Columns

It's disconcerting to be in a novel situation where we have no control over what's going to happen next. That's where we find ourselves in the midst of the Coronavirus pandemic. In California, we've been sheltering-in-place for two weeks and Governor Newsom indicates that it will continue "for as long as it takes." Here's my prediction of how this is going to play out. 

1.Shelter-in-Place isn't going to end soon. Life won't return to "normal" until there is a Covid-19 vaccine. Until there is a reliable, widely-available vaccine, most of us are going to have to live sequestered lives. Experts, such as Dr. Anthony Fauci, tell us we won't have a vaccine for at least a year. (https://www.newsweek.com/coronavirus-vaccine-treatment-antiviral-speed-covid-19-1491292) So be prepared to hunker down for an extended period. 

In Sonoma County, where I live, county officials have just received the results of a detailed analysis of how effective our "shelter-in-place" program has been. (https://www.pressdemocrat.com/news/10871235-181/during-a-surge-1500-sonoma) The good news is that it seems to have made a big difference in the number of cases here (95). The bad news is that the number of Covid-19 infections will not peak until June and then begin a gradual decline that will stretch out for 300 days -- unless we have a vaccine. 

2. The United States is going to be segmented into quarantine zones. We can already see this with the news that states adjacent to New York, New Jersey, and Connecticut are restricting travel from the three states -- that have about 50 percent of the U.S. Coronavirus cases. 

Meanwhile, "shelter-in-place" orders vary from state to state. That's a particular problem in the South where the number of Coronavirus cases is exploding, particularly in Florida and Louisiana. That suggests that certain areas of the United States will soon become so toxic that travel restrictions will be issued. BB's prediction: There will be four quarantine zones: the northeast; the south --- including Texas; the center -- Nebraska to Ohio; and the west -- Colorado to California. 

3. Some states will "recover" from the Coronavirus crisis before others do. That doesn't mean their shelter-in-place programmed will be over. It means that these states have "flattened the curve;" for example, Washington started social distancing on March 11 (https://www.washingtonpost.com/nation/2020/04/01/lockdown-coronavirus-california-data/) and for the past week, the number of new Covid-19 cases has diminished. Here in California, there's a growing consensus that we have "flattened the curve," particularly in the San Francisco Bay Area where we began aggressive social distancing on March 14. 

As noted above, the Sonoma County shelter-in-place program appears to be effective but will continue for the foreseeable future -- until there's a vaccine. Before that happens, we'll hit several important milestones. 

Milestone I: In a major area, there are no new cases. Obviously, it will be a good sign if there are no Coronavirus cases in your area. Sonoma County forecasts this will happen around the end of 2020. That won't mean that we can abandon "shelter-in-place" but it will mean that there will be a heartening reduction in demand for hospital facilities; and we can adopt other interventions, such as aggressive contact tracing. 

Milestone II: There's a test available that permits us to identify individuals who are immune to the Coronavirus. Several companies are working on an antibodies test: "The tests are designed to detect whether a person has developed antibodies to the COVID-19 virus, indicating that they were at one time a carrier and may have built up immunity." (https://www.businessinsider.com/coronavirus-germany-covid-19-immunity-certificates-testing-social-distancing-lockdown-2020-3 ) "Gerard Krause, the [German] epidemiologist leading the project, [said] that people who are immune 'could be given a type of vaccination card that, for example, allows them to be exempted from restrictions on their work.'" 

An American biotech company is testing the entire community of Telluride, Colorado, to determine which of the 8000+ residents have Covid-19 antibodies. (https://abcnews.go.com/Health/antibody-testing-colorado-town-provide-forward/story?id=69856623 ) Once again, the notion is that these residents would be exempt from the "shelter-in-place" restrictions. 

Here in the Sonoma County, once we get antibodies tests, we'll first use them to test those on the frontlines of the pandemic: healthcare professionals and first responders. Then we'll test other critical professionals, such as employees at nursing homes and community health centers. 

Milestone III: Creation of Safe Zones. On Monday, Donald Trump announced that 1 million citizens had been tested for Covid-19. Given that the U.S. population is 330.5 million, that means that .3 percent of residents have been tested. Trump said that tests were being generated at the rate of 100,000 per day. (https://www.wired.com/story/video-coronavirus-testing-in-the-us/ ) That's woefully inadequate. Even if the U.S. tested 1 million citizens per day, it would take more than 11 months to test us all. (On March 29, the New York Times (https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html ) detailed the U.S. decision errors that led to this testing crisis.) 

If you are in an area where there are few or no Covid-19 patients, you may wonder why folks in your area need to be tested and why you have to shelter-in-place. The answer is that a large percentage of those infected with the Coronavirus are not symptomatic. "As many as 25 percent of people infected with the new coronavirus may not show symptoms, the director of the [Federal] Centers for Disease Control and Prevention warns." (https://www.nytimes.com/2020/03/31/health/coronavirus-asymptomatic-transmission.html) You, and everyone in your area, needs to be tested so you know whether you are truly safe. 

Unless there's a dramatic increase in the rate of testing, there's no alternative but to "shelter-in-place." In the meantime, we can use the test kits we receive to test potential Covid-19 cases and to create safe zones. 

Sonoma County has 95 Coronavirus cases. We've tested 1915 individuals in a county of 500,000 residents (.38 percent) -- our testing has been delayed by the unavailability of swabs. As we receive more intact test kits, the logical way to use them -- beyond testing suspected Coronavirus patients -- is to first test healthcare providers, and their families, and then emergency responders, and their families. At a certain volume of test availability, we will be able to create safe zones; for example, determine that a cluster of nursing homes is Covid-19 free. 

How long will we shelter in place? Months. Probably as long as it takes to develop and deploy a Covid-19 vaccine.