President Donald Trump says he would like to see "the country opened" by Easter, which is only three weeks away. Unfortunately, relaxing national vigilance and movement restrictions aimed at preventing more covid-19 infections that soon would be like throwing a drowning person a life raft and then shooting it full of holes.
Based on everything we've seen so far in this pandemic, it's reasonable to assume that the United States already has rampant community transmission across the country. Urgent action is needed even when case counts are relatively low because of the length of time that the most severe infections last, and how long it takes them to get severe. A lot of covid-19 disease is probably gone within a few intense days. Some people are only minimally symptomatic - but they can still pass the virus onto others, who might get much sicker. How many, exactly, we don't know because we still lack adequate testing.
The worst ones though, tend to take their sweet time getting there. In the pandemic's epicenter of Wuhan, China, the peak demand for ICU beds came four weeks after the lockdown started in late January, at which point a little fewer than 500 cases had been identified in the city.
The people that covid-19 is going to kill in a month in the United States are already infected - even if they don't know it yet. Think about that as the ICU demand climbs remorselessly, and remember that we have not implemented restrictions that come anywhere near what China put in place.
Could we? Across the nation and the world, businesses are shuttered. Schools are closed. Gas stations are usually busy places, but the business is dwindling. And the clamor grows, understandably. When can I go back to see my friends at my beloved local sports bar? The Dow is down, and recession beckons. It seems an awful choice: You can have the economy, or you can have health care, but not both.
Social distancing will not last forever, though. The country does not need to confine to quarters for 18 months until a vaccine might be developed, nor will the 14-day staycation many people have already embarked on suffice (although it would help). The immediate goal must be to avoid adding to the numbers of people who are already sick.
Still, once the pandemic has peaked in ERs and ICUs, we will enter a new period in which social distancing will not be required to the extent it is now. The goal will be to avoid explosive outbreaks that overwhelm our resources to cope. We don't yet know exactly when this will be, but we must deal with the initial surge of infections, which we expect over the next month or so. When to relax social distancing will depend on a lot of things, including how much population-level immunity we built up in the first wave, and the extent to which our health care capacity has been expanded through the purchase of essential equipment like ventilators. The resumption of economic activity in China has thus far not resulted in evidence of increased transmission - although concerns remain about the reliability of the data. Wuhan is starting to open up again, two months after the shutdown.
So many misunderstandings persist. A journalist asked me this week if the widespread infections in New York City were because New York is "multicultural" and has a relatively chilly climate. But the situation there actually reflects the outbreak dynamics we have seen elsewhere - notably Italy. We have known this is coming, and public health experts have been trying to get people to prepare, and some places have listened more than others. New York is also running far more tests for the infection than most of the country, more per person than even South Korea. So the rising numbers there reflect that. As other places test more, we should expect to find the numbers increasing elsewhere, too.
The United States is an ingenious country, though. Already, we are discovering new ways of working together, and pioneers are thinking about ways forward to understand and calibrate risk that make use of smartphones. It's about time we all saw some of the benefit from surveillance capitalism. But even though many white-collar professionals - folks like me - can work from home, a huge proportion of workers need to be in a specific place to get their paycheck, and the effect on so many people cannot be ignored. The trillions of dollars Congress is throwing at the problem will help, though they'll probably need to do more.
The threat of this virus is on a scale that most have yet to fully grasp. In responding to it, we need to understand the science. Everyone should understand that we are still in the early stages of this pandemic, and as we study the virus, we will learn more about how it can be controlled. Scientists who study diseases like this have managed in the past to give us vaccines, antibiotics and other ways of protecting ourselves that have saved literally millions of lives.
In 1986, along with millions of others around the world, I watched in horror as the space shuttle Challenger exploded shortly after takeoff costing the lives of six career astronauts and one schoolteacher. A subsequent investigation into the cause identified what went wrong. But the wider story was the multiple occasions during the development of the mission, when engineers on the shuttle program had attempted to report safety concerns over the exact component implicated in the disaster, yet they had been overruled. The Nobel Prize-winning physicist Richard Feynman reacted with dismay, seeing this as the consequence of prioritizing the appearance of the shuttle program over science and human lives. It was more important to look good than to actually be good. Feynman commented, in an appendix to the official report, that "reality must take precedence over public relations, for nature cannot be fooled."
Everyone should remember this now. We are outside the space of alternative facts. What you believe will not stop you becoming infected, nor will it stop you passing the virus on to others. It will not stop you or other people from dying. The only way to do that is the dedicated medical professionals too many of us take for granted.
Trump would like the country to reopen in three weeks. I truly wish I could agree without risking lives. Italy started its shutdown around March 10 - barely two weeks ago. The epidemic there still has not reached its peak. This is the immediate future we face. This is reality in a dose most are not ready for. We must prepare for our future by learning from those who are suffering now.
This is a virus - a part of nature. And a virus cannot be fooled.
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William Hanage is an associate professor of epidemiology at the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health.