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We've had this thing for a while...

It's been 7 months since the initial outbreak, 5 months since it came to the U.S., and 4 months since politicians started quarantines. We now have tests and treatments, and scientists have rough estimates of infection rate (R0: 2.5) and mortality rate (symptomatic mortality rate 0.4%, with 35% of infections being asymptomatic). CDC

There's been time to think since the moment of crisis: hospitalizations have dropped 3x from their peak and most emergency hospitals were unused and are being dismantled (NPR).

...so what is the long-term plan/idea?

I'm not asking about timeline "this will end in 4.2 weeks"...just general "this is what we anticipate happening long-term." For example:

  1. Are politicians planning on the number of cases dropping permanently and then quarantine ending?

  2. Are politicians planning on a vaccine being discovered, the manufactured, the distributed, and then quarantined ending?

  3. Are politicians planning on a cure being discovered and then quarantine ending?

  4. Do any of these expectations include anything to do with mutations?

I understand this is fairly broad, not focused on Gov Cuomo or Gov Ige or anyone in particular. I've been able to find very little from any leader, so all info on expected scenarios is appreciated.

Currently, it seems that despite lots of epidemiological study and political attention, there is very little public understanding of the expected scenarios or long-term vision by governments. Like...maybe somehow it will all go away one day.

How do U.S. government leaders (federal or state) expect this to turn out?

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    I count 6 distinct questions, and the sixth is extremely broad. – CGCampbell Jun 26 '20 at 20:12
  • @CGCampbell pay tell what are the five (six?) questions that each deserve a separate post? – Paul Draper Jun 26 '20 at 22:26
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    @PaulDraper The one in bold text, the four that are numbered and the last line. That makes six questions. You could also count the number of question-marks (also 6). – Oscar Bravo Jun 29 '20 at 6:52
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    We have a plan? – Mike G Jun 29 '20 at 21:31
  • In general politicians may not have a complete plan or may adapt their plan along the way our just may tell about one plan but then doing something else. This question should ask for published things. I guess the center of disease control in the US might have published something. – Trilarion Jul 1 '20 at 20:46
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This is a really broad answer, and I'm planning on editing in more links.

  1. Are politicians planning on the number of cases dropping permanently and then quarantine ending?

This strategy is known as "elimination," where cases drop to a number small enough to be quarantined (with support from the government) long enough to stop transmission. This is how New Zealand succeeded. The only way for cases to drop permanently is herd immunity (which everyone is very, very far from) or preventative measures that a large conservative section of the country is rejecting. It seems most states have given up on preventative measures both in the population and in leadership, so this cannot be the goal.

On herd immunity: The basic problem with herd immunity is that we need a large number of people to get sick. In order to control an epidemic, one person has to infect fewer than one person on average. So with no preventative measures, an infected person with COVID infects three1 others, then more than 67% of those people need to be vaccinated in order to create only one new infection. If we assuming getting COVID means you're immune to reinfection, then more than 200 million people would have to get sick. And there's not room in this answer to touch on the uncertainty surrounding immunity!

Experts estimate that in the U.S., 70% of the population — more than 200 million people — would have to recover from COVID-19 to halt the epidemic. If many people become sick with COVID-19 at once, the health care system could quickly become overwhelmed. This amount of infection could also lead to serious complications and millions of deaths, especially among older people and those who have chronic conditions. [Mayo Clinic]

We may be at 20 million infections (less than 10%). At 126k deaths, we would be looking at 1,260,000 deaths to reach herd immunity. Even more once you factor in overwhelming hospitals.

  1. Are politicians planning on a cure being discovered and then quarantine ending?

We are not very good at "curing" viral infections, which is why we vaccinate for them so heavily. Antivirals are limited in scope, so we focus on treating the symptoms, like pneumonia. I have not seen any infectious disease expert posing this as our way out.

  1. Are politicians planning on a vaccine being discovered, the[n] manufactured, the[n] distributed, and then [quarantine] ending?

Basically, yes. Dr. Fauci believes we will have a vaccine by the end of the year or early 2021. In early stages of COVID, we were worried that vaccines for coronaviruses were hard or impossible to make, because we haven't made one before. However, we haven't focused this hard on one before. Obviously manufacturing and distributing is a monumental task, but efforts are underway.

Luckily, we can combine a vaccine with other preventative measures to get out of it sooner. If wearing masks reduces person-to-person transmission to two new infections, we only have to vaccinate 50%+ of the population to slow the spread significantly. By targeting highly exposed people (nurses, doctors, cashiers, etc.) we can be even more effective. With really smart vaccine distribution, it may be possible to control this epidemic with less than 100% coverage.

  1. Do any of these expectations include anything to do with mutations?

Compared to other viruses, the family of coronaviruses don't mutate very fast. This suggests SARS-CoV-2 is less likely to mutate fast enough to invalidate a vaccine. This also bodes well for our ability to treat it, and we don't expect death rates to spike for mutation reasons (compared to refusals to implement preventative measures that causes effective treatment to decline).

In conclusion, the plan in the US seems to be to ride it out until there is a vaccine. Because states cannot close their borders (the federal government could enforce this, if they cared to reduced deaths), it is not realistic to reduce infections in an area enough to return permanently to normal. We will have to continue with prevention measures like masks and social distancing until there is a vaccine.

Dr. Fauci was recently quoted in the New York Times, implying slowing the outbreak until a vaccine is the goal (emphasis added).

“You have an individual responsibility to yourself but you have a societal responsibility because if we want to end this outbreak, really end it and then hopefully when a vaccine comes and put as a nail in the coffin, we’ve got to realize that we are part of the process,” Dr. Fauci said, noting that some states are doing better than others.

Because we aren't sure you can only get COVID once, we may have to continue vaccinating against it like the seasonal flu (or more frequently) until each case can be stomped out as soon as it's detected.

1: The CDC currently estimates that with no measures, a person with COVID infects two to three others. I used 3 here as a round number and to compare with two later. Note that the 67% number is napkin math, it's not like a vaccination rate of 68% would magically get us out of the pandemic.

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In the absence of any federal plan besides pretending that it doesn’t exist, each state had their own separate plan for when and how to reopen. Generally they amount to a series of tiers where certain restrictions are relaxed as the state or counties pass certain testing thresholds. For example, you can see the metrics Washington state is using here: https://coronavirus.wa.gov/what-you-need-know/covid-19-risk-assessment-dashboard

Of course, as the situation changes, these plans will change. Texas, for example was aggressive in opening up but is now pausing and rolling back their plans as cases rise. New York, New Jersey and Connecticut are trying to hold off a second wave that would stop their reopening by instituting mandatory quarantine for people from hot spots. It’s impossible to know how these will play out in the long run, however

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  • The plan was the the cases would stay low even when fully reopened? Because there was enough herd immunity or something? – Paul Draper Jun 26 '20 at 17:28
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    @PaulDraper No, see my answer for why we can't count on herd immunity in the near time span. The plan would be (1) that cases would stay low because there is no one in the community infected, combined with better isolation and less travel would allow people with COVID to be rapidly identified, contact traced, and quarantine; and (2) phases would roll back when numbers go up again. – Azor Ahai -him- Jun 26 '20 at 17:39
  • @PaulDraper Basically what AzorAhai’s answer says: the plan seems to be to ride it out, while keeping infection rates low, until a vaccine comes out. With masks, social distancing, a low starting point of infected people, and contact tracing, it’s possible, at least in theory, to keep the infection simmering at a low rate for a long time. – divibisan Jun 26 '20 at 17:42
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    @PaulDraper you need to be careful in giving too much credence to the herd immunity concept in general wrt covid. It's unclear how much of an immunity recovered covid individuals have and how long that effect lasts. This is not as far as we know, a disease you only ever catch once. It may turn out to be, it hasn't been totally ruled out, but basing policies on say a chickenpox-type profile of hard to get twice should be done very carefully at this point, if at all. – Italian Philosophers 4 Monica Jun 26 '20 at 18:16
  • @ItalianPhilosophers4Monica, "the herd immunity concept in general" is the entire idea behind vaccines and it's solid. The concern you have is over is duration of immunity. Forever like chickenpox, or a few months like influenza. Over the past several months I've seen no confirmed report of a repeat infection. So...immunity probably lasts at least that long. – Paul Draper Jun 26 '20 at 22:29

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