Social Distancing 2.0: A New Normal
Q&A with Abram Wagner
Research Assistant Professor of Epidemiology
April 27, 2020, Alumni, Epidemiology, Faculty, PhD, Biostatistics, Coronavirus, Detroit, Epidemic, Epidemiology, Health Care Policy, Infectious Disease, Michigan, Social Epidemiology, Statistics, Vaccines, Women's HealthClick Here for the Latest on COVID-19 from Michigan Public Health Experts
We are all getting antsy, wondering when we can return to work, see our friends and family in person, and get back to some sense of normal. Meanwhile, we might notice a planned temporary hospital wasn’t built or that some data on the local news seems to show a reduction in the spread of coronavirus. What can we do with these emerging shades of gray in a situation that felt so black and white not too long ago?
We connected with Abram Wagner, research assistant professor of epidemiology at the University of Michigan School of Public Health, to help us think through these questions.
At the front of everyone’s mind is when we can return to some form of normal, whatever that might look like? Why are public health experts telling us that, for now, we should keep doing what we’re doing?
Coronavirus is spreading through the state at different rates. We had a really big outbreak in Detroit. We’re not exactly sure when that is going to peak. Hopefully, it already has—it seems to be plateauing a bit in the past week. It is spreading to other areas as well, including rural areas.
When stay-at-home orders work, we see fewer cases of disease. So then people think that it's less of an important thing.
People are looking for evidence that this is not a serious thing. Whether it’s a field hospital not being used or perceptions of how many people are actually going to get infected—certainly this influences their own beliefs on how effective social distancing measures are and how important the disease is. I'm worried that people will start thinking that the COVID-19 disease just isn't that important. In reality, it is causing serious disease not only in old people but in younger people as well. And it is a huge burden on the hospital system. Fortunately, our social distancing measures are working to an extent. So when the government says our projections of the number of cases are going down, that's because social distancing is working. It's because there are fewer people in contact with other individuals—so there is less viral spread in the population. When stay-at-home orders work, we see fewer cases of disease. So then people think that it's less of an important thing, and then they wonder why we have these recommendations in the first place.
What did we learn from other recent viral outbreaks and what concerns you about public discourse around our current social distancing measures?
There are protests in Lansing at the state capitol—people are really frustrated with all these restrictions. Some of it is the social distancing. But a lot of it is that some nonessential businesses are closed, so people are just stuck at home. They’re not able to work. This is a time of economic sacrifice for a lot of people, and I think in the younger generations, we've never really been told that we need to sacrifice for something before. Even after September 11, there was this idea that you could just go out and buy-buy-buy and make sure the economy is doing well.
We're in a different scenario now, where everybody is going to take some kind of financial hit. Hopefully, we can develop a stronger social safety net. But people are certainly upset about this, and that's understandable. Not everyone is seeing cases of COVID-19, when people don’t have a personal experience with a disease, they don’t always comprehend the severity of the disease. This can influence whether they think addressing that disease in the population is important or not.
My concern is that, if people become less compliant with social distancing measures over time, it will feed into a second wave of peaks.
In previous outbreaks—the 2009 H1N1, the so-called swine flu, or the SARS at the beginning of the 21st century—what we saw in areas hard hit with these viruses is that it starts with everyone being good at following government recommendations but that over time compliance goes down. Some of that is due to people becoming exhausted or apathetic. Some people think they are less at risk by the end of an outbreak. The problem with coronavirus is that we don't know when the end of the outbreak is. My concern is that, if people become less compliant with social distancing measures over time, it will feed into a second wave of peaks.
As we wait for a vaccine, what can we expect as some social distancing measures ease and we live in that new normal, where many of the behaviors we consider normal look completely different?
Vaccines take a long time to develop. Vaccines are already being tested in humans, but it takes a while for us to see if there is sufficient immune response, if protection against the disease develops in those who receive it. We probably won't see a vaccine on the market until the end of 2021.
Which means, for now, social distancing remains the only proven defense against spreading COVID-19. It is difficult to guess about the future. Some epidemiologists are modelers, and they make very detailed, educated guesses—they do try to predict, but they offer a range of predictions depending on the actions we are taking. My own hope is that we can get the number of cases sufficiently low so that instead of having really broad stay-at-home orders and really rigid social distancing measures, we can shift to focusing more on contact tracing as a way to limit the spread of disease.
What will the new normal be like? There will be halfway points. We will have to shift our thinking over the coming months.
This outbreak is particularly difficult in certain homes, such as single-parent households. Think of a mother who has a kid or two and also needs to work and probably lives in a smaller living space. There are examples of multiple families clumping together and sharing childcare duties. This can work. Think of it as a monogamous family relationship, where you have to believe the other family is not going out and sharing germs with other people. If you can trust another person or family not to cheat on you—that they're not going to have all these contacts with other individuals and exposures—then sharing childcare duties seems a logical step in making sure that, if people need to return to work, they can.
What will the new normal be like? There will be halfway points. We will have to shift our thinking over the coming months. The more rigid stay-at-home orders and social distancing we have now can't be in effect perpetually. Eventually, we will have to ease them a bit. But will it look like when we do?
Right now our stay-at-home orders in Michigan extend into May. I could see us at least through June having another series of stay-at-home orders, maybe with some easing of certain restrictions. But this will have to follow what the epidemiology of the disease is telling us. I can't predict politically what will happen, but I hope they continue to look at what the disease looks like in our state, what it’s doing in surrounding states, and make sound policy decisions based on that.
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