COVID-19 cases may again be on the rise as a second wave of infections coincide with the reopening of many businesses throughout the United States.
Perhaps the first thing I should mention is that a second wave is going to occur as society reopened. I repeat: Regardless of the timing or the measures taken, at one point or another there is going to be a second spike in cases. This is to be expected; It’s what many pandemics do. Health officials and political policies can do little to stop it.
If we look at previous infectious disease outbreaks, like the Spanish Flu of a century ago, it’s clear that there were, not two, but three waves in Spring and Fall of 1918 and winter of 1918-19. Each wave claimed its share of victims.
Most health officials have long stated that more cases are expected. Social distancing, face coverings, and other important measures to prevent spread of infection may be breaking down. In some cases, it’s because of what I call “COVID fatigue”. People are weary of staying home, donning personal protection equipment, and avoiding the restaurants, movie theaters, malls, and other staples of normal American society. The New Normal compares poorly to the “good old days”.
Even for those who have adjusted to pandemic prevention guidelines, current headlines have sparked nationwide mass protests which are spilling over internationally. As you can imagine, large demonstrations don’t follow the rules of social distancing and hamper efforts to stop the spread of infection.
Public policy may also play a part. Reopening too quickly due to COVID fatigue-fueled anger may cause large numbers of new cases, while staying in semi-permanent lockdown must eventually throw the nation into a major economic depression. The balance is so delicate that a perfect solution is almost impossible to achieve. Either option is fraught with risk.
All of the above factors make it more likely that a second wave will be significant, but how significant? Will we see just a ripple in the pond or a massive tidal wave?
One expert, Dr. Lawrence Kleinman of Rutgers University, says: “I think people mistake the idea of society reopening with the idea that society is safer, but things are no safer today than they were weeks ago when we were in full lockdown,” said Dr. Lawrence Kleinman, MD MPH of Rutgers University. He goes on to say that the recipe for personal safety doesn’t change even as society opens up.
Others aren’t as pessimistic. Columbia University virologist Dr. Vincent Racaniello said, “I’m hoping we can continue our lives without having to go back into quarantine in the fall, because we’ve learned that distancing and face masks can really make a difference.”
Indeed, we have learned much about SARS-CoV2, the virus behind the COVID-19 pandemic. Besides social distancing, we have come to realize the importance of mass testing, and keeping close track of contacts. With a contagious disease, we have to know who is capable of spreading it. With workplaces beginning to reopen, this information becomes essential.
We have also realized the importance of having personal protection items in our medical kits. Surgical and N95 masks are considered to be for medical workers only, leaving the average citizens with a limited array of less-effective cloth coverings. These were endorsed by health officials, but only because of the lack of standard supplies.
Yet, many folks ended up becoming “medical workers” when someone in the family came down with a mild to moderate case of COVID-19. You can bet that there will be more face masks to go around in future outbreaks; many of these will be made in the U.S.A.
Despite knowing more about the SARS-CoV2 virus, there are still many unknowns out there: As Fall approaches, opening schools and colleges will provide another avenue for the second wave of COVID-19. The risk to children may not be severe: only about 20 U.S. deaths have occurred so far in those 14 and under, and 120 in those 15-24 years of age. Still, these children and young adults may infect their older relatives if they aren’t careful about hand and respiratory hygiene.
What will happen when sports events and concerts attract large crowds again? Can a nationwide opening of a popular movie cause a spike in cases? What if the virus mutates to become more contagious?
The hope is that a combination of continued social distancing, face coverings, and continued research into treatments will prevent a major second wave. I consider this unrealistic, at least in the short term. What, then, can we do to prevent a total shutdown and long-term economic ruin?
As the disease seems to be worse in those 65 and older who have underlying health conditions, perhaps restrictions designed by age could reopen most of society and save the economy. Those over 65 comprise perhaps 12% of the workforce but the grand majority of severe cases and deaths. Those 15-54 years old easily comprise 80% of the workforce, but only a total of less than 7,000 out of 115,000 U.S. deaths (and more than 2,000,000 confirmed cases). Why can’t those 54 and younger rejoin the workforce?
Admittedly, this policy would be a textbook form of “ageism”. Indeed, I would be a victim of it myself, but placing restrictions on certain groups for public health reasons is nothing new. Travelers returning from other countries are required to self-quarantine, as are contacts of COVID-19 patients. The CDC specifically singles out the elderly and those with underlying health problems for special concern even now.
Of course, I know it’s more complicated than just telling those 54 and younger to get back to work. What about workers 55-64 years old? How about school cafeterias? Even if allowed to return to work, younger folk would still need to be especially careful around elderly clients and family (but at least the entire nation wouldn’t collapse economically). I don’t have all the answers, and, at this age, I’m losing more brain cells every day.
These are questions for someone higher than my pay grade. That’s why they get the big bucks. Still, with the second-wave on the way, age-related guidelines are something to consider.
Joe Alton MD
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