With the majority of the population practising social distancing and staying at home, thousands losing their livelihoods, a faltering economy and a rising death toll, the question on every American’s lips is – when will the coronavirus pandemic be over?

The United States has the most reported cases of Covid-19. As of 29 March, John Hopkins confirmed there are nearly 700,000 cases of coronavirus worldwide, with over 125,000 of those in the US. 33,000 people have died, however only 1,000 of those deaths occurred in the US.

The nation has lagged behind on testing, with every other G8 country except Japan performing more tests per capita than the US. Approximately 0.3 per cent of the population has been tested at this point, with tens of thousands of coronavirus tests still pending according to the COVID Tracking Project. That compares to 6.1 per cent in South Korea, 1 per cent in Russia, 0.9 per cent in the UK and 0.6 per cent in Spain, according to researchers at the University of Oxford.

The Independent spoke with Saralyn Mark, former Senior Medical and Policy Advisor for the US Department of Health and Human Services, NASA and the Obama White House, to explain America’s unique standing in this health crisis, and what might be to come for the nation.

How this virus progresses in the US will “be different to the rest of the world,” Dr Mark says. It’s not just the specific disease but the socioeconomic makeup of a nation that impacts how a pandemic is handled; access to healthcare, wealth distribution, age, population, a myriad of factors come into play. Once you combine such factors “with a disease where you have no known immunity, you see what the results are,” Dr Mark says. “And they’re very graphic, they’re very dramatic.” Responding to a pandemic of this nature relies on a sturdy infrastructure, reliable data, and capacity to test as well as treat. “I think as we see, when there is any weakening of that chain, you see how the whole link falls apart.”

Access to both care and testing is not a problem unique to the US, but it is particularly felt here. America is plagued by a strained healthcare system, with many uninsured, as well as many insured but still unable to get adequate access to care. “You have a system that is already extraordinarily stressed and then you add that other element on top of it. And you see what we’re seeing – it’s cataclysmic.” Dr Mark also points to the issue of undocumented people fearing receiving tests or treatment because of their fragile status, potentially posing further issues for the US down the line in both accurately reporting numbers and treating the infected.

Obesity is another reality the US must reckon with. “42 per cent of Americans are overweight. We know obesity impacts your immune system and your inflammatory responses. It provides a restriction to your breathing. How do you ventilate with that?”

New York has now been dubbed the epicentre of coronavirus, with approximately a quarter of all US cases in the one state. The high density and population of New York are two of the biggest factors in the spiralling of the disease in the city. As Andrew Cuomo said: “Our closeness makes us vulnerable.” The Independent has a more detailed report on New York and how it became ‘ground zero’ here.

But America’s problem doesn’t end with this one state. “New York is getting hit hard, and they’re getting hit first,” director of the Harvard Global Health Institute Ashish Jha told USA Today, predicting the rest of the US will follow suit. The US is expected to reach its peak use of hospital resources in relation to Covid-19 on 14 April 2020, according to current tracking for Institute for Health Metrics and Evaluation.

One end to the pandemic would be the creation and widespread availability of a vaccine. Numerous potential drugs are in development, but getting to the point of human trials, mass production and mass availability will likely take a year or longer.

Stay-at-home is the current official advice across the US. In an op-ed to USA Today, director of the Johns Hopkins Center for Health Security Dr Tom Inglesby urged leaders not to ease social distancing prematurely. In the short term flattening the curve is the goal, avoiding a surge in capacity and stopping systems from being overwhelmed.

To a lesser extent, many citizens may resist continued social distancing as un-American. Dr Mark suggests that “Americans are used to their freedoms, enforcing restrictions is not something they are used to”.

As vital as it is right now, social distancing will – at some point – end. Dr Mark postulates May or June, with the chance of this being earlier if the measures have proven to be “extremely effective”. Record-high numbers of Americans are filing for jobless claims, stocks have had their worst week since the 2008 financial crisis, and countless industries will be unable to cope long-term with the current restrictions. “We’re moving out of what would be a theoretical best case scenario of how you would handle a disease to ‘what do we need to do to be able to maintain society as we see it’”, Dr Mark says.

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One scenario the US could experience is having people who recover from Covid-19 becoming “the backbone for the workforce” to help keep the economy driving as much as possible, keeping the rest of society going. In such a situation testing and date are imperative.

“We need a database of those infected and recovered,” Dr Mark says. She also says testing for Covid-19 antibodies, something being done in the town of Telluride, Colorado, is a way to “catch those who did not have a diagnostic test but were infected.” In addition to this, recovered patients can be sources of immunoglobulin which could be given to expand passive immunity in the community. “If we are able to advance more antibody testing that would help us ensure that people are immune.”

There is no exact time scale for how long this process of mass immunisation would take, but Dr Mark suggests a process of reintroducing, then isolating again, then reintroducing and so on could take a year or longer. Just as quickly as the virus spread, our knowledge of it and how to handle it grows. Washington state initially saw a high number of coronavirus cases, yet now Seattle – under strict measures – is seeing an easing in deaths.

“It’s terrifying for people because I think we’re so used to having those magic bullets ... But perhaps the best magic bullet we have is our own immune system right now.”