Dear Friends, Prepare For A Marathon

Dear friends - I hope you had a restful weekend with loved ones, getting outside in the fresh air a little, and practicing social distancing. I noticed many spokespeople on the news and social media talking about the coronavirus “first peak” being over and the possibility of a bad “second peak in the fall”, with great treatments and a vaccine coming soon.

I'm writing because I'm 90% certain our leaders are painting an overly optimistic picture of how the next few months are likely to unfold, and I see many, many friends contemplating "returning to work" as though this wave of the pandemic is nearly over — when in actuality our leaders should be educating and preparing us for a 6 month - 3 year marathon, and unfortunately most are not. Here's the real deal:

(1) The first peak is over for NYC, but not for the rest of the country. 20% of New Yorkers got infected and 18K have sadly passed away, but only 2-3% of Americans in the rest of the country have been infected and we’re still just in the **first inning** of this deadly ballgame (despite 68K deaths and counting). In most of the rest of the country we have not reached a peak yet, because hospitalizations continue to rise and tens of thousands of new infections are being discovered every day.

(2) Ten states will be coming out of lockdown in the next week (if they're not already) — almost certainly too early, because only a few places in the country have a proven R0 much less than 1.0. Many other political leaders will come under increased pressure to open up, and its my guess that forty States will be “back open” before May 25. 

(3) Here’s a key point — since hospitalizations and deaths lag behind 14-21 days, the month of May will increasingly seem like, “Hey this isn’t so bad, maybe we really are on the downslope”. We will feel this way even while deaths and caseloads continue to rise:

The chart above is from the CDC website, a summary of the ten best projection models

(4) Once the lockdowns are rolled back, and May (possibly falsely) seems like things are getting better, many Americans will start doing what they usually do in May, and too many are likely to become complacent and ignore social distancing guidelines, go back to work in-person, meet with friends, go see older family members, host and attend "small" events with 5-20 people, and generally do things that bring the contagion back to life.

(5) In my humble opinion, people on TV shouldn’t be talking about a second peak in the fall as though that's the most important concern (although that's likely to happen too). This talk is part of what's making people feel like the first wave is over. It’s **much more likely** the second peak will come sooner in June/July in the form of tens of semi-simultaneous peaks happening all over the country in local, regional hotspots. Think Chicago, think Miami, think DC Metro, big cities with compressed populations. A few regions of the country will get R0 significantly below 1.0, and could have outcomes like South Korea and Singapore, but many will not. And to repeat, since I haven’t seen this being reported anywhere yet, this “second peak in many places” is very likely to happen in June/July, well before the fall.

(6) The only way out of this dilemma is smart, science-based and nuanced leadership that can educate the public that (i) we need to keep up social distancing as much as we can; (ii) if we have to go out, we should wear masks; (iii) the economy can and should re-open, but (iv) it’s not the restaurants and hair salons that everyone should be focused on, it’s the food, water, housing, medical, manufacturing, construction, energy and charity segments of our economy that account for many more jobs, and are most essential for keeping people healthy and alive; and (v) We need to keep large indoor gatherings with circulating A/C to a minimum, this is how the virus spreads powerfully, indoors through air on microscopic droplets of water.

(7) New treatments and a vaccine are the only way to get truly back to normal, but really good vaccines at scale are 12-36 months away (18 months is an optimistic scenario). This is an incredible New York Times article about how difficult it will be to discover, prove and scale up a new vaccine in 18 months, normally this might take 5-10 years. 

Please keep safe, stay positive even though our prognosis is not great right now, and spread the word that the coronavirus is still (unfortunately) most likely on path to 250K-1M American deaths by the end of 2021. We’ve slowed it down through shared sacrifice over the past 8 weeks, but we’re now entering a new 8-week phase where we don’t have great leadership, our education program has been scattershot, the economy actually has to open-back-up somewhat, and we don’t have enough testing.

Please keep up the social distancing as much as you can, encourage those you know over 60 years old to stay inside, help them make it another 8 weeks if you can, and spread the word: this is likely to be a long, long marathon and we're still just in the first inning.