April 7, 2020

 The latest projections suggest cases of Covid-19, the disease caused by the new coronavirus, will peak in many U.S. cities this month, giving many Americans hope that social distancing measures will come to an end within the next few weeks. However, health experts say Americans should prepare for the restrictions to remain in place for the foreseeable future.

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US Covid-19 cases expected to peak this month

The number of reported U.S. deaths from the new coronavirus has surpassed 10,000, while the number of cases of Covid-19 has reached nearly 400,000.

According to White House coronavirus response coordinator Deborah Birx, cities like New York, New Orleans, and Detroit will likely reach their Covid-19 caseload apex in the next week, which is when hospitals will be most crowded, medical supplies will be in highest demand, and health care staff will be stretched to their thinnest. Other states are expected to reach their caseload peaks in mid-April, STAT News reports.

"The next two weeks are extraordinarily important," Birx said. "This is the moment to do everything that you can on the [social distancing] guidelines. This is the moment to not be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe."

Health experts say social distancing will be in place for 'months'

While the data suggest social distancing measures put in place to limit the new coronavirus' spread are working, experts warn that the projections are not an indication that those restrictions should or will be lifted any time soon.

In fact, relaxing social distancing efforts too soon could lead to a surge of new Covid-19 cases, health experts explain.

World Health Organization Director-General Tedros Adhanom Ghebreyesus on Friday said countries that lift social distancing restrictions sooner than advised risk an "even more severe and prolonged" impact on the economy, as well as an eventual spike in Covid-19 cases.

The risk might be particularly high for the United States, which, according to STAT News, has had a "patchwork response" to the virus that has made it difficult for the country to reduce transmission nationwide. For instance, while the majority of states have issued stay-at-home orders, others have not yet closed non-essential businesses or ordered residents to remain in their homes.

"We let things get out of hand," said Michael Mina, an infectious diseases epidemiologist at Harvard University's T.H. Chan School of Public Health and associate medical director of clinical microbiology at Brigham and Women's Hospital. "So now the place that we're left in is we have to absolutely beat this down with a hammer and get to near zero cases."

When will this social distancing end?

Thomas Frieden, president and CEO of Resolve to Save Lives and former CDC director, this week said while he understands that people want to get back to life as usual, "[d]ecisions to reopen society should not be about a date, but about the data. How well and how quickly we do these things will determine how soon and how safely we can reopen."

In a recent report, former FDA Commissioner Scott Gottlieb and colleagues outlined criteria each state should meet before they can relax social distancing guidelines without experiencing another increase in Covid-19 cases.

Gottlieb and colleagues in the report said, before relaxing the guidelines, a state's hospitals should be able to safely treat all patients that require hospitalization without restoring to "crisis standards" for care, including ventilator splitting and reusing personal protective equipment.

Gottlieb and colleagues also said the country should be able to test everyone with symptoms before relaxing social distancing guidelines—a goal the United States is still struggling to meet.

Finally, there would have to be a reduction in cases for at least 14 days, which is the incubation period for the virus, experts say. According to Aaron Carroll, a professor of pediatrics at Indiana University School of Medicine, "If the number of cases in an area is dropping steadily for that much time … public health officials can be reasonably comfortable that suppression has been achieved."

Currently, the Trump administration has extended social distancing guidelines through April 30, but Mina expects those guidelines will likely be extended again. "By the end of April shouldn't be anyone's consideration at this point," Mina said. "We have to assume at the very least this is going through May."

Others also have noted that, even if some restrictions are relaxed by the end of April, it could take months before the United States returns to its pre-Covid-19 gatherings and operations (Branswell, STAT News, 4/3; Restuccia, et al., Wall Street Journal, 4/4; Carroll, "The Upshot," New York Times, 4/6; Lovelace, CNBC, 4/3; Tankersley, New York Times, 4/6).

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