The Dawn of The Next Normal: When Will the Pandemic End?

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The Dawn of The Next Normal: When Will the Pandemic End?

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Whether it’s in the front of your mind or on the back burner, most people have been wondering if there’s an end to the pandemic in sight. We all want to know when we’ll be able to freely gather with family and friends once again, and when it will be safe for our children to return to school.

With over 34 million cases of COVID worldwide up until this point, Agatha and Dr. Greene take a look at current data regarding COVID rates, hospitalization, and outlooks for a vaccine in order to determine when we might be able to go about our lives without the need of a mask. While it still may take a while for that to happen, the good news is that there are a lot of things we can do to keep ourselves safe, which not only keeps us healthy, but will also contribute to the overall decline of the pandemic at large.

Below is a transcript of the episode, modified for your reading pleasure. For more information on the people and ideas in the episode, see the links at the bottom of this post.

Agatha Luczo: Hi, I’m Agatha, mother of four. 

[00:00:08] Dr. Greene: And I'm Alan Greene, pediatrician. 

[00:00:10] Agatha Luczo: Welcome to Bambini Furtuna's podcast. Mom Driven. 

[00:00:13] Dr. Greene: Dr. Aligned. 

[00:00:15] Agatha Luczo: Hello, Dr. Greene.  How are you today? 

[00:00:18] Dr. Greene: Good!  How are you? 

[00:00:19] Agatha Luczo: Great. I'm excited about our conversation today because we're going to address the question on everyone's mind. When are we going to get back to normal?

[00:00:29] Dr. Greene: That is the question on everybody's mind. 2020!  What a year, right? In so many dimensions. 

[00:00:34] Agatha Luczo: Yeah exactly.

[00:00:35] Dr. Greene: Well to understand that, one useful thing is to look back a hundred years to 1920. And it was another year that was kind of crazy. World War I was just officially ending. The great flu pandemic was coming to a close.

[00:00:49] It was a really tumultuous time. It was politically for empires, big world empires that were the powers that everybody in the world had known for their whole lifetime collapsed. Old countries were abolished. New ones are being formed. Boundaries were being redrawn. There were international organizations being established, all kinds of extremist ideologies were taking hold.

[00:01:11] There's a lot happening there. And because of that, there was this phrase, “a return to normalcy”, that became a big call.  It was an election year in 1920, and the big catchphrase of one of the candidates was a return to normalcy. It's what everybody wanted. He wanted a popular landslide because people wanted this return to normalcy that we want now.

[00:01:33] Agatha Luczo: Exactly. But do you remember what happened in the 1920s? Back to normal, the war ended and the pandemic ended and everyone started partying and going out.

[00:01:44] Dr. Greene: Yeah, so they didn't go back to the previous normal exactly. They went to the next normal and it was, there were some great years ahead. So among other things, a huge thing was that’s the year that women got to vote.

[00:01:57] It changed the entire political setting here in the United States and other countries. It was the first universal suffrage in Great Britain and in Germany and in Turkey, even. So that was huge. But also people started getting together. It was the jazz age. That's when all the big baseball stadiums were built and people got together at stadiums and that's where movie theaters got big and the big palatial theaters were built and people came together to watch movies and the automobile became widespread. And the first commercial radio stations a lot came out of that. A lot of really positive things. And I'm hopeful that for us that we're going to get to a “next normal” fairly soon. And that'll be a really good normal as well. 

[00:02:38] Agatha Luczo: And what about our kids? What's the data and where are we now with kids in school?

[00:02:43] Dr. Greene: So the last data that we have right now that state-by-state data about kids is from September 17th. It's a little bit back, cause it takes a while to compile the data, but there are some things we can learn from that. And that's data from the beginning of the pandemic, up to the present, up to September 17th.

[00:03:01] And we know the kids do indeed get COVID. There have been more than half a million children, more than 580,000 children that have been diagnosed with COVID in the United States. So it happens. But we also know that in the U.S. that kids make up about 20% of the population. So if this were a different respiratory infection, we would expect kids to be at least 20% of the cases, maybe far more of the cases, and this about 10% of all cases have been children.

[00:03:31] So whenever you see numbers in the community that are happening in the adults, you can kind of think about half that many kids are likely to have it. But the good news is that when kids do get it, there's a little bit less likely to be diagnosed over the whole course of the pandemic so far, but they're much less likely to be hospitalized.

[00:03:49] So it's not 20% of hospitalizations are kids. It's not even 2% of all hospitalizations are kids. It's about 1.7% of the hospitalized people with COVID are children. So it's 10 times more likely to be hospitalized if you're an adult more than 10 times more likely and for kids overall, the hospital rate happens to be coincidentally also 1.7%.

[00:04:11] So if you're diagnosed with COVID, there is a 98.3% chance that you will not get sick enough to be hospitalized. And probably the scariest thing for parents would be having a kid die. And the mortality rate for kids is even lower than relatively than the hospitalization rate.   In California so far, there've been 15,000 deaths overall in our state, which is significant.

[00:04:37] And you would expect if 20% of those were kids, you'd expect 3,000 kids to have died, but it wasn't 3,000. It wasn't 300. It wasn't even 30. They were just three children who have died so far. Real tragedies, but three is a fairly small number. 

[00:04:52] Agatha Luczo: So that was just in California, 

[00:04:54] Dr. Greene: So in California, where the background rate so far has been 0.04% of the population that's died.

[00:05:00] But when it comes to the percentage of kids with COVID who died, if you rounded it down, it'd be 0.0%. Really, really small. 

[00:05:08] Agatha Luczo: Uh, that is small. So it's good news that kids’ numbers remain low, especially really sick kids. 

[00:05:13] Dr. Greene: Right. And nationwide, at the last count, there were 109 total kids who died out of the, you know, there's been more than 200,000 people who've died and it wasn't 40,000.  Like if it had been 20% of the kids, it wasn't 4,400, it's 109 kids. 

[00:05:28] Agatha Luczo: But what does that mean going back to school though? Do you think the numbers would go up higher if we have the children together? 

[00:05:36] Dr. Greene: Anytime there's an increase in gathering right now, the rates go up. So they would.  We would expect that there would be some bumps when kids were back together in person.

[00:05:48] I really want the rates to be going down in a community before kids gather back together. And at a fairly low rate, when you look California, has it divided up into these different tiers and I'd prefer it not to be in the widespread tier, but at least once you're better than that and flat or going down.

[00:06:06] And sadly there has been actually a Labor Day bump.  After the Labor Day holiday, it's gone up. The cases in our County have gone up 23% since last week. And it's too soon to tell yet whether this is a Labor Day blip from the people getting together, or if this is the beginning of a fall surge. 

[00:06:26] Okay.  So, Dr. Greene, I have to ask you something.  As a pediatrician and a father of four, if you received an email from the school, which all parents are receiving today, you know, click the box, if you want to send your kids back to school beginning of October, or continue the distance learning.  What would you choose?

[00:06:47] Dr. Greene: Well, let me give a little bit of a longer answer to that.

[00:06:50] First of all, it is really different in different communities.  Like I said, I would want it to be what it works out to is seven per a hundred thousand new cases a day or less and flat or going down. And right now in our county, it's above that and going up. But to really make that decision, we have to kind of get the sense of when is this pandemic going to be over.  Cause that'll tell us how big a risk we want to take in the short run. And to understand when the risk is going to be over, Coronavirus was called a pandemic for two reasons. One, it was rapidly spreading widely. And two, that it's a severe disease. If it were just one of those, if it were just a severe disease, like polio, it wouldn't be a global pandemic cause it's not spreading widely and rapidly.

[00:07:34] And if it's just wide-spread, like the common cold, it wouldn't be a pandemic cause it's not severe. So coronavirus is a problem because it's widespread and severe. And for that to end, we just need one of those two things to end. 

[00:07:48] So when might those end?  Let's talk about the rapidly spreading bit first.  I would expect that to end by next fall, which is about a year from now and there are a few reasons for that.  One of them is that we'll have made it through a whole cold and flu season, but another big one is that we're getting close on the vaccine front. You know, Pfizer and AstraZeneca are in stage three trials right now.  Last week, Johnson and Johnson announced their phase three trial. There'll be a couple of other Santa Fe and Novavax coming in the next couple of weeks.

[00:08:22] In fact, Dr. Fauci is now saying that he believes we'll have a workable vaccine and 700 million doses of it by around April and I think there's a pretty good chance that's true from the preliminary results of the trials. Not necessarily a great vaccine, but that might reduce the spread. It might be 60% effective, but somebody's preventing them from getting it.

[00:08:42] And if that's true and if just the number of people who say in surveys and polls, that they're going to do it, which isn't everybody by a long shot, that would be enough to change the spread by sometime around next fall, most likely.  Could be earlier, could be as long as a year later, but chances are, that will likely be sometime next fall.

[00:09:05] Agatha Luczo: And has this ever been done like this before? And also, would you feel comfortable yourself getting these vaccines? 

[00:09:12] Dr. Greene: This is very, very fast. The average length of time for a vaccine to be developed is 10 years. And the fastest one that I'm aware of was four years. So this is really fast.  But part of the reason it's fast is that there's been so much effort to do things that used to happen one after another.

[00:09:30] First you would test to see if it's safe and effective. And then once you've decided that, you would start ramping up the facilities to be able to produce it and the logistics for spreading it, and they're doing all those things in parallel right now, assuming that one of them will prove safe and effective at least one, and then we'll be ready to ramp up.

[00:09:49] So some of that speed is, is good. Before I took it, I would want to look really carefully at the studies and see what we know and what the experience has been and if people who've had it, how safe it is, how effective it is. It's not a slam dunk for me, but I certainly wouldn't rule it out. I think the vaccine will likely prove a really powerful thing

[00:10:06] Agatha Luczo: Yeah. So do I. 

[00:10:07] Dr. Greene: But even if it were still widespread, if it were just not as serious, that would be powerful. And I think that we're likely to get to it not necessarily being serious, even before all that. And there are already signs of that. It's hard to know the actual case mortality rate. Cause we don't really know the number of people who have it, but we can tell the mortality rate for people who were hospitalized and the numbers of people who are being hospitalized.

[00:10:31] And that looks like it's falling across the board. And I think part of the reason for that is we actually are getting better at treating it with remdesivir and dexamethasone and proning, and we've learned a lot more how to handle it. 

[00:10:43] But I think another big reason for it is that severity correlates with the number of our particles you get at the beginning of the inoculum and because of distancing, because of masks, because people who do have symptoms are staying home, that inoculum is getting smaller. People who are diagnosed, have a smaller number of viral particles, and just don't get as sick.  And I expect that that will continue to accelerate.

[00:11:10] And particularly when cheap, widespread testing comes in, which I expect will come in sometime early next year, it's already been developed and Abbott has won the BinaxNOW that is a $5 test that can be done in 15 minutes. It's the kind of thing that you could do daily, even in a setting. And you would know if everybody who boarded a plane had it, then the odds of somebody being contagious are extraordinarily low and same thing with a school classroom or a Broadway show, it could really change things.

[00:11:41] Agatha Luczo: And when do you think this would be available? 

[00:11:43] Dr. Greene: So it's FDA approved. It's manufactured. It's there. It just hasn't been distributed yet. The government has bought out I think 150 million kits already, but I expect early in the first quarter that, that one or some of the other ones that are out there that are even cheaper, some of them appear to be, will be available.

[00:12:02] And that's a total game-changer. 

[00:12:04] Agatha Luczo: Yeah. That will change everything. And it'll make people more comfortable even having, you know, little dinner parties at home together. And reopening the schools so it will give us even more confidence. 

[00:12:13] Dr. Greene: One question that I get a lot about these rapid tests is are they really that good?  Are they really that accurate? And it depends what you're using them for. If I've got a patient who's got low oxygen and I'm trying to decide how to treat them, that I want the PCR tests, the most accurate tests that we can do. But if my question is, is it safe to go out? Will I be contagious? Those rapid ones are actually quite good.

[00:12:39] So the PCR could detect as few as 10 and viral particles, and you might need to have 10,000 viral particles or even a hundred thousand viral particles to turn when this little rapid one's positive, but it takes millions to be able to transmit it easily. So they're great for knowing I'm not contagious today, nor are the other people at this dinner.

[00:12:58] And so for me with that coming so soon, I'm less likely to want to take big risks in the short run, because it might slow that down. So I don't know if the little uptick now, 23% in our County since last week, is just a Labor Day blip or the fall viral season. But even if it's just a Labor Day blip, that concerns me because when you think about it, Labor Day is not a big gathering holiday.

[00:13:27] Nor was the 4th of July and they’re outdoor holidays.  But Thanksgiving is coming and Thanksgiving is a share a meal around a table together holiday...

[00:13:37] Agatha Luczo: And indoors as well.

[00:13:38] Dr. Greene: Christmas, yes, indoors. Right, which is 20 times more likely to spread indoors and Christmas and Hanukkah and New Year's Eve or all indoor and are much bigger holidays than Labor Day. So it wouldn't surprise me if there are some big surges around those and I would prefer to getting at least a couple of weeks in the rearview mirror from New Year's Eve. 

[00:14:01] Agatha Luczo: And I mean, we really have to pay attention to the symptoms. I mean, because we're heading into the cold and flu season right now. 

[00:14:08] Dr. Greene: Yeah, yeah, yeah. That's really important. So it's interesting at Stanford, the team has looked at people who get sick at the medical center with COVID.  Where did that come from? And the number one place is actually not from the medical center, but from family gatherings outside and sharing a meal with family members that are part of the same household, that's primarily indoors, but even one of them was from a big family picnic outdoors. So that's one spot. 

[00:14:33] Then actually sharing it in the medical center it's usually around sharing a meal in the lunchroom or in a break room that spread happens, not in the clinical areas.  But the other big spot where it's happened is people who have minor respiratory symptoms. They think it's just allergies or it's just a cold, it's not COVID and they come to work anyway, and then they spread it.

[00:14:57] So we have to change our mindset that if you're feeling a little sick, stay home, it helps everything get done faster. And you hear that recommendation a lot. And I think that's beginning to sink in that is really important to do, but if we take it one step further, we could crush the curves and here's what I mean.

[00:15:16] So if say you have a kid who is in a family and the parent has cold symptoms, has a cough. Then if it's COVID,  they were likely contagious a day or two before that. And so if the kid caught it, they are likely to be contagious in a few days after that. So if they go to school, when their parents are sick, that's the child most likely to spread it. But if everybody in the family stays home until they're tested, you know it's not COVID, then it's really unlikely that asymptomatic kids going to spread it at school. So if our family circle stays home until somebody is tested and we know they don't have it, then it just doesn't spread.

[00:16:05] Agatha Luczo: Yeah, it's a tough one especially with families and their kids have environmental allergies. 

[00:16:10] Dr. Greene: Right. And here in California, we just had all the wildfire smoke and so everybody's compromised.

[00:16:15] Agatha Luczo: Exactly.  Some sort of symptoms that seem like COVID, but it could be just allergies, but it's always better just to stay home and be safe.

[00:16:21] So with the vaccine, do you think that COVID will just go away or how will that play out? 

[00:16:27] Dr. Greene: Really too soon to know what's going to happen in the long run, but likely it will be something that is more contained, like a regular flu season. It will be cold, flu, and COVID season.

[00:16:38] Agatha Luczo: Right.

[00:16:38] Dr. Greene: But it's way too early to know. Nobody's had a vaccine [and we’ll need at least a year of data after that to know].

[00:16:41] Agatha Luczo: Right, but do you think it could be comparable to like the measles?

[00:16:45] Dr. Greene: It's possible that it'll end up that it's really contained like measles and only sort of rare outbreaks. But either way, I think we'll get to a spot where this is something really manageable, that the spread will go down, the severity we'll be able to control by keeping the viral inoculum low.  And I think there's really light at the end of this tunnel. 

[00:17:04] Agatha Luczo: That's reassuring to be able to see a light at the end of the tunnel. 

[00:17:08] Dr. Greene: Yeah. And I know it feels like it's just going to always be this way. But remember baseball stadiums and movie cinema houses started right after all of that quarantine and masking, which was coming to a close in 1920.

[00:17:22] Agatha Luczo: This has been really helpful Dr. Greene and it's helped me figure out my own personal decision for our family and what to do in the next few months and how to look at it in regards to kids going to school and gatherings and all.  And I hope that it helps all of our listeners as well to make their decisions. So, Dr. Greene, I think that our four takeaways for our conversation today are: one, this will come to an end when it stops spreading widely or becomes less serious, 

[00:17:52] Dr. Greene: Right. Either of those will do it. And two things that may help that happen are having a vaccine or more quickly having an available inexpensive, rapid test.

[00:18:01] Agatha Luczo: Yes, I can't wait for the rapid test. Two, if people stay home if anyone in the household has symptoms, it will rapidly drop the number of cases. Three, I think all of this will be achieved by sometime early next year. 

[00:18:17] Dr. Greene: We can turn the corner by early next year, 

[00:18:19] Agatha Luczo: We will be turning the corner by early next year, hopefully.  And four, our “new normal” will still include taking precautions and changing how we think about our symptoms so we stop the spread.

[00:18:30] Dr. Greene: Right. And we get to invent this “next normal”. We can think about what we've learned about what's important to us and how we want to get together and the things that we're missing and create a future that's pretty cool. 

[00:18:40] Agatha Luczo: That's pretty amazing. Thank you everyone for joining us today. And please join us next time and please rate, review, and share Mom Driven, Doctor Aligned.

[00:18:50] Dr. Greene: Until next time, be well.

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