The New COVID Normal

Last week, California, Oregon and Washington began formulating principles for a regional plan to return to work and education and a degree of socialization. The governors of these states are setting high barriers and using science-backed criteria to evaluate when we can re-emerge into our neighborhoods and communities. Most of California will soon be ready to move forward in terms of having seen a peak in cases, and all areas having sufficient hospital capacity to handle a resurgence. Now the devil is in the details, and with more vague criteria set out by the federal government, how do we proceed exactly?

What opens first? Under what conditions? At what pace do we expand opportunity for commerce and grouping of the less vulnerable (such as elementary school children) without stoking a resurgence? At what level of COVID-19 treatment success – it will never be perfect – do we throw caution to the winds and emerge from our isolation? Even as things do re-open, it is still going to be important to realize this is not a sudden return to our prior “normal.” For at least the rest of this year, we must adapt to our new “COVID normal.”

This still means no handshakes, no large gatherings, continued physical distancing, enhancing social connections via other means, continued aggressive hand hygiene and the continued presence of face masks in public spaces. Even if we develop treatments for the most severe aspects of the disease, no one wants to spread a bad flu. It is still debilitating for many even if it does not force hospitalization. For many people such as older adults, immunocompromised and others in at-risk categories, it will still be crucially important they continue to shelter-in-place and carefully protect themselves against potential exposures until a vaccination is available.

We are at a crossroads. The choices we make now will resonate for months, if not years. Bad choices will cost lives. Deaths are still climbing around the world, in the U.S., and in our region. Each day this week, more people died from COVID-19 than any day previously. More than 40,000 Americans have died, and that heartbreaking total will continue to climb.

But it feels as if there is sunlight peaking over the horizon from the dark times of COVID-19. We are cheered by reports of slowing infection rates and flattening curves. It’s spring and it might seem harmless to cheat just a little on our isolation. But if everyone feels that way – we are all sick of our cabin fever - those slips can put us back on an arc of more infections, overwhelmed resources and deaths that could have been prevented. That would mean an extended period of more sheltering-in-place.

To understand why, look at the current infection rate. We have indeed flattened the curve – a phrase virtually unknown to most people two months ago and now a catechism for fighting back at COVID-19. The rate continues to grow more slowly than earlier models – but the crucial point is that it continues to grow, and we still don’t know when it will peak. It may still be a month or more away here in Northern California. As Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases has said, the virus sets the timetable.

 At UC Davis Health, our chair of public health, Brad Pollock, is a nationally-respected modeling expert. He’s been evaluating many models to find the ones that have been the most consistently on target and that apply to Sacramento and California. Part of the difficulty is that the larger models don’t work for us, or for most of California, because in this state we actually have three different epidemics – one in the Bay Area, one in Los Angeles and one in Sacramento. Extracting precisely where we sit in terms of peak infections and the length of the epidemic here takes a combination of scientific detective work and leaps of faith that people will continue their excellent behavior of physical distancing, washing our hands and, now, wearing masks.

In addition, those who are most vulnerable – the homeless and those in nursing homes – need constant surveillance testing and care so they don’t become an incubator of a new local epidemic that could set back our whole community. It won’t be their fault if that happens, it will be ours for not providing the resources and help they continue to need right now. We are working closely with the Sacramento County Department of Health Services to put our expanded testing capacity at their disposal for just this purpose. We should soon be able to do 1,000 virus tests per day and the same number of antibody immunity screens per day.

So, what do we do now? We keep fighting. We can’t shelter in place for an entire year. But we can keep fighting the virus by smartly continuing to protect ourselves – and others. That means sheltering in place a bit longer, and when that’s done, continuing rigid social distancing in public, frequently washing hands and wearing masks until the disease has run its course in the large majority of people. Soon, the new “COVID normal,” will become a phrase as common as “flattening the curve.” We will still follow many of the current precautions for months more, and possibly until a vaccine is developed.

What we can also do is trust science and the scientific method. Impatience won’t stop a pandemic, science will. We can’t just wish for cures, we have to find them with hard work and real, peer-reviewed science to be sure they’re actually effective. We also have to be sure to prevent false cures from harming people. We are conducting research at UC Davis, caring for patients, participating in clinical trials to develop treatments and working toward that vaccine. The longer we hold out as a community, the flatter the curve, the farther along science will be in that research if a surge does hit.

We don’t know how many more people will get infected with COVID-19 or how many more people will die. We don’t exactly know how flat the curve will be or how long that infection rate will continue to rise. We do know social distancing works. We know that hand hygiene and protection against droplet transmission works. We’ve learned all of this at UC Davis since treating our first COVID patient two months ago – and other university-affiliated medical centers are sharing these same findings.

Sheltering in place has bought UC Davis Health and hospitals throughout California precious time to prepare and to work toward treatments and cures. Now, every day we stay strong, every day we follow every science guideline, is a day when each of us has saved lives and moved us all a step closer toward the time that will come sooner rather than later when we walk out into that sunlight on the horizon.