Today marks the 40th day of confinement in New York City. We spent April indoors, watching the gradual arrival of spring from our apartments, tracking the rainstorms that mirrored our darkened moods. The wail of sirens was ever-present, with phantom echoes invading even our dreams. The tulips bloomed and people donned masks. Each night at 7 p.m., we opened our windows to acknowledge those who continue to leave their homes to work during this pandemic, the clapping now accompanied by banging on pots and pans, cathartic yelling, and the occasional primal scream.
As much as I long for elements of our lives of just a few months ago—the ability to hug a friend, or to run to the grocery store if I’m missing an ingredient for dinner—I find myself increasingly accustomed to confinement. Some days it feels as though this is all we’ve ever known. Routines help, as well as the knowledge that most of the country, if not the world, is in the same boat. Levels of comfort and safety vary. There are those with more space and more ability to stockpile supplies and stay indoors. Some face dangerous domestic situations, while others are incarcerated or lack domiciles entirely. The uneven ways in which the pandemic has affected communities across the country underscores what needs to change as we begin to recover: an intensive focus on public health and disease prevention, particularly in vulnerable populations; a radical expansion of social insurance and the safety net; and drastic changes to the ways in which companies treat and compensate workers. Those of us who grieve for our former lives must remember that, for millions, the old system was cruel and unjust.
The 1918 influenza pandemic that infected 500 million people and killed between 50 and 100 million worldwide occurred in three waves over two years. The second wave, in the fall of 1918, was the deadliest, with more than half of the fatalities occurring over a six- or seven-week period from mid-September to early December. But those who were infected and recovered developed some natural immunity to the virus. People who had been ill during the first wave fared better during the second wave, and so on. At the same time, the virus, a form of H1N1 influenza, appeared to mutate over time to a less severe form. Over one hundred years later, H1N1 strains related to the 1918 virus continue to circulate in the population, but in much milder, less lethal forms.
Whether acquired immunity and beneficial viral mutations will happen with SARS-CoV-2 remains to be seen. We know a fair amount about the origins of this pandemic: in bats in Wuhan, China, sometime in 2019. It’s much less clear how it will end. A handful of states across the US have begun to loosen restrictions and allow some businesses to reopen, insisting either that the coronavirus was never rampant in their area or that cases are declining. But for all the talk of “flattening the curve,” the goal of staying at home and engaging in social distancing was merely to reduce vectors of transmission, to slow down the rate of new infections to prevent overwhelming the health care system if a lot of people got sick at the same time. Once the curve has flattened, as appears to be the case in NYC, it’s not a simple matter of allowing businesses to reopen and operate as they did before the lockdowns. Because this is a new virus, there is no immunity to it. Those who have recovered from COVID-19 may have limited protection against future infections, but it’s not clear yet if this is the case, and if so, how long it will last. And with an estimated 5% of the US population exposed thus far, the numbers we’re talking about are very small, nowhere near the estimated 60-70% we’d need for herd immunity.
It’s likely the virus will become endemic in our population: always present, never eliminated.