Social distancing, masks and herd immunity

This is the assumption :
The recent spike in positives cases in FL / TX etc.. right now is the result of their opening back business the first week of May (and not the result of Memorial day weekend), 1 month too early, despite the advisory to keep the lockdown in place until May 15th at least, June 8th in NYC. To top it off, in these states, without wearing masks and doing minimum to none social distancing.

The start of the spike in these states happened around June 21 perhaps a week prior. That is a 6 to 8 weeks window. Between the time these states reopened from a virtual free of cases state, as the whole country was on lockdown, to the start of the spike. And these states had very little cases to start with. Lets hope its a spike that gets addressed asap and doesn’t end up turning into a peak in 2 weeks.

If we apply that same assumption to the case of NYC, where the first ever wave of cases started spiking up the last week of March, peaking mid-April, then the point of no-return here must have been the first week of February, where many asymptomatic people may have unknowingly spread the virus throughout the city. And beyond.

With this assumption in mind, if NYC had locked down in January, or these now spiking states would have follow through on the lockdown for another month, in hindsight, we would probably be in better standing, like in Vietnam, South Korea, to name a few countries that have kept it under control, health wise at least. The economic impact being difficult to avoid all together.

So thats a lesson to learn. Once a single case is declared, is when we need to start implementing measures. And so far, it is what they seem to be doing in countries like China, New Zealand and a few others. We’ll see how we can sustain and implement this yo yo, schizophrenic push and pull, open close method on the long run, but for now it is the only way we know to avoid doing what we had to do again for so long here in NYC. Yes the economy will suffer. Yes it will be long and painful, socially, physiologically and psychologically…. It is just a matter of making it more bearable. We need to catch the one virus case “before” it spreads, at case zero. The “before” factor being the hard reality we are faced with this virus.

Looking into the future full opening up of business planned for phase 4 in NYC, if we apply the same timeframe to the protests that started June 1st for exemple, and in all logic and by nature goes against the principle of social distancing, despite wearing masks and having a bigger percentage of the population in NYC already being immune, we should see the spike of these protests, if it happens, around the last week of July. If we do, then we know that facemarks do not protect that much outdoors, hence not indoor either, and / or that our herd immunity being somewhere between 6-10% in NYC isn’t enough to protect the population.

If we don’t see a spike at the end of July, and we are betting on this, we first need to compare the difference between the protests in NYC where people were not socially distancing outdoors, but mostly wearing masks, and the people flocking at the beach in other states for Memorial day (at a week interval) where mask wearing was just not happening despite the lack of social distancing. We are measuring here the effectiveness of wearing masks outdoors, since social distancing was obviously not happening in either case.

We also need to compare the data between NYC protests and other big city protests (perhaps the ones in Minneapolis or LA) where people there were also mostly wearing masks, but unlike us, these cities among others, didn’t yet have as much built in herd immunity since they have been way less cases there until then.

The idea is to determine if wearing masks outdoors is a big factor in slowing down the spread or not. We are probably more sure that it does so indoor, even though we know it isn’t 100% protective. When in doubt, go the safe way, and wear the mask. We can only hope that they do, and the factor at play in NYC protests is more so masks then herd immunity. If not, its going to be painful until we get there, at this rate another 3 years if we don’t find a vaccine sooner.

Social distancing still seems like the safest bet, but obviously much harder to implement. Lockdown being the most intense form of social distancing.

* Update 07/01/20: this sums up the most important element to keep in mind when dealing with conclusions here, wise words from M. Osterholm in the Washington post:
“Unfortunately, we live with the elephant sign philosophy. I put a sign up in my front lawn three years ago to say ‘no elephants allowed.’ I have not had an elephant on my lawn in three years. So you think, see, it works! Epidemiology requires we think about much more than that.”

To be clear, here the elephant sign could be that because there has been no spike in cases attributed to the protests in NYC, we are lead to believe that wearing masks outdoors without social distancing is safe. Overlooking the fact that maybe the reason why the virus didn’t spread during the protests was that very few people if any, had the virus to begin with. Since NYC had just succeeded at not only flattening the curve but apparently also bringing down the amount of positive cases to virtually none after almost 3 months of intense lockdown.

Also, as new findings come and go each day, it seems that they are finding out that perhaps only 20% of people infected may infect others. And within this range, the “super spreaders” when combined with a large scale event where people greet, speak, sing, shout, hug, shake hands, and are rather physically close, thats where potentially many people got infected further spreading it to many different communities and locations at the onset of it all. With vs without masks, indoors vs outdoors, these are the factors we are trying to measure today, in contrast with these events happening months ago when the virus wasn’t officially declared, yet ramping around the world while no one was protected.

And so imagine if we all believe that wearing a mask outdoors is safe therefore allowing more and more outdoors gathering without social distancing, and a super spreader fresh out of Texas joins in a protest in NYC, but the reason why there wasn’t any resulting cases from the protest was because there was no infections to begin with, not because we were protected by masks, here we go. Exponential growth, we are back into full lockdown again. This would be a bad scenario, and what unfortunatly epidemiologists have no choice but to plan with in mind. Because we don’t know nearly enough yet about the ways this virus works, they ought to always proceed with caution. We can take bets, like right now they are taking the bet that wearing masks outdoors without necessarily social distancing is safe enough. But it is a huge guessing game, and if not the case, would be disastrous.

However even in such case today, on a more positive note, hopefully people continue to get tested regularly when attending forms of events where social distancing isn’t possible. Then, unlike at the start of the pandemic, they could self-isolate right away and we wouldn’t have such dire situation as we did back in April. This is everyone’s responsibility to assess the amount of risk we take on a daily base and to be strong enough instead of callous, to put up with the consequences. And hopefully, tests continue to remain free for everyone, and we can continue to mass produce them to have enough for everyone.

These bets apply to outdoor dining as well to some extend although the 6 feet distance is applied between parties tables. We could then evaluate outdoor concerts. For indoor measures, grocery stores, elevators and planes among others. The indoor bar / restaurant / club problem is obviously different and probably on hold indefinitely, since people can’t wear masks when drinking or eating.