There are still so many uncertainties about covid-19. We don’t know what percentage of infected people end up dead or disabled, how contagious it is, or how long a recovered person’s immunity might last. All we can really be sure of is that, without strenuous mitigation efforts, covid-19 will kill in terrifying numbers. So until we get a vaccine, it’s very likely we’ll all be engaged in a prolonged and grueling trench warfare with this virus.
The good news, as pharmaceutical researcher Derek Lowe recently noted, is that no fewer than 115 vaccine candidates are somewhere in the development process, and regulators are going to help researchers push those candidates through human trials faster than has ever been done before.
The bad news, as Lowe also points out, is that we are very unlikely to have a vaccine until some time in 2021 — at the earliest. Which means we’re going to have to be prepared to endure longer and more intrusive public health measures than any living American is used to.
All of which has become one of the best arguments in the arsenal of the lockdown skeptics. We can’t all sit at home for a year or two, they say, correctly. So we might as well all get it now rather than pointlessly trying to delay the inevitable. As the first month of quarantines draws to a close, with no clear end in sight, that argument becomes increasingly appealing.
But however appealing, it’s still wrong. For one thing, even if all we do is delay the inevitable, delay is very valuable. Delay spreads cases out over time, preventing a fast-moving pandemic from overwhelming our health-care system — “flattening the curve,” as you’ve heard many times over the past month. And that isn’t the only reason we should prefer infection later to infection now. Delay also allows us to build more capacity to treat and quarantine the infected, and gives us time to figure out what that treatment should look like.
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One of the amazing stories of this pandemic has been the collaborations that are going on around the world, through medical journals and Facebook groups and informal communications between scientists. Each day, the people on the front lines of research and treatment pile more information upon the mountain of data we’ve already assembled. But even at Internet speeds, it will take us time to process that mountain into usable chunks.
Already, as more data has emerged, doctors are altering their rules of thumb about critical decisions like when to ventilate patients. We should expect that process to continue, which means that someone infected six months from now will probably have a better chance of recovery than someone infected today.
Time also gives pharmaceutical companies the opportunity to conduct rigorous trials of existing drugs such as hydroxychloroquine, and figure out whether they actually help — or even develop new drugs, such as manufactured antibodies.
So even if all we’re doing is buying time, that time seems worth buying, even at a high cost.
It’s also possible, however, that we’re not just buying time. It may be that some combination of public health controls can reduce the ultimate number of infections far below where it would be if we allowed the infection to rage unhindered. Once you factor in the possibility that both things might be true — that we’re purchasing the time we need to set up the public health infrastructure, and also to develop treatments that could, by summer or fall, substantially reduce the case-fatality rate — the time we’re purchasing now could turn out to be cheap indeed.
Of course, it’s also possible, if unlikely, that the skeptics are right and there’s really nothing we can do except get it over with. Indeed, it’s possible that things are worse than even they imagine: that we’ll soon learn that having covid-19 once doesn’t confer much immunity, so we’re all doomed to get it again and again, or even more frightening, that the virus is mutating into an even more contagious and fatal disease than the one we’re now contending with. Those of us who support our current aggressive regime should acknowledge that there are no certainties, and that there’s some chance we’ll ultimately regret having advocated such a draconian policy to so little effect.
But, of course, there are also downside risks to the skeptic agenda, including the possibility that prematurely lifting restrictions could prove even more economically costly than keeping them. Meanwhile, embracing their prescriptions means giving up any chance at a considerable upside. You have to be pretty pessimistic about the capabilities of our doctors, our hospitals and our scientists to make that look like our best bet.
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