It turns out there are quite a few factors that contribute to the rise and fall of a pandemic, some within our control, some that are not. An outbreak becomes a pandemic when it meets two criteria, first, it spreads rapidly and widely, and second, it must qualify as a severe disease. If either of these factors change, it is no longer considered a pandemic. For instance, the common cold spreads quickly and to many hosts, but is not severe in its implications. In contrast, polio is a severe disease that was once widespread but now only occurs on very rare occasions. Neither polio nor the common cold now fit the definition of a pandemic. 

Slowing the Spread

While it’s not definitive, chances are that by September 2021 we will see that COVID is no longer considered widespread. This may happen months earlier or a year later. But by September, we will have made it through a cold and flu season, and it is also likely that we will have a vaccine by that point. Several pharmaceutical companies are in stage 3 trials with COVID vaccines, and there’s a good chance a workable vaccine will be available sometime around April. 

While a vaccine will be helpful, it’s likely it won’t be foolproof. It may only be 60% effective against the disease. However, even at this rate, it could still contribute to a significant decrease in cases within several months of its release. 

It’s also important to keep in mind that this is extremely fast in terms of vaccine invention. On average they take about 10 years to test and develop, with the fastest being released within 4 years. To get a vaccine to the public in such a swift amount of time is a feat in itself, but one that also comes with its own precautions. In addition to the fact that it will likely not be 100% effective, it will be important to review clinical trials and research before deciding if getting the vaccine is right for you or your family. 

When in Doubt, Stay Home

In the meantime, it is still critical to minimize contact with others and to stay home even if you think you only have a minor cold. Some of the common symptoms of COVID are very similar to pedestrian respiratory ailments, and if you have yet to be tested it’s best to stay home and keep yourself from spreading any germs to others. This means all adults in the household staying home from work, and keeping kids home as well. 

Once a person shows signs of respiratory infection, it’s safe to assume they were contagious several days earlier. That means other members of the household will be contagious within a couple of days after the first symptoms are displayed, so keeping everyone home until at least one of the first family members with symptoms  can get tested is the safest thing to do. What makes this more complicated is the presence of smoke and environmental allergies at this time of year in many parts of the world, but again, symptoms that are also symptoms of COVID should be taken seriously, even if they do not appear to be severe. 

There has been a rise of COVID cases in the wake of Labor Day gatherings. At this point it’s hard to tell if this due solely to the holiday or if it is signaling the beginnings of a fall surge, but either way it’s cause for concern. Labor Day is not considered a major holiday, and is often celebrated outside. The ripple effect will be far greater if people gather en masse indoors during the winter holidays. 

A Milder COVID-19?

The second factor in a pandemic, a disease’s severity, may actually change before its ability to spread rapidly does. We now know that the severity of a COVID case is directly correlated to how many viral particles a person comes into contact with at the onset of the illness. Wearing masks, washing our hands, and social distancing all play a role in reducing the number of viral particles that are able to enter the body. 

While it’s hard to determine an accurate number of all COVID cases that have occurred, we do know the numbers of those who have been hospitalized and their mortality rates, and rates of hospitalization and mortality appear to be falling overall. In addition to the previously mentioned safety measures, doctors are also getting better at understanding how to treat the disease, though a vaccine has yet to be released. It may be much less serious by April 2021.

When Can Kids Return to School?

While hospitalization and mortality rates are dropping, which is a positive sign, it is unfortunate that the number of COVID cases is still on the rise in most states. This means people are still contracting the disease, but fewer are in need of emergency care. It is wise to see the curve flatten or go down before sending children back to school. Typically, this means a rate of no more than 7 new cases per day for every 100,000 people in a state or community. 

We know that children can contract the disease, but fortunately, their cases are not usually as severe as they are for adults. As of data compiled on September 17, 2020, more than 580,000 children have had confirmed cases of COVID. While that sounds like a lot, it’s important to put this number in context. 

Children under the age of 18 make up about 20% of the population in the U.S. Logic would then say that 20% of all COVID cases are children, but that is not what the data has revealed. Only about 10% of all COVID cases are children, and on top of that, only 1.7% of all COVID cases requiring hospital care are children. Coincidentally, only 1.7% of children who test positive have ended up hospitalized. That means if your child gets sick, there is a 98.3% chance they will not need to go into the hospital for treatment. 

That being said, sending kids back to school at this point, while COVID rates are still on the rise, would likely lead to greater spread of the disease. Another facet to this is the fact that, while it’s great that kids tend to fare better than adults when infected, being in school almost certainly means a viral spread between children, which then reaches their families and their teachers, and adults are 10x more likely to end up in the hospital. 

Testing, Testing

There are currently some accessible COVID testing kits on the market, with more to be produced in the near future, some at $5 or less. Greater access to tests will help people to make better-informed decisions and therefore reduce the spread. However, it’s important to know that not all tests are the same. PCR tests, for example, can detect as few as 10 viral particles. Antigen or antibody tests might not be able to detect COVID until viral particles are in the tens of thousands, meaning it is possible to get a false negative. Using these tests, it would be possible to determine that someone is not contagious for the next 24 hours, but a negative test would not rule out infection after that. This kind of test is good for determining if a child could safely go to school today without spreading COVID, and that could help us all get back to our daily lives.

A Post-Vaccine World

At this point it’s hard to know how much of a change having a vaccine will make, especially early on. At a certain point it will likely make the spread more contained. COVID could become more like a regular cold and flu season. It could also be comparable to disease epidemics in the past, such as the measles, which are now mostly contained with only occasional outbreaks. While it’s hard to know how long it will take, the likelihood is that we will eventually get to the point where COVID becomes very manageable: the spread will lessen and the severity will be more controlled by keeping the inoculum low. 

A Lesson from History

If we look back 100 years to 1920, the Great Flu Epidemic was coming to an end, but it was also an election year, and a time of shifting in the political landscape around the globe. On a cultural level, the prevalence of jazz, baseball and movie theatres brought people together for entertainment in a way that hadn’t been done before. People were able to gather once again. 

While the experience of this pandemic has been trying and tragic, we are also on the brink of the “next normal.” The things we’ve learned during this time can be a great compass in how we’d like our world to look next. We can determine how we want our lives to change for the better, and that is a valuable gift. 

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Alan Greene MD contributor

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