When Will Coronavirus End—and Have We Reached the Peak in the US?
New projections reflect rise in deaths through August due to easing of social distancing.
As the world continues to grapple with the harsh reality of the coronavirus pandemic, daily life has drastically changed for most (if not all) citizens: Entire countries and cities have been locked down, and social distancing has been enforced.
But as more localities look to lift stay-at-home orders and reopen shuttered businesses, everyone's wondering the same thing right now: Is the worst over and, if not, when will the coronavirus pandemic end? The short, uncomplicated answer: No one knows for sure. It is totally dependent on the coronavirus outbreak itself and how we react to it.
While some have been looking at previous pandemics—like the so-called Spanish flu of 1918, and the SARS outbreak of 2003—to try to figure out when the current coronavirus pandemic may subside, even those aren't perfect correlations due to different viruses and less-advanced medical technology and treatments.
Still, the similarities between SARS (severe acute respiratory syndrome) and COVID-19 are there: Both are coronaviruses and have similar DNA, Ravina Kullar, PharmD, MPH, infectious diseases researcher at Expert Stewardship, Inc., and an Infectious Diseases Society of America expert tells Health. They also have the same main transmission route of respiratory droplets and similar incubation periods.
But with the SARS outbreak in 2003, only 8,098 people worldwide fell ill, according to the Centers for Disease Control and Prevention, and just 774 people died over the course of eight months. COVID-19, on the other hand, has already exceeded 3.8 million cases worldwide, and there have been more than 267,000 deaths since the outbreak began, including more than 75,000 US deaths.
Dr. Kullar says that the flu of 1918 pandemic may suggest a pattern more similar to COVID-19, but even that's not an exact comparison. "I think what you can see with the [so-called Spanish] flu is a very similar pattern in terms of how many people it impacted, how many people it killed, and how social distancing measures were not put into place quickly enough," says Dr. Kullar.
For reference, the CDC says that an estimated 50 million people worldwide died during the 1918 flu pandemic, with about 675,000 of those deaths occurring in the US. The 1918 flu pandemic reportedly began in March 1918 and, after multiple waves of the virus, began to subside in the US around February 1919, per the CDC.
Because it's difficult to determine when COVID-19 will end based on the trajectories of other pandemics, some experts suggest a better question than "when will the coronavirus end?" is instead "when will the coronavirus peak?" While nothing is definite, there may be a bit more current information to back up these projections.
Dr. Kullar points to data from the Institute for Health Metrics and Evaluation (IHME), a population health research center at the University of Washington School of Medicine. The group of statisticians, computer scientists, and epidemiologists have been tracking and forecasting COVID-19 in the US since February. Initially, their goal was to predict when deaths would peak and when health systems would experience surges in demand for care. Deaths and hospital use in the US were expected to peak on April 15, or thereabouts, with state and regional variations.
In New York City, new hospitalizations are leveling off, while other localities brace for the worst.
The IHME recently revised its model for projecting the next phase of the epidemic. The new framework takes into account the public's rising mobility as more states ease social distancing and lift stay-at-home orders. It also incorporates trends in COVID-19 infections and testing, as well as the effects of temperature and population density. The new forecast, issued May 4, anticipates nearly 135,000 COVID-19 deaths in the US through the beginning of August, nearly double an earlier estimate of 72,000. That's primarily due to longer peaks and slower declines in new infections.
Under the new model, many—but not all—states have passed their peaks. In Georgia, for example, the need for ICU beds is expected to top out in late May or early June. In addition, IHME cautions that there could be state or regional resurgences in infection, driven partly by the easing of social distancing. "We expect that the epidemic in many states will now extend through the summer," IHME Director Christopher Murray, MD, stated in a news release announcing the new model.
Aside from the projections by the IHME, it's also helpful to look at the trajectory of COVID-19 in other countries that dealt with the disease before the US had to. "I think we can learn from China in terms of how they implemented physical distancing measures as quickly as they could, and now they're seeing very minimal cases," says Dr. Kullar. In an interview with CNBC, former FDA commissioner Scott Gottlieb, MD, shared that what's happened in other parts of the world could suggest what will happen in the US. "If you look at other countries, the time between the implementation of the most restrictive measures, like lockdown and significant social distancing, to when they hit their peak in the epidemic, it’s anywhere from four to six weeks,” Dr. Gottlieb said.
Even after the coronavirus peaks and subsides in the US, another wave may hit. "The virus will still be here when things start opening up again; it happens in waves," says Dr. Kullar, adding that if the US begins opening everything up again immediately after the peak, "it can put us in another bad situation." Stefan Flasche, MD, a disease modeler at The London School of Hygiene & Tropical Medicine echoed this in an interview with CNN. "One scenario is we can indeed reverse the spread as done in China and South Korea, then reach a point to lift the distancing measures," Dr. Flasche told CNN. "But (we may) have to repeat this cycle for a few times because of an inevitable resurgence of cases in the absence of population immunity. In that scenario, we would see multiple peaks in the upcoming 12 months."
If IHME modeling is accurate, relaxed social distancing and greater demand to lift restrictions on businesses may mean greater opportunities for transmission of the coronavirus. That, along with the lack of a national plan for testing and tracing, has some experts worried.
As the World Health Organization Director-General Tedros Adhanom Ghebreyesus cautioned during a recent media briefing, the virus remains extremely dangerous. "Make no mistake: we have a long way to go," he said. "This virus will be with us for a long time."
The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.
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