“It’s going to get worse before it gets better.”
No, it’s not reassuring. But that’s the message from epidemiologists, biostatisticians, and infectious disease doctors, who have been sounding the alarm for weeks about the growing threat of the novel coronavirus and the dire consequences the United States will undoubtedly face if the spread of the disease, Covid-19, is not aggressively tamed.
“This virus will not be conquered until we have a vaccine — period. It’s just so unstoppable," said Dr. Eric Feigl-Ding, an epidemiologist and senior fellow at the Federation of American Scientists, a nonpartisan think tank based in Washington, D.C. “We’re in this tough spot for the long haul."
According to a March 10-11 unpublished survey of 21 of the world’s top infectious disease modelers and researchers by University of Massachusetts Amherst biostatistician Thomas McAndrew, experts predict the outbreak in the United States will continue to escalate over the next several weeks, with the number of hospitalizations for Covid-19 peaking nationwide in May.
They believe that just 13 percent of all coronavirus cases were reported to the Centers for Disease Control and Prevention as of March 9 and that the number of confirmed infections in the United States will have increased four-fold by Monday. Eighty percent of the experts polled also believe community-level spread has already occurred or will happen within the next 10 weeks.
The paucity of widespread diagnostic testing for the virus across the nation has hampered experts’ ability to assess the true scope of the outbreak or forecast its spread with any certainty. As of Monday, the number of Covid-19 cases surpassed 4,100, as cities and states across the country instituted new measures, including school closures and bans on public gatherings, to minimize interaction among residents, a practice known as “social distancing.”
"Right now, for the most part, we’re catching the tail end — the backlog of cases — because we had such a freeze on testing over the last two months,” said Feigl-Ding, who was not one of the epidemiologists surveyed, but agrees with the experts’ consensus. “Once we ramp up enough where we have the capacity to test everyone in the population, then we’re going to have an accurate picture of the new cases that emerge.”
Although dozens of pharmaceutical companies and academic institutions are racing to develop a vaccine for the new virus, it will take a year — at least — before it’s ready for public use. So how long should Americans expect to live like this — separated from friends, coworkers and classmates, away from churches, movie theaters and shopping malls?
“Unfortunately, the answer is not one most people want to hear: We don’t know,” said Bill Hanage, an associate professor of epidemiology at Harvard’s Center for Communicable Disease Dynamics. “We’re not trying to come up with long-term plans to stop the pandemic. What we are doing now is trying to stop it from destroying us."
The answer also depends “on how we respond over the next few days,” said Samuel Scarpino, an assistant professor at Northeastern University’s Network Science Institute, and "if we increase the amount of social distancing, remote work, school closures, etcetera,” or blithely ignore the advice of public health officials by going to crowded bars and restaurants, as many in Boston and beyond have done over the St. Patrick’s Day weekend.
Governor Charlie Baker on Sunday banned gatherings of more that 25 people in Massachusetts, shut all schools for three weeks, and limited restaurants to take-out and delivery. But not every state has instituted such sweeping measures on schools and gatherings.
“The goal in social distancing efforts is to ‘flatten the curve’ — slow the spread of the virus, decreasing the peak of the epidemic and hopefully thereby limiting the chance of overwhelming the health care system,” said Dr. Yonatan Grad, an assistant professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, in an e-mail to the Globe. “But by slowing the spread of the virus, we extend the amount of time it circulates."
Experts say it’s unlikely the warm summer months will offer any respite from the virus, as preliminary evidence from China shows that the rate of infection initially accelerated at the same pace in both the country’s dry northern and humid southern regions, Hanage said.
“After that, it’s difficult to draw any conclusions due to the interventions the Chinese government put in place," Hanage said. While other seasonal viruses, such as the flu, subside during the spring and summer, when humidity levels are higher, “it doesn’t look like it happens to the same degree [with the new coronavirus]," Hanage continued, and unlike the flu, “there is no immunity."
“The challenge right now is we don’t really have anything to combat the disease,” said Natalie Dean, an assistant professor of biostatistics at the University of Florida’s Emerging Pathogens Institute. "Certainly, if we can find a highly effective therapeutic — something that reduces mortality or something that reduces the severity of illness — that would be very valuable. And that might give us some reassurance in relaxing some of these strategies.”
For now, “we’re buying ourselves time for a vaccine to be evaluated, manufactured, and deployed,” Dean added. “It is possible that this will be a new way of life for a stretch that’s longer than any of us would like.”