The Daily - The Next Year (or Two) of the Pandemic

Episode Date: April 20, 2020

As President Trump urges states to begin reopening their economies, a debate is raging over when and how to end lockdowns across the country. Our reporter spoke to dozens of public health experts to try to understand our path out of lockdown — and how our world will change in the meantime. Guest: Donald G. McNeil Jr., a science and health reporter for The New York Times. For more information on today’s episode, visit nytimes.com/thedaily. Background reading: While the economy is likely to reopen slowly, there is hope that society will adapt to manage the uncertainty of our new circumstances. Here’s what experts say the next year (or more) will look like.

From The New York Times, I'm Michael Barbaro. This is The Daily. Today, as President Trump urges states to begin reopening their economies, a debate begins over when and how to end the lockdowns. Science reporter Donald G. McNeil Jr. on what that might look like. It's Monday, April 20th. So Donald, we have come to you

at just about every turn in this pandemic to understand what's next. And the portraits of the future that you have painted for us each time we talk have been strikingly accurate. You told us all the way back in February to prepare for lockdowns. Those happened. You told us to prepare for high death rates. You said that people we know would die. And that, sadly, has happened. You warned us of shortages of medical supplies. That too has happened. Just about everything you said would happen has more or less happened. So I want to turn to the next installment of this kind of rolling conversation we've been

having with you and start with a question that I think is on everyone's mind right now, which is when and how we start to reopen our society and what that would look like. Okay. Well, look, I'm not some dark angel who's simply looking into the future. I'm talking to experts. I'm looking at the other pandemics I've covered. I'm talking to medical historians and making predictions based on data. And so

I think a lot of people think that by May or June or August, we're going to return to something like normalcy. But all the experts I talk to say, no, that's a fantasy. Why is it a fantasy? Well, because if we all tried to come out at once, everything would look cool for about three weeks. And a week or two after that, the emergency rooms would start to fill again and people would start to die again. I mean, flattening the curve is a notion that people love. But when we say we're flattening the curve, no, we're plateauing at a very high level of the curve. That means a steady rate of deaths. So what we want is to see the lockdown last until

we get back down to close to what the normal baseline rate of deaths is. And it's going to be piece by piece. You know, we might be able to let a certain number of people ride the subway each day, you know, people still staying apart from each other. You know, we're be able to let a certain number of people ride the subway each day, you know, people still staying apart from each other. You know, we're not going to be able to let people sit next to each other in football stadiums. Maybe the team will play on the field and there will be some cameramen in the stands, but it's not going to be the way it was before. Okay, so if there's not going to be any kind of single moment where the curtain goes up and life resumes. What does a lifting of these lockdowns start to look like? Well, the best description I heard of it was in an article. It was on March 19th by Thomas Pueyo, a writer in San Francisco, and it was called The

Hammer and the Dance. And the hammer is the lockdown. You know, there was no question of social distancing light. It was more like, bam, everybody has to go into their houses. But then once you get the deaths down to a minimum, then you begin the dance. And the dance is dancing a little bit out and opening up some of the restrictions and seeing, you know, how far can you let people go? And then you see what that does to death rates. And once the death rates go up, you have to go back and leave the dance floor

and go into lockdown again. So, and it repeats again and again, and this is dance in, dance out, dance in, dance out. And basically that's what the epidemiological models show we have to do. So in this scenario, tiptoeing back to normal happens. And if there is a resurgence in infections, then the hammer comes back down.

Exactly. So let's talk about what the opening starts to look like. Describe the dance. Okay. So the dance is you have this whole list of things you can ask people to do, one of them being wear masks. Another one is sit six feet apart from your dining companions at a restaurant. So a restaurant that had 100 customers before now has about 10 customers in it. You have to cut down travel between cities because people from a hot zone, like New York recently, could go to a cool zone and start infections. International travelers will have to be quarantined for 14 days so that

we're sure they're not infected when they come in. So we will have to find restrictions on people's movements that keeps them from getting too close and letting the virus spread again, because when the virus spreads, deaths follow. Okay, let's get a little more specific here. What does the dance mean for, let's say, schools? Well, schools is a big mystery because we don't know much about the virus in children. Very, very few children get hospitalized and die. It happens, but it's very uncommon. But the question is, how much do the kids get the virus and transmit the virus?

Because if you open schools, the children may be fine, but the teachers won't necessarily be, and the children's parents and grandparents won't be. So mayors and governors are going to have to decide, you know, maybe we're going to open school for two weeks and see what happens. Or maybe we're going to, you know, let half the kids go to school this week, but have them sitting six feet apart. And then next week, the other half of the kids get to come to school. And Don, what about the typical workplace? From the way you're describing schools, it sounds like at the very least, people at an office or a factory would need to be six feet apart. What else? Well, it depends on what you mean by the average workplace. Are you a construction crew? Are you

an office like the New York Times? Are you a factory? Are you a food processing plant? Every one of these is different. And for those of us who work most of the day on computers, there's not a whole lot of reason to go back to the workplace. I mean, it may be more of a source of danger than any advantage you get from being there. Whereas if you work in a chicken processing plant, you got to be near the chickens. So somehow they're going to have to stretch out those chicken disassembly lines so that people can do it safely without infecting each other. And they'll have to wear masks, and maybe there'll be plexiglass between the workers. There's lots of measures you can take, and they're going to be different for every single workplace.

I want to talk for just a moment about geography, because I wonder if the scenarios you're describing would apply as rigorously in one part of, for example, the United States as another based on issues like density or the cycle of this virus. There are many places in the United States that have been largely untouched by this virus, or there are places like Washington State where it seems the virus has turned a corner. So would this hammer and dance scenario apply in the same way to every corner of the country? Or could it be applied more lightly or more severely based on density, based on number of infections? Yes and no. I mean, it's a fantasy to believe that there are any parts of the country that are untouched by this virus. I mean, it is much more intense in some places like New York and New Orleans and Detroit, but it's everywhere. I mean,

if you look at any map of cases, it's certainly in every state. It's in multiple counties in every state. So it's going to have to be different techniques developed for not just for every state and every county, but for every work situation, so that you are not transmitting virus to each other. Donald, is the point of the hammer and the dance to avoid having the rest of the country get infected? Or does it simply slow a kind of inevitable version of mass infection, but not prevent it? It slows it down. I mean, a certain amount of infection is inevitable because emergency workers are going to have

to be at their jobs. Medical workers are going to get infected. There's going to be a certain level of infection at all times. But you want to damp it down to the minimum. But all the models say that maybe 3% of America is infected by now. The other epidemiologists think maybe it's 10%. That 10% is a pretty high guess. So that still leaves 300 million Americans uninfected. So we're a country that's somewhere north of 90% susceptible. And each time we do the dance out and dance in, we chop a few more people off that susceptible list.

A few of them are dead. A bunch of them become immune. But it only proceeds in fits and starts. Maybe we go three million at a time, three million at a time, three million at a time. You know, it's not a fast process. And how long do the experts you talk to say that this dance will need to occur? At some point, do we stop dancing and we just get to go back to normal? The dance will end when we have a vaccine that we can all take, or if we have a prophylactic

pill that will protect us all, like PrEP protects you from HIV. Or when so many of us have become infected, you know, 70 plus percent have become infected and the virus dies out or slows down just because it can't find any new victims to infect. But making a vaccine within 18 months is extremely optimistic. The record we've ever had for producing a vaccine is four years. That was the most vaccine produced back in the 50s. Hmm the 50s. We've got new techniques that speed it up, but some things can't be sped up. And then after we design the vaccine, we have to think about producing the vaccine. If we need 300 million doses of vaccine, or if we need two shots, if we need 600 million doses of vaccine, that's a gigantic undertaking.

I talked to some vaccine production experts and they said the average vaccine plant in America makes five to 10 million doses. So we've got to find some way to make 300 to 600 million doses of vaccine. And we have to start planning now, even before the vaccine exists. Don, you just said that the record

for making a vaccine is four years. Are you saying that there is a version of this where this dance in the hammer and dance metaphor goes on not for one year, but something like four years? You know, that's a kind of worst case scenario as far as timing is concerned. Everything may get lowered in this. We may test vaccines in a way that we would think of as ethically unthinkable in normal times. We may go with somewhat lower safety standards for vaccines because we're facing a situation where life is dangerous. But yeah, the fastest human vaccine ever made was mumps, four years from start to finish.

four years from start to finish. So I just want to be clear. Is there a world, according to the experts you're talking to, who say the world of tiptoeing out and coming back and realizing that there's a resurgence and then tiptoeing back out again, that that could last years? Yes. And during that, the virus lasts? It doesn't die off in the hot summers. It doesn't... There is zero evidence that this virus dies off in hot weather. I mean, the virus is circulating now in India, in Brazil, in Australia. I mean, you name it. Very, very hot environments. Exactly. There's no evidence that it's going to die out in the summer. Don, I'm willing to speak for many listeners when I say that the idea of living in masks with everyone sitting six feet apart and the expectation that a viral resurgence might mean that even that becomes too risky and so everyone goes back under lockdown, that that could go on for years is really pretty depressing and kind of hard

to wrap one's head around. I know. But if we don't go into a dance, means there's going to be more infections and more deaths. We'll be right back. We'll be right back. Don, during this period, it feels like not everyone is going to be on equal footing in the sense that some of us will have been infected and will possess some kind of immunity to COVID-19, right? And many of us, of course, will not have been infected and will not possess that immunity. So how does that factor into this give and take this dance you're describing? Well, we're already seeing this happen. There are a very small number of people now who are immune and they're very much in demand. They're in demand for their blood because you can harvest antibodies from their blood.

They're in demand for doing medical jobs that are dangerous, like intubating patients, because they can do it without fear of infection. They'll be in demand for all sorts of other jobs, because they can travel anywhere, they can do face-to-face interactions with customers without any fear. And they're going to be sort of a special class in society. They'll be at sort of different standards, different ways of living for two different classes in society. So say you're an immune and I'm not. I basically have to stay inside here and hiding. And I'm depressed as hell about it. I have a granddaughter who's going to be born in June, and I sit here in my apartment thinking I may not see her until she's two years old. I mean, that's

horrible to contemplate, but it may be a fact. Meanwhile, you, as an immune, could go visit my granddaughter or go out and take my job or... No one can take your job, Donald, just to be clear. Not a whole lot of people want my job. There'll be a sort of different standards, different ways of living for two different classes in society for a while. It's quite science fiction-y. It's kind of dystopian. Right.

I mean, that kind of a societal schism, right, between the immune and the still susceptible, it would seem to require a few pieces of firm knowledge. One is that there's a widespread ability to tell who is immune versus who's not. And the other piece of knowledge is that we know for sure that being infected confers immunity. So how do you resolve either of those? We don't know those things yet. We don't know them for dead sure. But as Tony Fauci says, you know, usually when you recover from disease, you're immune for a while. But we don't know how long the immunity lasts because this disease has only been around since November at the earliest. Are there plans? Do you envision a universe in which people literally wear some sort of sign that they are immune and that they can be rigorously proven.

Yes. I mean, that's already beginning to take place. Germany is talking about issuing certificates, but you don't want something you can pass from person to person. So China takes people's cell phones and has a QR code that you read as you come into the subway, you come into a restaurant, you come into any place where somebody can check your phone, and that readout tells the person looking at your phone that you're immune. So yeah, I mean, people are already thinking about this. In the scenario that you're laying out, immunity and the ability to show immunity would seem to be incredibly desirable and might create some very complicated incentives. Yes. People are going to be tempted to become immunes and to do it the chickenpox party way. What do you mean?

To deliberately infect themselves, hoping for the best, but that they emerge at the end of it as an immune. I mean, that temptation is going to be enormous. You're describing deliberate and perhaps large-scale acts of self-infection. Yes, I am. There is a lot of historical precedent for that stuff. In the years before smallpox vaccine, people used to take pus from the blisters of smallpox victims or dried up scabs from smallpox victims and put the pus into a, you know, stab a little hole in their child's arm and put some of the pus in there or blow the scabs into your nose. And that would give you a usually mild case of smallpox. And I talked to an immunologist who said, look, the child had about a 1% chance of dying. And the parents recognized that. And that was better because if you had a smallpox

that didn't come through, usually about a third of the susceptibles died. So if you had six kids, you might think hard about giving them all a little bit of smallpox in their arm. Don, what you're describing is a very calculated risk that some people may take to self-infect. And I wonder just how dangerous it may be if people miscalculate. With the virus acting the way it is acting now, it's very dangerous. We know that there are people who are more at risk, but we also know that it's unpredictable that young, athletic, healthy people totally unpredictably end up on a ventilator and a few of them die. So it's people making life or death decisions for freedom.

And a paycheck. And a paycheck, yes. Everything that you're talking about here seems to assume the absence of a successful treatment and a world where we're pretty much waiting for a vaccine. Could that change? When we've asked you this question in the past, you have said that there wasn't a viable treatment. Do you have any sense that that may be changing and that a treatment might come before a vaccine?. Do you have any sense that that may be changing and that a treatment might come before a vaccine? I don't have any sense that it's changing in an important way. There is something that doctors place some hope in, and that is taking the blood from people

who've recovered from the disease and removing the red blood cells and the white blood cells and everything else and leaving just the antibodies. Those antibodies glom onto the virus and neutralize it. And so you can inject them into somebody who's sick. But it's a technology that is not fast moving. So it's not in the immediate future, but scientists are hopeful that it's in the midterm future. So in other words, for the time being, we are left pretty much with the hammer and the dance as our most practical solution. Exactly. So Donald, with everything that you just said in mind, I want to return to that first time we ever spoke. Because when we had that conversation, you were well ahead of

anybody else in preparing us for what the pandemic would mean on a personal level. You told us about your stockpile of food, your month worth of medicine, and you told us that we should be prepared not to see our friends and our family for a while. And all of that proved prescient. But there's one area where I recall you perhaps underestimated something. You said, be prepared for a couple of months of something that might look like a lockdown. And now it's feeling like it's going to last a lot longer. So with that in mind, what preparations are you making now that the rest of us may end up making for ourselves in the coming days, weeks, months to prepare for that new reality? I mean, I'm busy. I'm working harder than I've ever worked before. And that's given me

a sense of purpose that gives me some psychological stability that a lot of other people don't have the luck to have. I'm thinking about, you know, what am I going to do to entertain myself? I'm thinking of buying a fishing rod and becoming one of those old guys on the piers who's, you know, fishing for bluefish. I mean, I like trout fishing, but it seems unlikely I'm going to get away and do that for a while. So it's just, you have to sort of mentally prepare yourself to these things. And be it said, I have visions for the future that are rosy. And that keeps me going too. You do? Yeah. If you look at the periods after World War I and after World War II, I mean, not only did the economy come back after both those periods. I mean, remember, after the one-two punch of World War I plus the Spanish influenza, we had the Roaring Twenties.

a period in which, in Europe, the War Widows and Pensions Fund became the European welfare state. War profiteers suddenly faced higher taxes and a lot of scrutiny. People had pretty much had it with the rich by that time. And they wanted more. They wanted the GI Bill. They wanted federally sponsored mortgages for housing. They wanted better healthcare. And to some extent, they got it. I mean, I was born in 1954, and my parents were of the generation that had made it through the Great Depression and through the Second World War. And they had a different attitude on life. They had a sense of, hey, we did this incredible thing. We did it all together. We got through it. did this incredible thing. We did it all together. We got through it. I hope that sort of era comes again, that people will take more pleasure in small things in life and that we will do more to make sure that we take care of each other and that that'll go through all levels of society.

And like I said, I try not to predict the future, but maybe something like that will emerge from this. Well, of all the visions that you have given us, I like that one the best. Me too. Donald, thank you very much. Thank you. On Friday, Vice President Mike Pence declared that states have sufficient amount of testing to begin the process of reopening their economies, a claim that governors in multiple states immediately rejected as untrue. It's not accurate to say there's plenty of testing out there and the governor should just get it done.

That's just not being straightforward. In interviews on CNN on Sunday, the governor of Maryland, Larry Hogan, and the governor of Virginia, Ralph Northam, said they would need significantly higher levels of testing before they would consider lifting their lockdowns. That's just delusional to be making statements like that. For the national level to say that we have what we need and really to have no guidance to the state levels, it's just irresponsible because we're not there yet. We'll be right back.

Here's what else you need to know today. Demonstrators took to the streets in several states across the country over the weekend to protest stay-at-home orders that they said were destroying the economy. I hope Whitmer understands that she's not just going to be able to rule Michigan like other politicians rule, you know, China or something like that. You know, we're going to take our liberties and we're going to keep them and we're going to fight for them. The protests, which drew hundreds of people in Michigan, Texas, and North Carolina, among other states, were largely organized by anti-government activists and libertarian groups and were encouraged by President Trump, who took to Twitter to urge residents to liberate their states.

But polling shows that most Americans support the lockdowns. A recent survey by Pew Research found that 66% of respondents feared that states would lift restrictions too quickly. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.