According to the latest data collected by The New York Times, at least 265 million Americans, across 32 states, 80 counties, 18 cities, Native American lands, the District of Columbia and Puerto Rico, are living under some directive to stay home and practice social distancing.
On March 29th, the Federal government extended the social distancing guidelines to at least April 30th, 2020.
Some of us are approaching 3 weeks without leaving home for school, work, or entertainment. In fact, we’ve been told we shouldn’t really be leaving home at all for anything, besides essential activities like grocery shopping or medical appointments, unless we are essential workers.
Now, many of us are starting to ask – When will social distancing end?
According to most epidemiologists, this is a very difficult question to answer. As Dr. Anthony Fauci, the nation’s leading infectious disease expert and director of the National Institute of Allergy and Infectious Diseases puts it, “The virus dictates the timeline.”
Still, it’s what we do with the time that will make all the difference.
During a televised interview, Thomas Inglesby, MD, director of the Johns Hopkins Center for Health Security, laid out 5 criteria that he believes would allow us to move from this severe phase of social distancing (what we are now starting to call “physical distancing”) to a step-wise approach for opening up parts of the country. These criteria, largely echoed by other experts, are aimed to minimize the health and economic harms to people in our country.
According to Inglesby, we can move past this strict level of social distancing when the following conditions are met:
- When the number of new infections in states and regions start go down over time
- When we have a massive ability to diagnose cases through testing
- When proper equipment, like masks and other personal protective equipment are fully available for doctors, nurses, and hospital staff so that the sick can be cared for safely and effectively
- When hospitals have all of the equipment they need like beds, ventilators, and are fully prepared for new cases
- When a robust public health infrastructure is in place to identify new cases and trace contacts to prevent spread and contain new outbreaks
These conditions echo many of the recommendations in a report released by former FDA Commissioner Scott Gottlieb and his co-authors. They detail a 4-stage approach to managing the COVID-19 response and moving past social distancing.
Social distancing is only Phase One, to buy us time to accomplish the conditions described by Inglesby. The report’s authors suggest that states or regions may then be able to begin to move to Phase Two if cases do not increase over a 2-week period. Their vision of Phase Two allows businesses and schools to reopen with appropriate physical distancing measures and increasing disinfecting and cleaning of public spaces. They suggest that large gatherings will likely still need to be limited. High risk people like the elderly and those with medical problems may still need to limit time outside of the home until there are validated treatments available. They stress, however, that if at any time cases go up in an unmanageable way, we would probably need to go back to social distancing.
Phase Three would be a time when we can lift almost all physical distancing restrictions. This would depend on whether or not our country has a strong COVID-19 surveillance infrastructure in place to stamp out any new cases quickly, readily available drug treatments, and potentially a safe and effective vaccine.
Ultimately, they describe Phase Four as a time when we use all of the lessons learned from this pandemic to expand American public health and health care infrastructure, along with developing strong emergency preparedness plans to “rebuild our readiness.” This will help protect us from future threats without the same severe conditions we have faced during this pandemic.
Aggressively implementing Phase Four would probably allow us to respond to future threats similar to the way South Korea responded to COVID-19. South Korea and other countries like Singapore have not had to shut down their country or economy like most countries in Europe and the United States because of the strong emphasis on early testing and aggressive contact tracing.
Again, it’s not clear what the timeline would be to move from one stage to another, some stages could take weeks – others make take months to years.
So, when might social distancing end for the United States?
If we take Italy as an example, it is now being estimated that they will have virtually eliminated new COVID-19 cases by May 16th, 10 weeks after the entire country went into lockdown. It took them 4 weeks after lockdown to reach their peak and then show a sustained decline in the number of cases. It’s still not clear when they will start easing up their restrictions.
For the US, the next 2-4 weeks of social distancing are key – what happens to cases during this time will give us a much better sense of how much longer these measures will need to be in place. Beyond that, the faster we can mount a nationally coordinated response to meet the conditions outlined by Dr. Inglesby, the faster we will reach a time that we can safely begin to ease social distancing in our nation.