Covid-19 is now a rapidly growing pandemic, sending countries around the world into states of emergency. It is unprecedented in our lifetimes, what one senior World Health Organization pandemics official called the “Wayne Gretzky of viruses.” The disease has taken over most of mainland Europe, caused major cities in the United States to go into historic lockdowns, and in a matter of weeks has affected every continent except Antarctica — with new countries being affected by the day.
Accordingly, we need to take measures that have never been done before. These preventative actions, such as social distancing, travel restrictions, and canceling mass gatherings, are likely to slow down transmission and reduce the immediate burden on our health care systems.
Estimates from a very early New York Times model for the United States suggest that aggressive social distancing, widespread testing, and other interventions could reduce Covid-19 infections from a possible peak of 9 million to just 513,000, and total deaths from 982,000 to 51,000 over the span of the next few months. By just staying home (if you can afford to) and avoiding non-essential social activities, hundreds of thousands of lives could be saved.
While we await the development of a vaccine, these measures are our best bet, and we know that they work from past experiences with pandemic flu. They help to reduce what’s known as the reproductive number (or the average number of cases that one infected case causes), and reduce the peak number of infections at any given time. This is the general idea behind “flattening the curve.” There is a threshold at which the demand on our health care system exceeds the supply, likely leading to many deaths. Social distancing allows us to reduce how much we cross that threshold.
The reactions to the national calls for social distancing have highlighted different extremes. There are people who have already been hiding out in their bunkers with month’s worth of toilet paper and hand sanitizer — and others who were drunk at packed bars for St. Patrick’s Day, as recently as this past weekend. Regardless of which camp you fall into, we will all be affected by the preventative actions our society collectively takes today.
And yet, the great irony of prevention is that if we do succeed, we may not even know that we did. People who today are being asked to go to great lengths to prevent spread — including missing work, canceling social events including weddings, and staying away from their older loved ones — are doing so at an obvious personal cost, and a less obvious future gain. The problem with prevention is that you don’t always get your name in the rafters; it is hard to appreciate something that did not end up happening.
While most people could tell you that Covid-19 is “bad,” I doubt most would be able to tell you just how bad it could end up being, at its worst. As a global health doctor who has worked in many low-income countries where the rationing of limited resources — essentially deciding who gets to live — is unfortunately common practice, I know what bad looks like. I can tell you that you don’t want to find out. If we do avoid that worst-case scenario, we may never truly appreciate the fact that we survived.
The same is true with our efforts at preventing the spread of Covid-19. It is likely that if all our coordinated efforts to effectively shut down large parts of our society and economy do end up working to curtail the pandemic, people may later turn around and accuse the public health response to Covid-19 as having been overblown.
I was asked by a medical colleague this past weekend to go out to a bar, despite all of the messaging on social media and by local leadership that has been screaming the opposite. Why such a disconnect? I believe that because we are still at least a few weeks away from the peak of the novel coronavirus outbreak in the United States, most people misperceive their own risk to be what it is in the current moment, rather than what it will inevitably be in a matter of time.
The issue is that if we wait to truly and strictly implement social distancing, it will be too late. The pandemic will already be a runaway train at that point, and there won’t be much we can do about it except watch our health care providers fight for their lives and the lives of those who we love.
We can’t let that happen.
We need to take social distancing very seriously, avoiding any unnecessary risks that would put us in close contact with groups of other people. Many friends have asked me about different specific scenarios. A few ground rules will be more helpful. Ask yourself: Am I going to be closer than six feet of someone else at any time? Am I going to be touching objects that are not regularly cleaned or that other people commonly touch? If the answer is yes, you should try to avoid it.
But social distancing is really better characterized as physical distancing — the social part of it just needs to become more virtual for the time being. Social solidarity has never been more needed.
We live in a country where our individual rights trump most other things. We need to exercise them wisely, ensuring that we protect ourselves and our society’s most vulnerable by staying home if we can afford to do so, and otherwise taking all necessary precautions if we do need to go out for essential tasks, like getting food or medications.
In the end, the problem with prevention isn’t prevention itself, but our collective failure to appreciate that we still have a chance to change an otherwise bleak future.
Abraar Karan MD, MPH, DTM&H is a physician at Brigham and Women’s Hospital and Harvard Medical School working on population-wide Covid-19 response work. Follow him on Twitter: @abraarkaran.