How will this end?

Some say widespread infection is the only way out

IT’S THE QUESTION everyone wants an answer to – but no one knows what the answer is. How will this end? Americans cannot remain holed up in their homes forever, but what circumstances will allow society to reopen safely, despite the coronavirus?

In a fascinating and provocative piece in The Boston Globe’s Ideas section on Saturday, Northeastern journalism professor Jeff Howe argues that the only way to eliminate the spread of COVID-19 is by developing herd immunity – achieving a threshold where enough of the population is immune to the virus that it can no longer spread significantly. Without a vaccine, which experts say is at least a year away, Howe says the only way to do that is through exposure.

“It’s easy to forget that if a disease can’t be contained — and it’s too late for that in the COVID-19 pandemic — then there’s only one possible ending to the story: We must collectively develop immunity to the disease,” Howe writes. “In lieu of a vaccine, that means most of us will need to be exposed to the virus, and some unknowably large number of us will die in the process.”

Howe cites research showing that the more successfully Americans “socially distance” now, the more likely the disease will spike later. He argues for “controlled exposure,” periods where some segment of the population – presumably those least at risk – resumes normal activities, alternating with periods of restrictions.

Todd Ellerin, director of infectious diseases at South Shore Hospital, speaking to CommonWealth for a story on the implications of COVID-19 immunity, made a similar observation — that social distancing is at odds with achieving herd immunity. “Social distancing flattens the curve but doesn’t break the chain of transmission,” Ellerin said. “What breaks the chain is immunity, and the way you get immune is you get infected.”

This doesn’t mean Massachusetts is wrong in pursuing social distancing, which is vital to ensure that the health care system does not get overwhelmed, as happened in Italy. “Flattening the curve,” or slowing the spread of disease, means hospitals have time to ramp up capacity, and researchers have more time to develop treatments and potentially a vaccine. Both those things can save lives.

But it remains an open question how society will reopen after social distancing, as long as the coronavirus persists. Some have suggested alternating periods of relaxing then resuming social restrictions. It is likely some industries will open before others – for example, construction work may resume before large concerts can be held. On Monday, several northeast governors, including Gov. Charlie Baker, announced that they have agreed to coordinate re-openings between states.

Baker, asked Monday about reopening Massachusetts, said a lot of work is being done around preconditions for a “soft opening.” “I don’t think anybody thinks you can just flip the switch at any point in the not-so-distant future given the surge is not the same everywhere,” Baker said.

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Shira Schoenberg

Reporter, CommonWealth

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

Baker said the state will have to pass its peak of infections; there will need to be safety standards in place for things like social distancing; and the spread will have to be reduced to where one person is unlikely to infect more than one other person.

Baker said a big part of reaching that point will be having enough testing capability to know what percentage of the population has been infected. Baker participated in a call Monday with Vice President Mike Pence and other governors, which was all about testing. “The fundamental notion is we need to do a lot more testing because that’s a big part of surveillance if we’re going to get to the point where we can start thinking about how do we make people believe it’s safe to go back to work, safe to going back to doing the things they did before,” Baker said.