Where is the light?

As days of social distancing grows and the astonishingly abnormal patterns of our lives started to become the “new normal”, my sense of hopelessness and depression about the distance future continues to blossom.

It is no question that my mind, despite the battle we are facing and continue to brace for ahead of us, has been more bogged down by our lack of endgame, universally across our planet. I have eluted to this fact numerous times before.

Last night, in a rare “social” encounter with friends on Google’s video chat platform to celebrate a friend’s birthday (poor girl had to eat her cake by herself in front of the camera), my friends asked me whether I truly believe this would stretch into the summer.

Why the hell would it not? Do you see a breakthrough coming before then. I don’t.

The fact of the matter is, all these extensive efforts in city-wide shut down and social distancing (a necessary evil, despite the profound affect on our economy and way of lives), is purely to buy us some time. Effectively, it stretches the trajectory of the disease in the population down a line, in an effort to keep our current needs at bay. A necessary evil, but nothing to celebrate on.

Ultimately, until there is a breakthrough, nothing will have changed. Having globally infiltrated every country on the planet, there is zero chance of us getting as lucky as we did in SARS, when the disease just vanished, before any of us arrived at a long term solution.

We cannot count on such luck. Even if it goes on a hiatus during the summer, this will be back, next fall, again and again. Like the flu. But deadlier.

Of the three paths to victory: diagnostics, vaccination, and therapeutics; I see the latter two obviously too long to wait on, as there is little chance of them becoming of widespread use within a year (without us being recklessly in doing so). Diagnostic holds the most promise to reality in our current year, but even then, I have yet to see something promising on the horizon. What we need, is something as cheap and simple, and as sensitive and timely, as a test like a home pregnancy test. But it cannot be antibody based, because the we still miss the window period of the infection. There lies the technical challenge. Currently, the most sensitive tests requires PCR machines to amply the RNA of the virus, dependent on a good acquisition of the sample (a step that is prone to failure, thereby drastically limiting the sensitivity of such test, a measure of utmost importance in a screening assay). To me, that is the closest thing I can think of in order to drastically gain an upper hand on this battle. Something that is cheap and foolproof enough that can be used in all parts of the globe, including the slumps of India, and the favelas of Brazil.

Short of such a breakthrough, all we can do is social distance, and continue to erode our lives.

Realistically, I gave our society one to two months maximum, before message fatigue kicks in, and people, despite their good conscience, starts breaking the rules even if they remain in place. Policies makers know this too, I believe, and will strategically loosen their measures, only to allow some slack so they can tighten them again in the next cycle.

So summer we should be looking at a relaxation of the measures, if only by necessity, for our salvation, and to allow the economy a needed dose of relieve.

Come next fall, I told my friends, I don’t see us being a very different position globally. The virus will likely still be with us. We will likely still be afraid. And measures will likely still have to take place.

But likely, we will know much more about this virus, and how to track it, and how to handle the infected. That would allow us to implement less stringent policies, and use better diagnostic tests and tracking measures, to maintain a tighter but much more accepted way of life as we enter into next flu season. Hospital capacities will have evolved, based on the vast adjustments and improvements we are currently doing, and together with our increased understanding of management and therapeutics, would be in a much better position to handle a surge.

As for myself as a health care provide, that is where the light stops burning. We will still be on the front line. We will still be at high risk of exposure. We will still need a massive load of PPE to do our daily clinical duties. And unless we all acquire immunity through our work, assuming that such immunity is effective and lasting, we will still be afraid to see our families.

For the masses, it is likely that life will be “a little more” normal after the next few months, with an asterix. For the rest of us, we will continue to run this marathon.

Until a breakthrough is found.