How does the coronavirus outbreak end?
Governments’ failure to contain the coronavirus means it may be here to stay.
By
Brian Resnick@B_resnick[email protected] Mar 6, 2020, 11:40am EST
Students hold a memorial for Dr. Li Wenliang, who was a whistleblower for the coronavirus, outside the UCLA campus in Westwood, California, on February 15, 2020. Mark Ralston/AFP via Getty Images
Part of The Vox guide to Covid-19 coronavirus
In late January,
I posed a simple question to several experts in public health and epidemiology: How does the Covid-19 coronavirus outbreak end? Back then, the virus was still mainly just spreading in China, and the scientists we spoke with outlined a
hopeful scenario: containment.
The idea is that through identifying and isolating the sick, the virus could be kept from spreading in communities around the globe. It seemed reasonable: Containment was how the 2003 SARS outbreak — also caused by a member of the coronavirus family — ended.
Now, many experts tell Vox, that scenario seems impossible. “Two or three weeks ago, we were still hoping for containment,” says Tara Smith, an epidemiologist at Kent State University. “We’re really past that. ... The horse is out of the barn.”
One reason has to do with what we’ve learned about the virus itself: There’s now evidence that people who do not show severe symptoms can spread it silently. Another reason is the slow rollout of diagnostic tests in the United States and other countries like Italy and Iran: We don’t have a precise case count or know where the virus might be spreading.
Washington Gov. Jay Inslee and Director of Public Health for Seattle and King County Patty Hayes address public health employees in response to the coronavirus in Seattle, Washington, on January 29, 2020. Jason Redmond/AFP via Getty Images
Currently, the World Health Organization reports
there are more than 100,000 confirmed cases of Covid-19 across the globe, and more than 3,400 deaths. There could be many more undetected and unconfirmed both here and abroad.
Given this new, uncertain phase, I decided to go back to some of the same virologists, immunologists, and epidemiologists (and a few new ones) with my question: How does this outbreak end?
The most uncomfortable answer they gave is the possibility that Covid-19 keeps spreading at a high rate and becomes endemic — regularly infecting humans, like the common cold.
“Without an effective vaccine, I don’t know how this ends before millions of infections,” Nathan Grubaugh, an epidemiologist at the Yale School of Public Health, says.
To be sure, much is uncertain about the virus and how it will spread. There’s still no single,
accurate death rate for the illness. Little is known about the
susceptibility of children. So much can still change. But we asked these experts to weigh in with the best available evidence in mind.
Just because the virus isn’t being contained doesn’t mean we’re powerless to prevent serious illness and deaths among the most vulnerable. There’s still a lot communities can do to slow the spread, save lives, and buy crucial time for either a cure or a vaccine to be developed. There are many forking paths on the way from outbreak to endemic. Lives can still be saved, and the worst-case scenario can still be avoided.
Why scientists think the containment scenario is now unlikely
Earlier this week, World Health Organization Director General Tedros Adhanom Ghebreyesus said he believes containment is still possible and should be a top priority for all countries.
Tedros Adhanom Ghebreyesus
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Our message to all countries is: this is not one-way street. We can push this
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Your actions now will determine the course of the
#COVID19 outbreak in your country.
There’s no choice but to act now.
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What the epidemiologists and virologists told me is that containment, in the US at least, so far isn’t working. And the longer containment efforts fail, the harder they become to implement.
The biggest failure is the slow rollout of diagnostic testing. The Centers for Disease Control and Prevention
reports that there are 99 cases of Covid-19 in the US, with 49 cases under investigation. (The New York Times is
reporting 227 cases, including those who were infected overseas.)
Epidemiologists fear the actual case count is a lot higher. The CDC has
been slow to get Covid-19 diagnostic testing out to labs (due to a production error). And initially, testing was restricted to small numbers of people who had known travel to affected countries.
This all means “we don’t know what the prevalence actually is” in the US, Angela Rasmussen, a Columbia virologist, says. Two weeks ago, she says, “I probably would have said that there’s a
possibility that this will become endemic.” Now, “I think given our government’s public health response, I’m much more alarmed that this probably will become endemic.” And still, this week, the federal government is struggling
to produce tests.
