Quarantine Fatigue and the Social End to the Coronavirus Pandemic

What might learning to live with COVID-19 look like?


"If 18 months of extreme social distancing is what it takes to stop coronavirus, we're doomed," declared my Reason colleague Robby Soave way back on March 18. The 18-month timeline was based on speculations about how long it would take to develop and deploy an effective vaccine. On March 18, only some 7,000 cases and 141 deaths in the U.S. had been attributed to COVID-19, the disease caused by the novel coronavirus. As of today, the toll stands at about 1.4 million cases and over 82,000 deaths.

The Trump administration had released its social distancing guidelines two days earlier on March 16 partially in response to dire worst-case projections that as many as 2.2 million Americans could die of the disease made by Neil Ferguson's modeling group at the Imperial College in London. In mid-March I asked, "Are we battling an unprecedented pandemic or panicking at a computer-generated mirage?" It turns out that significant flaws were identified by other researchers once Ferguson's group finally got around to releasing their model's computer code.

Over at The New York Times, science reporter Gina Kolata asks, "When will the Covid-19 pandemic end? And how?" She observes that epidemics medically end when disease incidence and death rates plummet as herd immunity is achieved through either mass infection or mass vaccination. On the other hand, epidemics socially end when people grow tired of panic mode and learn to live with a disease.

"People may grow so tired of the restrictions that they declare the pandemic over, even as the virus continues to smolder in the population and before a vaccine or effective treatment is found," suggests Kolata.

And smolder it might. The lockdowns aimed to flatten the curve of the epidemic—that is, slow down the rate of infection. And it worked. Nationally, the daily number of new confirmed cases peaked at over 36,000 on April 24 and has dropped to under 20,000 as of yesterday. The goal is to spread out the infections over time in order to avoid overtaxing the health care system with a flood of cases; however, the number of people who become eventually infected will not necessarily be lower.

As their fears about exponential increases in infections and deaths abate, more and more Americans are easing themselves out of lockdown. For example, a Monmouth University poll reported earlier this week that 30 percent of respondents are not too concerned or not at all concerned that someone in their family might become seriously ill from the coronavirus outbreak, up from 16 percent a month ago.

"Lockdown is ending, whether governments approve or not," declared my Reason colleague Eric Boehm. Rising quarantine fatigue and the greater acceptance of disease risk by the public is behind the moves by a majority of U.S. states to at least partially reopen their economies by loosening social distancing guidelines. Anonymized cell phone data already reveals that many residents in 20 states have increased their mobility by 15 to 20 percent in the last few weeks.

So what might learning to live with COVID-19 look like? Keeping firmly in mind that all models are imperfect, the University of Washington's Institute for Health Metrics and Evaluation's (IHME) model recently raised its projection of U.S. COVID-19 deaths to 137,000 by the beginning of August. In comparison, the model developed by Youyang Gu and his colleagues projects a central estimate of 188,000 deaths by then.

The Centers for Disease Control and Prevention (CDC) reported in 2017 that deaths from all causes in the U.S. averaged around 7,700 per day. The summer trajectories of the two models suggest that the COVID-19 pandemic in the U.S. would add something like 666 and 1,273 deaths respectively to the daily toll. If the Gu model turns out to be more prescient, the daily death rate of 8,973 that it projects would be a bit above the average of 8,478 deaths per day in January 2017. This level of increased mortality is unlikely to overwhelm our health care system.

Another factor to keep in mind is who is at greatest risk of dying of the disease. About 75 percent of deaths from all causes—that is, about 5,750 per day—already occur in Americans over the age of 65. Since around 80 percent of Americans who die of COVID-19 are over the age of 65, that would boost the over-65 average by between 500 to 1,000 deaths per day respectively in these models' projections. If these estimates are anywhere near ballpark accurate, the steady tragic toll of COVID-19 deaths will no longer inspire panic and most Americans will resignedly learn to live with the disease.

As Americans exit lockdown and quarantine in their hopeful search for normalcy, some public health officials fear that the rates of coronavirus infection and death could begin to rise again. According to The New York Times, Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases and Trump administration pandemic adviser, is expected later today at a Senate hearing to warn against "the danger of trying to open the country prematurely." In his response to the Times, Fauci adds, "If we skip over the checkpoints in the guidelines to 'Open America Again,' then we risk the danger of multiple outbreaks throughout the country. This will not only result in needless suffering and death, but would actually set us back on our quest to return to normal."

How far back? Perhaps Sweden's relatively lax public health response to the pandemic may provide some hints as to how loosening restrictions might play out here. It is worth noting that Sweden's coronavirus death rate currently stands at 328 per million residents compared to 248 per million in the U.S. Sweden's death rate scaled up to match the U.S. population would suggest that 108,000 Americans would be dead by now instead of 82,000. On the other hand, if the IHME and Gu models are correct, that number of Americans will likely die of coronavirus infections before the end of this month. In any case, it is not at all clear that Sweden's economy will fare substantially better than those of other countries that implemented more comprehensive lockdowns.

All the signs indicate that the social end of the coronavirus pandemic in the U.S. is nigh.

A couple of caveats beyond due skepticism with respect to models should be noted. First, these projections presume that at least some moderate social distancing practices will be maintained through the summer. If not, the number of cases and deaths will concomitantly rise beyond these projections. Second, the projections also assume that test, track, and voluntary self-isolation programs that aim to contain the epidemic will remain somewhat hit-or-miss. And thirdly, they presuppose that no widely effective treatments will emerge in the next few months.