COVID-19: Some thoughts on what's next (Mar 15)

[This post is replacing a Twitter thread]

What a time we live in. Since many weeks, epidemiologists around the world had been looking at the COVID situation with great worry. As the story became bigger and bigger, some of us were sharing our thoughts both with decision makers and in the media, and were promptly called alarmists. But that's past, and water under the bridge. I'm offering here some thoughts of where I see things heading. This is not a scientific assessment, but rather a personal one.

All of Europe, and the US, is fighting an exponentially growing threat. The hashtag of the moment is #FlattenTheCurve - the idea to mitigate the epidemic wave in order to not overwhelm health care systems - but when you fight an exponential, at some point, a bit of flattening won't do enough. The question is of course when that point is. 

Some countries in Europe have now gone into shutdown because they think they've reached that point. When you look at the daily case data, and the reports from hospitals, this is not surprising. What is surprising to me is that even at this point in time, many people have a hard time understanding exponential growth.

Following a shutdown, a few weeks later, the numbers will indeed go down. It doesn't happen immediately because before the shutdown, the many people who got infected in the days before will will eventually get COVID19, thus the numbers will still increase for some time (the incubation period is up to 14 days). But when the numbers finally do go down, hopefully all governments will have copied South Korea's strategy of testing and isolation, and have the infrastructure in place to test and isolate.

Since most countries have been in some sort of partial shutdown before, this will likely be the time when the total shutdown will be relaxed back into a partial shutdown. During that time, I hope that every single case will be treated very very seriously, with all the isolation and quarantining necessary.

Once that is in place and we can feel we have it under control, there will be a resemblance of life as we knew it. We will be careful, but confident - local outbreaks can be contained. The end game is the vaccine. When the vaccine arrives, it will be a magical moment for many, as life can finally go back to normal. The relief will be enormous, followed by a massive economic boom. History books will be written. 

The optimist in me is hoping for more rapid relief. At any day, a (non-fake-news) announcement of a medical intervention drastically lowering severity and mortality may appear. That would instantly improve the trajectory. The pessimist in me is worried in particular about middle income countries, where economic hardship could lead to serious instabilities. 

All of this is speculation, but I am sharing it because it may help others think through the options. I am still among the optimists who thinks a vaccine is possible this year, and unexpected drugs may lead to rapid relief. But whatever happens, 2020 will be year like none we've ever seen. 

May we be strong, may we be lucky, may we be healthy. But most of all, may we learn something out of it. Never again shall another pandemic - basically guaranteed unless we get very serious about it - hit us at such a mind-boggling stage of unpreparedness.