Expert: Expect the fight against COVID-19 to last 'about 18 months'

The United States should be prepared to battle the new coronavirus for about 18 months, and any effort to reopen the country before cases have substantially dropped will likely bring about a resurgence, according to Ezekiel J. Emanuel.

"You are not going to be opening the economy at the end of April. We have to prepare the country," he said. "This is an 18-month process. That doesn't mean we're in the current situation for 18 months," he said, adding that if the country continues sheltering in place, implements widespread testing and contact tracing, "then we can slowly open up."

Emanuel, vice provost for global initiatives, an oncologist and bioethicist, and top health care advisor during the Obama administration, spoke Tuesday at a Perry World House virtual event co-hosted with the German Marshall Fund of the United States, a policy think tank based in Washington, D.C. Emanuel gave the more than 500 virtual attendees a status report on the fight against COVID-19 and put forward suggestions for next steps.

From speaking to researchers on the frontlines of vaccine development, Emanuel said he's learned the optimistic time frame for a vaccine available to the general public would be in perhaps August or September of 2021 and, without a vaccine, getting back to normal life isn't realistic.

He said he's frustrated by the White House's approach to the crisis, with messaging that the country needs to open up by Easter and that NFL teams should be back in packed stadiums in the fall. He is also frustrated with the government's short-term plans to deal with a long-term problem, including the $2.2 trillion bailout package.

"Yes, we've spent $2 trillion in the bailout, but the solutions have all been Band-Aids. It's not because we're not spending a lot of money, but it's because they're not thinking in the right way," he said, citing things like only 13 weeks of unemployment and forgivable loans to small businesses to keep people on their payroll for just eight weeks as examples of government short-sightedness.

"This is an 18 month process, we need structural changes, starting with universal health coverage for people, starting with a big dose of loan forgiveness for people."

The hourlong Zoom chat, moderated by Michael Horowitz, interim director of Perry World House, and Karen Donfried, president of the German Marshall Fund, touched on a host of issues, including the ethics of cell phone tracking the movements of citizens to trace the virus's spread, testing issues, what a global collaboration in the fight should look like, and why the jury's still out the effectiveness of hydroxychloroquine, which the president has been touting as a cure.

"We are in an emergency, a bigger emergency than I've ever had in my life, a bigger emergency than anyone who wasn't alive in 1918, or maybe World War II. It's certainly going to be more devastating than the Great Depression," he said of the crisis. "In some ways I analogize it to an explosion. It just descended on us."

The government must be prepared to make vast structural changes that will match the new realities when the economy comes back online, he said.

Asked how societies can best reopen after this crisis, he said governments must follow the data to make the best decisions on easing restrictions: looking at the number of new cases, the hospitalization rate, and the death rate. He cautioned that, rather than thinking of the outbreaks as having a peak and then being done, citizens should look at it as a rollercoaster, where there will be periods of peaks and troughs until there is more immunity and until a vaccine is available.

"What I'm fearful of is we get to the top of the curve, the number of cases begins to flatten out, go down even, and then people say, 'Well, let's open up; let's stop the face masks,' and that's going to be the wrong response," he said.

He pointed to the case of Singapore, which had a very strong initial reaction to the virus but has now eased restrictions and have seen a tenfold increase in the number of cases and had to close schools and nonessential businesses again.

"Anyone who opens up is going to have a second wave and needs to be prepared for this subsequent resurgence, and there's going to be multiple resurgences until we get that vaccine," he said.

Essential to reopening would be to have a certification system for those who are immune to the virus, saying it's crucial for hospitals, nursing homes, and schools, recommending something he calls a COVID recovery corps.

Since young people don't seem to have severe side effects from the virus, he suggests that, when the time is right, the nation could start easing stay-at-home restrictions with younger people first.

Speaking about hydroxychloroquine, which the president has been touting as a treatment for the coronavirus, Emanuel said it won't be a "magic bullet like penicillin."

In fighting cancer and HIV, multiple drugs are used, he noted, not like a bacteria where patients take penicillin or similar antibiotics and are cured. He predicts fighting this novel virus will also require a multiple-drug approach.

The top priorities for transatlantic cooperation in responding to the crisis should be collaborating on vaccine research and contact tracing technology and creating an international stockpile of supplies, Emanuel said

"Normally in these kinds of situations to bring everyone together; it's American leadership through existing institutions," whether through NATO or the IMF, he said. "We haven't been an international leader, and that's a problem."

He calls it "absurd" that each country is working to develop its own contact-tracing technology or immunity-certification technology.

"All of us appreciate the fact that there's an ATM system and you can get money internationally. We take this for granted, and yet we shouldn't take it for granted. That tells you that these cooperations can happen. If we had a strategic plan at the White House, we would be doing these things much more systematically."

If any nation should be interested in such cooperation, it should be the United States, he said.

"We don't have enough N95 masks, we don't have enough ventilators, we don't have enough equipment," he said. "We've been turning to the world and saying, 'Send them to us.' How can you say that unless you're willing to share whatever you have extra of, if it turns out to be a therapeutic or a vaccine? I don't see how we can say those two things simultaneously."

Nationalism is inevitable in these circumstances, but strong leadership could overcome most momentary nationalism for the greater good, he said.

"I only wish that the government was doing more of this long-range thinking rather than worrying about the next 30 days," he said.