The COVID-19 trends in the United States are moving in the wrong direction. More than 4,200 deaths occurred during the week of July 5th, and the highest number of new infections in a single day—more than 66,000—was reported on July 10th.
As the numbers of cases, hospitalizations, and deaths surge to record levels in multiple epicenters, local and state officials are struggling with whether and how much to reverse the rollback of restrictions on individuals and businesses. For example, following a gradual reopening over about a month, on Monday, California Gov. Gavin Newsom announced the reintroduction of statewide restrictions that would again shut down bars, all indoor dining, family entertainment, zoos and museums following a surge in coronavirus cases. The governors of Florida, Texas, and Arizona, all now epicenters of infection, have also slowed or reversed reopening, but their actions have been tepid. Florida Governor Ron DeSantis is even insisting on opening schools in the face of record-high numbers of infections.
These officials would do well to recall the observation of The Great One. No, not Dr. Tony Fauci of the National Institutes of Health—the other one, hockey legend Wayne Gretzky, who once explained, “I skate to where the puck is going to be, not where it has been.”
Anticipating what’s coming is important in confronting an infectious disease, especially one whose dynamics are what many infectious disease experts consider their worst nightmare. COVID-19 is highly infectious, has a lengthy incubation period (during which asymptomatic infected persons can unwittingly shed virus and infect other people), and causes serious, sometimes fatal illness.
Those unusual characteristics of the SARS-CoV-2 virus, which causes COVID-19, and the idiosyncrasies and spectrum of presentations of the illness—from pulmonary symptoms (including pneumonia and pulmonary fibrosis) to a range of non-respiratory manifestations, (including loss of sense of smell or taste, confusion and cognitive impairments, fainting, sudden muscle weakness or paralysis, seizures, ischemic strokes, kidney damage, and, rarely, a severe pediatric inflammatory syndrome) mean that we are on a steep learning curve.
The problem is: if we react too slowly to changing circumstances, we can fall off a metaphorical cliff.
There’s an old brain teaser that perfectly illustrates this point. Consider a pond of a certain size, on which there is a single lily pad. This particular species of lily pad reproduces and duplicates itself once a day, so that on day 2, you have two lily pads. On day 3, you have four; on day 4, you have eight; and so on. Here’s the teaser: if it takes the lily pads 48 days to cover the pond completely, how long will it take for the pond to be covered halfway?
The answer? 47 days. In just 24 hours, between day 47 and day 48, the lily pads would double in size and overtake the pond. Moreover, on day 40, the pond would still appear to be relatively clear; just eight days from the pond being completely covered, you’d hardly know the lily pads were there.
If the same thing happens with a virulent and highly contagious infectious agent, like the SARS-CoV-2 virus, you don’t know you’re in trouble until you wake up one morning to find that you’re overwhelmed. Like the lily pad example, the daily number of confirmed COVID-19 cases in the U.S. was 18,577 on June 15th—just three weeks later, on July 10th, the number had shot up to 66,281.