COVID-19 — Why we had to act, how it can be ended and what we can do until then

In the last few months, COVID-19 has turned the world upside down. With conspiracy theories on the rise and a lot of overwhelming information published every day, this article will focus on the facts and bring structure to the chaos.

While the pandemic has resulted in many consequences, I’ll focus on the pandemic itself and its public health implications primarily from the perspective of Germany and other developed countries.

Why we had to act

Taking measures to avoid a potential disaster can in hindsight feel like over-reacting. It’s important to remember why we had to act quickly instead of simply allowing the virus spread.

The coronavirus is often compared to the influenza virus (seasonal flu), but looking at its properties, it’s much more severe and therefore required a more radical response.

Coronavirus

Influenza virus

Fatality 1

~0.6% death rate

0.1% death rate

<2.2

1.3

Contagiousness (R0) 1, 2

no previous immunity in the population

previous immunity from infections and vaccines

Treatment 1

no approved antiviral drugs available

four prescription medicines available

Herd immunity

Resulting consequences if we hadn't reacted

Many people would’ve died (e.g. assuming a death rate of 0,4% and 60% of the population being infected that would mean ~200.000 deaths in Germany)
The health care system would’ve collapsed (meaning horrible decisions to be made and people would’ve died of other health issues because of the lack of treatment)
The economy would’ve suffered due to the simultaneous infection of many people

There are many things we didn’t (and still don’t) know about the virus, which would have made it very dangerous not to react. For example it’s currently unclear if in asymptomatic cases the virus is spread. 3

How we can end the pandemic

With more and more countries easing lock-downs and policies, there seems to be a feeling that “we’re almost through the worst”. Media and governments have focused on discussing the short-term, but it’s important to be transparent about how long we expect the pandemic to last.

There are three potential options to end the pandemic:

With a vaccine immunity is created by injecting either dead virus cells or just a protein of the virus.

Challenges:

Usually this takes years to develop if we find one at all. With short cuts we could have one in ~18 months. 3
It is unclear how to trial a vaccine
properly and how to manufacture enough of it for the entire world 3
It's unclear how to prioritize which countries and individuals should receive a vaccine first. 3

If about 60-70% of the population gets infected, they build up immunity against the virus, stopping the exponential rate of transmission. 4

Challenges:

It's unclear whether we actually become immune after infection, which seems likely. It's especially unclear if individual immunity lasts long enough to build up herd immunity. 6
For example in Germany, it would likely take years to achieve. 14
If we do achieve herd immunity, there is a potential for harmful long-term health impacts, even in mild cases and for otherwise healthy people. 7

Containment means eradicating the virus by making sure it cannot spread further (as has happened with SARS), for example through social distancing. 8, 9

Challenges:

It's very unlikely that we would be able to contain the virus, because it has already spread to the majority of countries. 9

What will mark the end of the pandemic will most likely be an effective vaccine, but we will realistically need a combination of all three options to eradicate the virus quickly.

What we can do until we control the virus

Considering it’s a long way to go until we have defeated the pandemic, the question is how our life will look until then. Especially relevant is how we can open up the social and economic life again as much as possible to reduce the negative impact on the world economy, society and mental health.

These are possible measures we can take which can allow us to do so:

Measure 1: Testing

Currently our testing capacities are very limited. Testing doesn’t help on its own, but is needed to make sure we can a) quarantine the right people and b) understand when to increase contact-limiting policies. 5

Requirements of tests: Quick enough to get results before an infected person can spread the virus and sensitive enough to detect an infection before symptoms appear.

PCR lab tests: available and can handle larger amounts, but still too limited and require sending the probe to a lab (= takes time which can lead to more infections) 3
Self-testing: might be available only in a few months 3
Antibody tests: could potentially detect immunity (currently unreliable results and uncertain if we can assume immunity due to antibodies) 3

Measure 2: Contact tracing

Allows us to quickly direct the testing capacity to whoever is most-likely to be affected and quarantine them until we know. 3

Currently done manually which is probably not scalable enough. 3
Still unclear if an app would actually help with this 10 and there are different privacy concerns which I believe can be overcome if done properly.

Measure 3: Treatment

There are already a lot of different treatment ideas and more will come with time. Most will fail, but we might find some that reduce the impact of the virus on infected people.

Probably 95% effectiveness necessary to make it safe enough that people will accept the risk of infection and attend larger gatherings 3
We might be able to have some in place by summer or fall 3

Measure 4: Policies

This could mean lock-downs or other regulations. It’s currently still unclear which activities are most risky and should therefor be prohibited the longest.

Already in place by most countries to various extends
This is necessary to reduce the reproduction rate: we need to find a balance based on the current reproduction rate and monitor it carefully when making changes as it’s very sensible (e.g. the difference of the reproduction rate between 1.1 and 1.3 means 2 months difference in when the German health care system could be at full capacity) 11
We will most likely have multiple lock-downs (or at least some sort of restrictions) due to additional waves or at least bumps in the numbers. This depends a lot on the behavior of people.

Measure 5: Isolation of at-risk groups

Currently it’s unclear what the severeness is for old people and this approach alone would most likely still make the health care system collapse. Additionally, in practice it will be impossible to completely isolate all people at risk. 12

Which combination of measures will be most effective and what a timeline might look like can’t be predicted. It will have to be explored as we go, always taking into account new research on the virus, the development of infected cases and the current reproduction number. How strict our policies have to be and the overall impact on public health depends on how fast we can develop these measures and on how responsibly individuals behave.

Conclusion

It’s clear that this pandemic will deeply influence our lives for a long time, but with the right focus and a combination of the aforementioned measures, we can create and adapt to the so-often proclaimed “new normal”.
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The world was unnecessarily caught off guard, as the pandemic could have been and was predicted. 13 While acknowledging how much damage COVID-19 has caused, we should also remember it could’ve been much more deadly and contagious. 15 Considering the lack of preparedness, we're fortunate that was not the case.

The way forward is two-fold: We must remain active in fighting COVID-19 even if it seems under control. And we need to create the infrastructure which can better handle the future pandemics sure to come.

Published by Till Leinen
last updated on June 11, 2020

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