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<h1 class="css-19v093x">We’re not going back to normal</h1>
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<div class="css-7kp13n">By</div>
<div class="css-7ol5x1"><span class="css-1q5ec3n">Gideon
Lichfield</span></div>
<div class="css-8rl9b7">technologyreview.com</div>
<div class="css-zskk6u">7 min</div>
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<p><span>To stop coronavirus we will need to radically change almost
everything we do: how we work, exercise, socialize, shop, manage
our health, educate our kids, take care of family members.</span></p>
<p><span>We all want things to go back to normal quickly. But what
most of us have probably not yet realized—yet will soon—is that
things won’t go back to normal after a few weeks, or even a few
months. Some things never will.</span></p>
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<p><span>It’s now widely agreed (<a
href="https://www.technologyreview.com/f/615369/uk-dropping-coronavirus-herd-immunity-strategy-250000-dead/">even
by Britain, finally</a>) that every country needs to “flatten
the curve”: impose <a
href="https://www.technologyreview.com/s/615355/coronavirus-social-distancing-during-pandemic/">social
distancing</a> to slow the spread of the virus so that the
number of people sick at once doesn’t cause the health-care
system to collapse, as it is threatening to do in Italy right
now. That means the pandemic needs to last, at a low level,
until either enough people have had Covid-19 to leave most
immune (assuming immunity lasts for years, which <a
href="https://www.theatlantic.com/health/archive/2020/03/coronavirus-pandemic-herd-immunity-uk-boris-johnson/608065/">we
don’t know</a>) or there’s a vaccine.</span></p>
<p><span>How long would that take, and how draconian do social
restrictions need to be? Yesterday President Donald Trump,
announcing new guidelines such as a 10-person limit on
gatherings, said that “with several weeks of focused action, we
can turn the corner and turn it quickly.” In China, six weeks of
lockdown <a
href="https://www.washingtonpost.com/world/asia_pacific/locked-down-in-beijing-i-watched-china-beat-back-the-coronavirus/2020/03/16/f839d686-6727-11ea-b199-3a9799c54512_story.html">are
beginning to ease</a> now that new cases have fallen to a
trickle.</span></p>
<p><span>But it won’t end there. As long as someone in the world has
the virus, breakouts can and will keep recurring without
stringent controls to contain them. In a <a
href="https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf">report
yesterday</a> (pdf), researchers at Imperial College London
proposed a way of doing this: impose more extreme social
distancing measures every time admissions to intensive care
units (ICUs) start to spike, and relax them each time admissions
fall. Here’s how that looks in a graph.</span></p>
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<figure> <img
src="https://pocket-image-cache.com//filters:no_upscale()/https%3A%2F%2Fcdn.technologyreview.com%2Fi%2Fimages%2Fperiodic-social-distancing_0.jpg%3Fsw%3D616%26cx%3D0%26cy%3D0%26cw%3D1245%26ch%3D762"
alt="Periodic bouts of social distancing keep the
pandemic in check.Imperial College Covid-19 Response
Team."> <figcaption>Periodic bouts of social
distancing keep the pandemic in check.Imperial College
Covid-19 Response Team.</figcaption> </figure>
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<p><span>The orange line is ICU admissions. Each time they rise
above a threshold—say, 100 per week—the country would close all
schools and most universities and adopt social distancing. When
they drop below 50, those measures would be lifted, but people
with symptoms or whose family members have symptoms would still
be confined at home.</span></p>
<p><span>What counts as “social distancing”? The researchers define
it as “All households reduce contact outside household, school
or workplace by 75%.” That doesn’t mean you get to go out with
your friends once a week instead of four times. It means
everyone does everything they can to minimize social contact,
and overall, the number of contacts falls by 75%.</span></p>
<p><span>Under this model, the researchers conclude, social
distancing and school closures would need to be in force some
two-thirds of the time—roughly two months on and one month
off—until a vaccine is available, which will take at least 18
months (if it <a
href="https://www.technologyreview.com/s/615331/a-coronavirus-vaccine-will-take-at-least-18-monthsif-it-works-at-all/">works
at all</a>). They note that the results are “qualitatively
similar for the US.”</span></p>
<p><span><em>Eighteen months!?</em> Surely there must be other
solutions. Why not just build more ICUs and treat more people at
once, for example?</span></p>
<p><span>Well, in the researchers’ model, that didn’t solve the
problem. Without social distancing of the whole population, they
found, even the best mitigation strategy—which means isolation
or quarantine of the sick, the old, and those who have been
exposed, plus school closures—would still lead to a surge of
critically ill people <em>eight times bigger</em> than the US
or UK system can cope with. (That’s the lowest, blue curve in
the graph below; the flat red line is the current number of ICU
beds.) Even if you set factories to churn out beds and
ventilators and all the other facilities and supplies, you’d
still need far more nurses and doctors to take care of everyone.</span></p>
<figure>
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<div class="RIL_IMG" id="RIL_IMG_3">
<figure> <img
src="https://pocket-image-cache.com//filters:no_upscale()/https%3A%2F%2Fcdn.technologyreview.com%2Fi%2Fimages%2Fmitigation-scenarios.jpg%3Fsw%3D616%26cx%3D0%26cy%3D0%26cw%3D1121%26ch%3D682"
alt="In all scenarios without widespread social
distancing, the number of Covid cases overwhelms the
healthcare system.Imperial College Covid-19 Response
Team"> <figcaption>In all scenarios without
widespread social distancing, the number of Covid
cases overwhelms the healthcare system.Imperial
College Covid-19 Response Team</figcaption> </figure>
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<p><span>How about imposing restrictions for just one batch of five
months or so? No good—once measures are lifted, the pandemic
breaks out all over again, only this time it’s in winter, the
worst time for overstretched health-care systems.</span></p>
<figure>
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<div class="RIL_IMG" id="RIL_IMG_4">
<figure> <img
src="https://pocket-image-cache.com//filters:no_upscale()/https%3A%2F%2Fcdn.technologyreview.com%2Fi%2Fimages%2Fsuppression-scenario-for-five-months.jpg%3Fsw%3D890%26cx%3D0%26cy%3D0%26cw%3D1505%26ch%3D663"
alt="If full social distancing and other measures are
imposed for five months, then lifted, the pandemic
comes back.Imperial College Covid-19 Response Team.">
<figcaption>If full social distancing and other measures
are imposed for five months, then lifted, the pandemic
comes back.Imperial College Covid-19 Response Team.</figcaption>
</figure>
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<p><span>And what if we decided to be brutal: set the threshold
number of ICU admissions for triggering social distancing much
higher, accepting that many more patients would die? Turns out
it makes little difference. Even in the least restrictive of the
Imperial College scenarios, we’re shut in more than half the
time.</span></p>
<p><span>This isn’t a temporary disruption. It’s the start of a
completely different way of life.</span></p>
<h3><strong>Living in a state of pandemic </strong></h3>
<p><span>In the short term, this will be hugely damaging to
businesses that rely on people coming together in large numbers:
restaurants, cafes, bars, nightclubs, gyms, hotels, theaters,
cinemas, art galleries, shopping malls, craft fairs, museums,
musicians and other performers, sporting venues (and sports
teams), conference venues (and conference producers), cruise
lines, airlines, public transportation, private schools,
day-care centers. That’s to say nothing of the stresses on
parents thrust into home-schooling their kids, people trying to
care for elderly relatives without exposing them to the virus,
people trapped in abusive relationships, and anyone without a
financial cushion to deal with swings in income.</span></p>
<p><span>There’ll be some adaptation, of course: gyms could start
selling home equipment and online training sessions, for
example. We’ll see an explosion of new services in what’s
already been dubbed the “<a
href="https://medium.com/matter/the-shut-in-economy-ec3ec1294816">shut-in
economy</a>.” One can also <a
href="https://slate.com/business/2020/03/coronavirus-goodbye-to-the-before-times.html">wax
hopeful</a> about the way some habits might change—less
carbon-burning travel, more local supply chains, more walking
and biking.</span></p>
<p><span>But the disruption to many, many businesses and livelihoods
will be impossible to manage. And the shut-in lifestyle just
isn’t sustainable for such long periods.</span></p>
<p><span>So how can we live in this new world? Part of the
answer—hopefully—will be better health-care systems, with
pandemic response units that can move quickly to identify and
contain outbreaks before they start to spread, and the ability
to quickly ramp up production of medical equipment, testing
kits, and drugs. Those will be too late to stop Covid-19, but
they’ll help with future pandemics.</span></p>
<p><span>In the near term, we’ll probably find awkward compromises
that allow us to retain some semblance of a social life. Maybe
movie theaters will take out half their seats, meetings will be
held in larger rooms with spaced-out chairs, and gyms will
require you to book workouts ahead of time so they don’t get
crowded.</span></p>
<p><span>Ultimately, however, I predict that we’ll restore the
ability to socialize safely by developing more sophisticated
ways to identify who is a disease risk and who isn’t, and
discriminating—legally—against those who are.</span></p>
<p><span>We can see harbingers of this in the measures some
countries are taking today. Israel is going to <a
href="https://www.nytimes.com/2020/03/16/world/middleeast/israel-coronavirus-cellphone-tracking.html">use
the cell-phone location data</a> with which its intelligence
services track terrorists to trace people who’ve been in touch
with known carriers of the virus. Singapore does exhaustive <a
href="https://www.technologyreview.com/s/615353/singapore-is-the-model-for-how-to-handle-the-coronavirus/">contact
tracing</a> and publishes detailed data on each known case,
all but identifying people by name.</span></p>
<p><span>We don’t know exactly what this new future looks like, of
course. But one can imagine a world in which, to get on a
flight, perhaps you’ll have to be signed up to a service that
tracks your movements via your phone. The airline wouldn’t be
able to see where you’d gone, but it would get an alert if you’d
been close to known infected people or disease hot spots.
There’d be similar requirements at the entrance to large venues,
government buildings, or public transport hubs. There would be
temperature scanners everywhere, and your workplace might demand
you wear a monitor that tracks your temperature or other vital
signs. Where nightclubs ask for proof of age, in future they
might ask for proof of immunity—an identity card or some kind of
digital verification via your phone, showing you’ve already
recovered from or been vaccinated against the latest virus
strains.</span></p>
<p><span>We’ll adapt to and accept such measures, much as we’ve
adapted to increasingly stringent airport security screenings in
the wake of terrorist attacks. The intrusive surveillance will
be considered a small price to pay for the basic freedom to be
with other people.</span></p>
<p><span>As usual, however, the true cost will be borne by the
poorest and weakest. People with less access to health care, or
who live in more disease-prone areas, will now also be more
frequently shut out of places and opportunities open to everyone
else. Gig workers—from drivers to plumbers to freelance yoga
instructors—will see their jobs become even more precarious.
Immigrants, refugees, the undocumented, and ex-convicts will
face yet another obstacle to gaining a foothold in society.</span></p>
<p><span>Moreover, unless there are strict rules on how someone’s
risk for disease is assessed, governments or companies could
choose any criteria—you’re high-risk if you earn less than
$50,000 a year, are in a family of more than six people, and
live in certain parts of the country, for example. That creates
scope for algorithmic bias and hidden discrimination, as
happened last year with an algorithm used by US health insurers
that turned out to <a
href="https://www.technologyreview.com/f/614626/a-biased-medical-algorithm-favored-white-people-for-healthcare-programs/">inadvertently
favor white people</a>.</span></p>
<span>The world has changed many times, and it is changing again.
All of us will have to adapt to a new way of living, working, and
forging relationships. But as with all change, there will be some
who lose more than most, and they will be the ones who have lost
far too much already. The best we can hope for is that the depth
of this crisis will finally force countries—the US, in
particular—to fix the yawning social inequities that make large
swaths of their populations so intensely vulnerable.</span>
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