A Tale of Two Worlds

Based on the possible conclusions presented in previous sections, there’s a possibility that countries might split in two classes: dancing countries and infected countries.

With hard work, dancing countries will have eliminated most internal coronavirus cases. They will welcome travel between them, with few limitations. However, they will shun countries that go for herd immunity, for fear of causing new outbreaks. Infected countries, in turn, might welcome visitors from all countries, since they have nothing to lose. Unfortunately, they might mostly receive visitors from other infected countries, since those from dancing countries won’t want to catch the virus and their countries may not let them come back without a quarantine.

This is another reason for countries following herd immunity to beware. They might have a hard time enabling their citizens to travel abroad, and struggle to keep their tourism industries afloat due to extensive travel restrictions to and from their origins

So far, I’ve only talked about countries, but the exact same logic is valid across regions. 

Within the United States, some dancing states have very few cases, such as Alaska, Oregon, Montana, Idaho, Hawaii or Maine. Infected states with bad outbreaks include Illinois, Iowa, New York, New Jersey, or Maryland.

We could imagine dancing states opening up for travel between each other, but preventing visitors from infected states or forcing a quarantine, like Hawaii and Alaska already do. States like California, Nevada or Washington might work hard to get to a level of prevalence low enough to get accepted to the club.

Conversely, some states like Iowa, Nebraska or Illinois might have such intense outbreaks that they decide to go for herd immunity. These could be joined by Southern states like Georgia, Tennessee or Mississippi. States in the middle might decide whether they want to belong to the dancing or the infected club. 

Something similar is being considered in many countries.

In Australia, local and regional travel is allowed as regions enter Step 1 (some already have). Step 2 will allow some interstate travel, and Step 3 will include international travel.

In Spain, where different regions will have different rights based on their levels of prevalence, travel to and from dancing provinces will be allowed, while infected provinces will have to work harder to stop their epidemics. The central government does not allow for provinces trying to reach herd immunity.

Conclusion

Countries that want to dance successfully might be able to do so with just testing, contact tracing, isolations, quarantines, masks, hygiene, physical distancing, and public education. On top of that, they might need to limit social gatherings until coronavirus prevalence is low and they figure out ways to limit contagions in these events. Throughout the dance, they will have to limit infections coming from abroad through quarantines, filtering measures at the borders, or outright bans.

The countries who do all of that well will be able to open their economies as well as travel between each other.

For the countries that don’t and end up pursuing herd immunity, their suffering will not be limited to the loss of travel from dancing areas. It’s worth remembering the cost in deaths, chronic conditions, ongoing outbreaks, and economic impact.

If the Transmission Rate R is 2.7, around 65% of the population might get infected, or around 214 million Americans. If the Infection Fatality Rate (IFR) is between 0.5% and 1.5%—which seems likely based on the most reliable seroprevalence studies—the death toll across the US could be between 1 and 3 million people. 

On top of that, there might be chronic conditions that emerge from the effect of the virus on lungs, kidneys, blood, brains… Reaching herd immunity would take months, during which the economy would be depressed since people will not want to go out, catch an infection, and spread it to their loved ones. Around 45% of Americans have conditions that would make the coronavirus very dangerous, such as diabetes, obesity, or simply being older. 

All of that will likely be worthless anyways, because they won’t be able to prevent further outbreaks: herd immunity through sickness doesn’t mean the population is now free of it. Outbreaks frequently re-emerge, especially if the virus behaves like other flu viruses and our immunity disappears after 1-2 years.

So the herd immunity strategy would be bad for the health and the economy.

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