Coronavirus: Opening the US by Easter could kill over 80,000 people despite social distancing, warns study
Discontinuing social distancing measures early could lead to a massive surge in infections, hospitalizations and deaths in the US
US President Donald Trump recently said that he wants to open America by Easter. That could be disastrous for the US, show multiple new studies. One study predicts that even if people observe strict social distancing, thousand of Americans will die over the next several months from COVID-19 and cautions that current measures should not be lifted.
Researchers from the US attempted to answer an important question: Assuming social distancing measures are maintained, what are the forecasted gaps in available health service resources and number of deaths from the COVID-19 pandemic for each state in the US?
There will be a total of 81,114 deaths from COVID-19 over the next four months in the US, shows the forecast by experts from the Institute for Health Metrics and Evaluation at the University of Washington's School of Medicine. "But the range is large -- from 38,242 to 162,106 deaths. The figure shows that uncertainty widens markedly as the peak of the epidemic approaches, given that the exact timing of the peak is uncertain," they say in the study's pre-print version. Deaths from COVID-19 are estimated to drop below 10 deaths per day between May 31 and June 6, according to the estimates.
Compared to licensed capacity and average annual occupancy rates, excess demand from COVID-19 at the peak of the pandemic in the second week of April is predicted to be 64,175 total beds and 17,309 ICU beds. The analysis shows that at the peak of the pandemic, ventilator use is predicted to be 19,481.
Experts warn that the number of deaths could be substantially higher if excess demand for health system resources is not addressed and if social distancing policies are not vigorously implemented and enforced across all states.
"The estimated excess demand on hospital systems is predicated on the enactment of social distancing measures in all states that have not done so already within the next week and maintenance of these measures throughout the epidemic, emphasizing the importance of implementing, enforcing and maintaining these measures to mitigate hospital system overload and prevent deaths," recommend researchers.
Dr Tom Inglesby, Director, Center for Health Security of the Johns Hopkins Bloomberg School of Public Health, had explained that big social distancing measures take time to work. "The impact of big interventions in Wuhan China took about 3 weeks to start to reverse things. And then every day after the situation got better. In the US, we're about 7 to 10 days into this, depending on the state. To drop all these measures now would be to accept that COVID patients will get sick in extraordinary numbers all over the country, far beyond what the US health care system could bear," said Dr Inglesby said on March 24.
The Trump administration issued new guidelines on March 16, asking all Americans to avoid social gatherings and groups of more than 10 people. Trump, however, recently said that he was "hopeful to have Americans working again" by Easter.
Till March 26, the US Centers for Disease Control and Prevention (CDC) has reported 68,440 cases and 994 deaths in the US.
Science shows what happens if measures are lifted early
An interactive model created by epidemiologists show discontinuing social distancing measures early could lead to a massive surge in infections, hospitalizations, and deaths in the US. The interactive model, which has been published in the New York Times, suggests that if current interventions in the US - such as social distancing and limiting crowds to 10 - are lifted after 15 days, 123.5 million people could contract the coronavirus across the US between January and late October (with 36.4 million at the peak on June 5). More than 1.2 million people would die under these conditions and 122 million people would recover.
Changing the settings would change the numbers. For example, if the interventions are lifted after 30 days, the model suggests that 74.9 million people could be infected with COVID-19 between January and late October (with 17.1 million at the peak on June 29). Further, over 717,600 people would die under these conditions and 72.7 million people would recover.
The experts, however, caution that "these numbers offer a false precision, for we don’t understand COVID-19 well enough to model it exactly. But they do suggest the point that epidemiologists are making: For all the yearning for a return to normalcy, that is risky so long as a virus is raging and we are unprotected," says the article.
No intervention could have caused 7 billion cases
In the absence of interventions, COVID-19 would have resulted in 7 billion infections and 40 million deaths globally this year. The projections by Imperial College London, UK, say mitigation strategies focussing on shielding the elderly (60% reduction in social contacts) and slowing but not interrupting transmission (40% reduction in social contacts for wider population) could reduce this burden by half, saving 20 million lives.
“But we predict that even in this scenario, health systems in all countries will be quickly overwhelmed. This effect is likely to be most severe in lower-income settings where capacity is lowest,” says the team.
The analysis suggests that healthcare demand can only be kept within manageable levels through the rapid adoption of public health measures including testing and isolation of cases and wider social distancing measures to suppress transmission, similar to those being adopted in many countries currently.
The projections show that if a suppression strategy is implemented early at 0.2 deaths per 100,000 population per week and sustained then 38.7 million lives could be saved. “If it is initiated when death numbers are higher (1.6 deaths per 100,000 population per week) then 30.7 million lives could be saved. Delays in implementing strategies to suppress transmission will lead to worse outcomes and fewer lives saved,” says the study.
Longer social controls will stall second wave
An analysis indicates that keeping tighter measures in place for a longer period of time to control COVID-19 would help relieve pressure on hospitals and healthcare providers.
The new modeling research estimates the impact of social distancing measures in Wuhan. It suggests that school and workplace closures in Wuhan, China, reduced the number of COVID-19 cases and substantially delayed the pandemic peak giving the health system the time and opportunity to expand and respond.
The study, published in The Lancet Public Health, also suggests that longer social controls will stall a second wave of COVID-19 in China
Using mathematical modeling to simulate the impact of either extending or relaxing current school and workplace closures, researchers estimate that by lifting these control measures in March, a second wave of cases may occur in late August, whereas maintaining these restrictions until April, would likely delay a second peak until October relieving pressure on hospitals and healthcare providers in the intervening months.
The projections show that physical distancing measures are likely to be most effective if the staggered return to work was at the beginning of April, potentially reducing the median number of new infections by more than 92% and 24% in mid-2020 and end-2020, respectively.
"Our projections suggest that premature and sudden lifting of interventions could lead to an earlier secondary peak, which could be flattened by relaxing the interventions gradually," say the researchers.
The team says that the results will not look exactly the same in another country, because the population structure and the way people mix will be different. "But we think one thing probably applies everywhere: physical distancing measures are very useful, and we need to carefully adjust their lifting to avoid subsequent waves of infection when workers and school children return to their normal routine. If those waves come too quickly, that could overwhelm health systems," says co-author Dr Yang Liu from the London School of Hygiene & Tropical Medicine, in the analysis.
Writing in a linked comment, Dr Tim Colbourn from University College London, the UK, who was not involved in the study, says that the study is crucial for policymakers everywhere, as it indicates the effects of extending or relaxing physical distancing control measures on the coronavirus disease 2019 (COVID-19) outbreak in Wuhan.
"Given many countries with mounting epidemics now potentially face the first phase of lockdown, safe ways out of the situation must be identified," says Dr Colbourn.
"New COVID-19 country-specific models should incorporate testing, contract tracing, and localized quarantine of suspected cases as the main alternative intervention strategy to distancing lockdown measures, either at the start of the epidemic, if it is very small, or after the relaxation of lockdown conditions, if lockdown had to be imposed, to prevent health-care system overload in an already mounting epidemic," he says.