COVID-19: Where Do We Go From Here?

The town of Bolinas, California, is attempting to test all residents for COVID-19. There's a blood test to look for antibodies and a mouth swab to look for active infections. Ezra Shaw/Getty Images

While much of the world has been in some sort of lockdown because of the coronavirus pandemic, life is starting to change. Some locales are beginning to loosen restrictions and more people will soon be venturing out, even though social distancing and the rules for wearing face masks will remain in place for many.

COVID-19, the disease caused by the coronavirus, isn't simply going to go away. There's a lot we don't know about what happens next, but here's a look at some of the key questions that may be answered over the next several months.

Have we done enough COVID-19 testing?

Someone being tested in their car for Covid-19.
Drive-thru testing sites have become the norm across the country. JHDT Productions/Shutterstock

In most states, testing availability has been limited. People with severe symptoms or those who work in health care settings have had priority for testing.

But health experts agree that widespread testing is the key to helping communities identify people who have the disease and those who had the disease.

Testing those who currently have the disease can help trace the people they've come in contact with so they can be isolated until they are no longer at risk of spreading the virus. That can stop more waves of the illness.

An average of about 147,000 people each day have been tested for the coronavirus in the U.S. so far this month, according to the COVID Tracking Project, which on April 21 reported 4.1 million total tests in the country.

A new report by researchers at Harvard University suggests that the nation must deliver 5 million tests per day by early June for the nation to safely reopen.

"This number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy," the authors write. "We acknowledge that even this number may not be high enough to protect public health. In that considerably less likely eventuality, we will need to scale-up testing much further. By the time we know if we need to do that, we should be in a better position to know how to do it. In any situation, achieving these numbers depends on testing innovation."

How do we determine coronavirus immunity?

A technician in Torino, Italy, performs molecular tests to search for COVID-19 in samples.
A technician in Turin, Italy, performs molecular tests to search for COVID-19 in samples. MAURO UJETTO/

If you've had COVID-19 and recovered, are you immune or can you catch it again? That's where antibody tests come into play.

Antibody tests are blood tests that help determine whether someone was infected with the SARS-CoV-2, the novel coronavirus that causes COVID-19, even if they never had symptoms.

In the beginning of the epidemic, health agencies believed the coronavirus was transmitted only by people who were showing signs of the disease. But since then, they learned that it could be spread by people who were asymptomatic or presymptomatic — meaning they either never showed signs of the disease or they were contagious before symptoms appeared.

It's been estimated that about 25% of people who have COVID-19 don't show symptoms.

But at a White House coronavirus task force briefing in early April, Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, suggested a much broader range.

"It's somewhere between 25 and 50 percent," Dr. Fauci said, reported The New York Times. "And trust me, that is an estimate. I don't have any scientific data yet. You know when we'll get the scientific data? When we get those antibody tests out there."

Although the tests show if someone had the disease, having antibodies doesn't necessarily prove that they won't get it again. As Scientific American points out, immunity plays by different rules.

"With some pathogens, such as the varicella-zoster virus (which causes chicken pox), infection confers near-universal, long-lasting resistance. Natural infection with Clostridium tetani, the bacterium that causes tetanus, on the other hand, offers no protection — and even people getting vaccinated for it require regular booster shots. On the extreme end of this spectrum, individuals infected with HIV often have large amounts of antibodies that do nothing to prevent or clear the disease."

Researchers are still working to discover how immunity works for COVID-19. Most people who've had the disease appear to make antibodies, but scientists don't know if they are protected from being re-infected and, if they are, for how long.

"Some other viruses in the coronavirus family, such as those that cause common colds, tend to induce immunity that is relatively short-lived, at around three months," Peter Openshaw at Imperial College London told New Scientist. "Because [the virus] is so new, we do not yet know how long any protection generated through infection will last. We urgently need more research looking at the immune responses of people who have recovered from infection to be sure."

Stacey McKenna writes in Scientific American, "In an ideal world, SARS-CoV-2 immunity would resemble that acquired by children who get chicken pox. Early research suggests we are in for a much more complex scenario but one that time and unprecedented global cooperation might be able to untangle. Eventually antibody tests could be the key to getting our lives and economies back on track. For now, they promise to give experts, officials and citizens a clearer picture of the pandemic."

How long until we create a vaccine?

senior getting flu shot
People over 65 are more likely to have their vaccines lose effectiveness as flu season tapers off. JPC-PROD/Shutterstock

We are far behind the virus in a race to reach herd immunity, when 50% to 66% of the population has the protective antibodies. That race is being run alongside another: the one to create a vaccine. The general estimate is that it will take at least 12 to 18 months to create a vaccine, and that's considerably faster than the traditional process, WebMD says, explaining all the stages the vaccine must go through.

The current vaccine push is benefitting from past research on other related coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

But it's still a race against time. Gregory Poland, who specializes in the immunogenetics of vaccine response at the Mayo Clinic and who is also an expert with the Infectious Diseases Society of America, told MarketWatch, "We will not have a vaccine by next winter." "The Southern Hemisphere is just starting their fall and winter. They will have a severe course of this disease due to less preparedness, less medical infrastructure and less public infrastructure."

All that means we should expect a second round of the disease.

What happens when the flu and coronavirus meet?

free flu shot sign
What happens if the flu and the coronavirus collide next winter?. Tada Images/

Next winter, a second coronavirus outbreak could develop in combination with flu season resulting in an even more serious health crisis, the director of the Centers for Disease Control and Prevention (CDC) told The Washington Post.

"There's a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through," said CDC Director Robert Redfield. "And when I've said this to others, they kind of put their head back, they don't understand what I mean."

He added, "We're going to have the flu epidemic and the coronavirus epidemic at the same time."

White House coronavirus task force coordinator Dr. Deborah Birx was asked during a White House news briefing about Redfield's comments and how dual epidemics could affect country lockdown plans.

"We were very clear in the guidelines that we believe we can monitor, again, monitor communities at the community level by using the influenza-like illness," she said, according to CNN, and added that the administration is working to build testing capacity and it's important to "have testing in place."

Asked whether she thinks a second coronavirus epidemic could be worse, Birx said, "I don't know if it will be worse, I think this has been pretty bad. When you see what happened in New York, that was very bad. I believe that we'll have early warning signals both from our surveillance that we've been talking about in these vulnerable populations. We're going to continue that surveillance from now all the way through to be able to give us that early warning signal."