions, NPIs) ranging from case isolation alone to enforced lock-down. This is illustrated in Figure 1, where each measure adds to the previous going from A to B.
These two extremes can be further characterized by their effects over time.
At the more “liberal” extreme A, much more cases (and consequently much more fatalities) would occur and peak in the short-term (in less than 3 months) and the public health systems would be extremely overwhelmed but there is a good chance that the population develops natural immunity against the disease (independent of a vaccine being introduced and made available to the general public, which is estimated to happen within the next 12 to 18 months).
At the stricter extreme B, it is hoped that the number of cases and fatalities would be controlled to a significant extent as compared to the extreme A and the public health systems would be much less overwhelmed, hence the outbreak will be contained in the short-term (in less than 3 months). But this comes at the expense of a significant delay for the general population to develop natural immunity (hence people will remain vulnerable to the disease for a long time until a vaccine is introduced). Furthermore, unless the extreme B is maintained in one way or the other for a time period longer than 3 months, there is a great chance that there will be a second, more serious wave by the end of the year. This last observation is summarized by the following statement in the Imperial College report:
Once interventions are relaxed (…), infections begin to rise, resulting in a predicted peak epidemic later in the year. The more successful a strategy is at temporary suppression, the larger the later epidemic is predicted to be in the absence of vaccination, due to lesser build-up of herd immunity.
Both of these options are tough to choose by design. Extreme A is cruel and still risky unless this was a game; extreme B, albeit somewhat comforting for the governments and “safe” for the general public, is not sustainable and widely applicable by all shades of the society. The romanticized “stay-at-home” movement can be embraced only by those who can financially afford living in the interiors for a long time and it can be somewhat tolerated at least for some time by those that are less well off, but it will soon become unbearable for the remaining majority of the people at large, independently of the geography in which they reside.
So what will happen?
In the face of a tough problem such as this one, however tough the problem is, the world and its people have this persistent habit of finding an operating point, a solution that defies all catastrophic scenarios and the associated numbers, an actual solution that lies somewhere in between the extremes. While it is hard to fully and unequivocally characterize such an actual solution by design and before the fact, below I am giving it a try.
As of today, solutions leaning towards extreme A are somewhat abandoned by the governments for one reason or the other, so the doomsday scenario of millions of deaths worldwide in the short term won’t happen.
Solutions leaning towards extreme B, which seem to be the strategy of choice as we speak, will soon become impossible to maintain and governments know that. Policy measures building up to extreme B will be relaxed progressively, not because the disease is contained as claimed but because of feasibility reasons. The honesty of governments on this matter will not be the same in every country. From May 2020 on, people will start to go out and businesses will start to pick up at a speed which cannot be predicted at this point. As a result, a sort of natural immunity will emerge not by design but by reality. The second peak expected by the end of the year probably won’t occur or if it occurs, not as seriously as predicted. Maybe a vaccine or an effective and affordable cure will be introduced and made available sooner than expected.
Unfortunately some people will die. We will understand how vulnerable we actually are. In one way or the other, we will adapt.
