Coronavirus: No, we aren't even close to ready to ease up on social distancing We shouldn’t consider relaxing social distancing measures until we have slowed the spread, dealt with supply shortages and diagnostic capacity and prepared to deal with patient surges.

Dr. Tom Inglesby | Opinion contributor

Show Caption Hide Caption Coronavirus: Social distancing key to fighting COVID-19 Social distancing matters. Here is how to do it and how it can help curb the COVID-19 pandemic.

In recent days, there have been prominent U.S. voices calling for a stop to social distancing soon, citing rationale that the consequences of social distancing are worse than the impact of COVID-19 itself. It’s worth looking very closely at that claim, where we are in the U.S. epidemic and what happens if we stop the social distancing efforts in place around the country.

COVID-19 has been spreading with exponential growth in the United States, and we're just beginning to get an understanding of how extensively as testing has become more available. There are nearly 65,000 U.S. cases confirmed as of Wednesday evening and more than 900 deaths. A few weeks ago, we had recognized 70 cases.

We shouldn’t be considering the relaxing of strong social distancing measures until we have drastically slowed the rate of spread, dealt with our dire shortages of supplies and diagnostic capacity and prepared our health care system to deal with surges in patients.

Some hospitals in New York City have said publicly that within one to two weeks, they will not have ventilators to treat everyone. In terms of diagnostics, there are shortages of reagents and swabs. We still don’t have rapid diagnostic testing in place in many hospitals, so it can be days before health workers find out whether a patient has the disease. We don’t have capacity to diagnose many of the COVID-19 cases that are not sick enough to be in the hospital, so those cases aren’t yet recognized or counted in the trajectory of the epidemic.

There are terrible shortages of the masks that health care workers need. How do we gain time to let hospitals get more supplies and prepare for high numbers of patients? How do we slow the spread of disease in America? How do we lower odds that intensive care units will run out of ventilators or space? The answer, for now, is large scale social distancing.

Social distancing works

In Asia, we've seen these social distancing interventions, which in some places have been in place for two months, work to slow the pace of the epidemic. They've slowed the disease by slowing social interaction. Left to its own, this disease spreads from 1one person to about 2.5 people, and then each of those people spread to an average of 2.5 more and so on. For this disease to stop, we need to make it so that on average, one person spreads it to less than one other person.

These social distancing measures take time to work. The impact of big interventions in China took about three weeks to start to reverse things. And then their situation got better. In the USA, we're only about 10 days into large scale social distancing, depending on the state.

To drop all these measures soon would be to accept that COVID-19 patients will get sick in extraordinary numbers all over the country, far beyond what the U.S. health care system could bear. Many reputable models predict that health care systems will be completely overwhelmed by the peak of cases if social distancing is not maintained.

If hospitals become completely overwhelmed, they could struggle to provide even oxygen for some or many of the 15% of COVID-19 cases expected to be “severely ill,” and the case fatality rate for COVID-19 could far exceed 1%. Beleaguered hospitals also might not be able to provide care for other serious and life-threatening conditions.

Millions might die

Anyone advising the end of massive social distancing now needs to fully understand what the country will look like if we do that. COVID-19 would spread widely, rapidly, terribly — and could kill millions in the year ahead with huge social and economic impacts across the country.

Before considering changes to social distancing measures, we should use all our energy to get to the strongest possible position for COVID-19 response. We are not ready. We need rapid diagnostics in place. We need extraordinary quantities of personal protective equipment. We need more ventilators, and we need capacity to provide medical care to many more than we can now.

It’s encouraging that we are beginning to make progress. The Food and Drug Administration has provided recommendations for developers who may wish to develop serological tests, which can be used to identify who has been infected and recovered already, and to know how prevalent the disease is in the USA. Looking ahead, we will hopefully have therapies to treat at least the sickest patients.

Together, these measures will help reduce the number of cases to such a low level that we could do contact tracing and isolation of cases.

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At that point, it will be a far less risky to pull back on social distancing measures. In the coming weeks, we will learn from the experience in Asia as leaders there begin to relax social distancing.

For now, we need to keep production lines for medical equipment running, doctors’ offices working and groceries, pharmacies and banks open. It is important to have science-informed dialogue about which businesses need to be closed versus what can stay open if social distancing can be accomplished.

These measures are clearly painful for society and have bad economic consequences, but there would be no return to a normal society or economy now even if these measures were ended given that COVID-19 is rapidly spreading across the country. We need to press ahead for now with closed schools, mass telecommuting, no gatherings and staying home unless you need to go out. It is critical that generous economic programs be put in place to help those suffering from social distancing measures. Through social distancing, we can slow this epidemic together.

Dr. Tom Inglesby is the director of the Johns Hopkins Center for Health Security. Follow him on Twitter: @T_Inglesby