Future tense

Why scientists say we may be "intermittent social distancing" until 2022

When life can feel normal again depends on the answers to two crucial questions.

Roughly 90 percent of Americans are living under some kind of stay-at-home order, eager for the day when they can forget about "social distancing." States and the federal government are currently considering plans that might help "reopen" the country, and get everyone back to their normal lives.

But how normal can life become? Scientists have a few ideas — all of which suggest that life won't be normal in the short-term, possibly not even until 2022.

"Return to normal" plans will likely present a strange middle-ground between quarantine and regular life, say experts. One way this middle-ground can possibly be achieved is through "intermittent social distancing," report scientists from Harvard's TH Chan School of Public Health.

Intermittent social distancing means that we toggle between switching social distancing "on" and "off."

In the "off" periods some of the current policies (like shelter in place orders) may be relaxed — but communities will still have to be prepared to switch them back down to "on." That switch would be flicked if cases surpass 35 per every 10,000 people, note the Harvard scientists in their new paper. If the number of cases approaches that threshold, it's a sign that we need to limit how many people we interact with and give hospitals time to prepare for new cases.

It may be possible to withstand subsequent waves of the virus without overwhelming hospital facilities, the authors explain. But to live in that future, the model suggests we'll have to intermittent social distance until about 2022.

Wearing masks will be "pervasive" suggests Chowell-Puente, even if restrictions are loosened.

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What will the new normal look like?

The "on" periods of intermittent social distancing would be very much like what we're experiencing right now: working from home, not going to school, and wearing masks in public. There's no hiding from reality, senior author Marc Lipsitch, explained in a press conference on Tuesday. Stringent measures work — they bring cases down faster and to a lower level.

Even with loosened restrictions, the new normal will include certain baseline measures, Gerardo Chowell-Puente, the chair of population health sciences at Georgia State University, tells Inverse.

Most school and work will happen online, he explains. If kids go to school, it might be only for a few days a week. Mass gatherings will almost certainly be limited or not happen at all — that likely means few to no summer concerts. Face masks will be pervasive and, if restaurants open, only a few diners will be allowed inside at once.

"Pretty much everyone will wear face masks to go to the supermarket or any confined setting," Chowell-Puente says. "There will be temperature checks at the entry of any major public setting."

He believes that, with these measures, it will possible that life can get back on track — even if some people, inevitably, still get sick. Chowell-Puente adds that we'll have to remember that if another wave of transmission occur we may have to impose lockdown measures again, similar to Lipsitch's intermittent social distancing scenario.

Will the same rules be applied everywhere?

These are blanket recommendations. Different cities and states will have to come to better understand their own local transmission — and take responsibility for the disease burden — before they even consider lightening restrictions at all, says Chowell-Puente. Experts will need to use local-level data to guide how and when restrictions are lifted, he says.

How comfortable people will feel returning to normal life, even if restrictions are lifted, is another question to consider. That, like the lifting of restrictions, likely depends on where one lives. A Gallup poll released Tuesday suggests that, should restrictions be lifted, 23 percent of people living in small or rural towns would readily return to normal activities right away.

By comparison, only 15 percent of city dwellers said they would do so.

Temperature checks are already commonplace in Italy, and may also become common in the United States, if we loosen restrictions.


Do we really have to be so cautious?

If there is any wiggle room in terms of loosening restrictions, it will hinge on whether or not someone can truly become immune to the virus once they've had it.

In the Science paper, the authors suggest that if immunity is only short-term (around 40 weeks after you've had the virus) that could lead to annual outbreaks of the coronavirus. However, if immunity lasts longer (around two years) it could favor biannual outbreaks. If immunity is permanent the virus could disappear for five or more years.

Immunity is important in the short-term because it raises the idea that we could achieve "herd immunity" – the idea that most people have already come into contact with the virus, became immune, and can't spread it.

Understanding how immunity works can open up another way to think about social distancing in the future, says Lipsitch. If getting the virus confers long-term immunity, it may be worth risking more human contact, assuming we don't overwhelm health systems. But whether that risk is even worth taking depends on how long that immunity lasts.

Lipsitch puts it this way: Taking that risk is bad in that, more people will get infected. But it could also be good because it could allow more people to become immune while easing up on social distancing.

Still, Chowell-Puente says that we don't know enough to consider herd immunity as an option right now. For herd immunity to happen, there have to be more people who immune, compared to people who are susceptible. He simply doesn't think we're there yet.

"Right now, my view is that the percentage of the population that has been infected is fairly small, too small give us meaningful protection to the virus," he says.

Wide-scale antibody testing projects could solve this mystery, allowing us to know how many people have been exposed. Then, herd immunity could be viable.

What might bring back pre-pandemic life?

The key to returning to life pre-pandemic almost entirely hinges on the discovery of a vaccine, which could be up to a year away. Social distancing efforts are intended to keep new cases at a minimum until a vaccine arrives, and we can finally hit that "off" button.

In the meantime, a return to normalcy means we answer two crucial questions: How long does immunity last, and how many people in the population have been exposed to coronavirus?

Only with those answers can the new normal feel like pre-pandemic days.

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