Coronavirus, November 2020: What it could look like in America

People living in Italy, Iran, and South Korea are all grappling with a surge in the number of cases of COVID-19. In Italy, where officials report 528 people are infected and 14 have died, concerts are canceled, clubs and libraries are shut, and schools are pushing exams weeks down the line.

There are no signs that the new coronavirus is slowing down any time soon. As 2020 progresses, both past pandemics and the current outbreak offer lessons about what to expect come November 2020, when the heat of summer that suppresses viruses has dissipated.

Public health experts predict the new coronavirus will soon wreak havoc in the United States, where at least 60 people are confirmed to have the virus. Some experts predict that COVID-19 will be more deadly than seasonal flu.

So far, 3.4 percent of COVID-19 cases have proven fatal. Seasonal flu, by comparison, has a fatality rate of between 0.06 and 0.1 percent in the US, according to the Centers for Disease Control.

Instead, consider another, past pandemic: Spanish flu, which swept the globe in 1918 and killed some 50 million people worldwide. It had a similar mortality rate to COVID-19 — 2-3 percent, according to the World Health Organization.

As the new coronavirus starts to take a toll on everyday life in Italy and elsewhere, public health experts and people living in the midst of the outbreak's epicenters paint a realistic picture of how daily life could change as a result of COVID-19.

“We're trying to avoid, in all ways possible, closed places and large assembly,” Tommaso Ciani, a 23-year-old living in Milan, tells Inverse.

“The media is being super sensationalist. The news barely covers anything else: 45 minutes coronavirus; Five minutes everything else," he says.

Anxiety in the country, and around the world, is rising.

As the coronavirus spreads through the US, the way people work, travel, eat, and socialize may change dramatically.

And because COVID-19 shares some eerie similarities to the 1918 Spanish Flu, looking back at that epidemic could help understand the current situation and what we can expect the rest of 2020 to look like.

Spanish Flu vs. Coronavirus

The Spanish Flu, the deadliest viral outbreak of recent history, infected about a third of the planet’s population between 1918-1919. With similar mortality rates to COVID-19, it is a tempting comparison. But it’s not an entirely fair one, Bruce Ribner, a veteran infectious disease expert and researcher at Emory University School of Medicine, tells Inverse.

A century ago, when the Spanish Flu hit, the world was at war, which greatly inhibited public health responses, Ribner says. Soldiers were packed in close quarters, facilitating its lightning spread between people. At the time, antiviral medications didn’t exist, and there was no way to diagnose Spanish Flu. Today, we can track, diagnose, and manage flu infections far more easily than we could in 1918.

“Medicine has advanced dramatically since that time, with a better understanding of how to manage patients who have respiratory failure, better medications and equipment, and antibiotics for individuals who get a secondary bacterial infection after the viral infection," he says.

But unlike 1918, the world today is also more crowded and more connected. Rapid movement across borders and close contact speed up the spread of viruses like COVID-19 — just as it did with Spanish Flu during the war.

Staying home

Staying home — or, as in some places, forcing people to stay home — may help contain the new virus. If it progresses at the same rate, soon US citizens could find themselves having to forego their day-to-day routine.

Unlike the city of Wuhan and the Hubei Province, the epicenter of COVID-19, which are under lockdown, it is unlikely that the US will go under mass-quarantine, Ribner says.

“I doubt we will see the type of mass quarantine in the US that we have seen in China. But we might see school closures and even factory closures,” he says.

In Italy, authorities have taken a less draconian approach, designating certain regions of the country as “red zones.” More than 50,000 people live in these high-risk areas.

“Around the red zones, everything is closed; People don't leave the house,” Ciani says. “It’s literally military quarantine with the army at entries and exits to the cities. If you go in, you can't go out.”

In other cities, like Torino, life is a little more relaxed. Public spaces haven’t been shut down completely, but certain places — museums, theaters, concert venues, cinemas, libraries, and some universities — are closed.

“Thankfully young people are a lot less worried,” Virginia Ghiggia, a 22-year-old law student living in Torino, tells Inverse. “You see them at bars minding their own business.”

Companies and their employees need to be nimble under COVID-19. Businesses in the US should be ready for about 40 percent of their employees to work from home, Tom Frieden, former director of the Centers for Disease Control, told CNN.

In Italy, offices are not closed, but most people are staying home anyways, Ciani says.

Setting up reliable wifi, or creating a quiet, office-like environment at home, may enable people to prepare for the days, weeks, or even months they are forced to work remotely.

Stocking up

As more people stay home, the need for stockpiling food and other supplies grows, too.

In Italy, people are already finding it hard to find food in the containment zones.

“Everyone piles up at supermarkets and there is no longer anything in supermarkets," Ghiggia says.

“It’s true that there was a bit of panic to get pasta at the market,” Ciani agrees.

As COVID-19 spreads across the US, Ribner doesn’t predict supermarkets closing or that food supply will be drastically affected. At this stage, there is no need to rush out and stockpile canned goods, although keeping some bottled water and extra food at home is not a bad idea.

But food isn't the only thing that could end up in short supply. Supplies of prescription drugs and medications, from birth control to antidepressants to statins, may be threatened by COVID-19. In Italy, potentially life-saving medications are already hard to get.

“My grandpa wanted to go get a prescription, but unless you have something urgent they won’t let you go to the hospital,” Ghiggia says.

Health systems are not likely to run out of drugs completely — there are built-in safeguards that prevent this. But about 90 percent of active pharmaceutical ingredients come from China. If production in China is disrupted on a large scale, there may be ripple effects felt in pharmacies everywhere.

“Medication shortage is likely because many of our medicines are made in Southeast Asia and many of those plants have been closed due to ill workers and quarantine,” Ribner explains.

During a pandemic, it is a good idea to stockpile anything from two weeks to a month or two's supply of medications, Erin Fox, a senior policy director of drug information and support services at the University of Utah Health, told ABC. But hoarding drugs is not good either, and could strain pharmacy supplies unnecessarily.

The future of COVID-19

Even if public health officials get the current outbreak of COVID-19 under control, it is possible it will rear its head once more this fall or winter, as temperatures drop. Viruses don't thrive in hot weather, but they do in cold environments. Again, the Spanish Flu offers a lesson here.

While it was at its most deadly in 1918 and 1919, the virus morphed into a seasonal problem. Some viruses experience a season-related rebound effect, where the virus returns for one or two seasons, before petering out.

But like the Spanish Flu, the novel coronavirus could also become endemic, which means it pops up on a regular, continuous basis, much like the seasonal flu. It's too early to tell which pattern, if any, COVID-19 will follow.

"We don’t know if it will be seasonal like influenza or occur all year round," Ribner says. "If it does become endemic it may not decrease in incidence over time, because there are indications that immunity after an episode of illness is not long-lasting."

In other words, if it does follow the same pattern as seasonal flu, then it could become a major public health problem for years to come.

The hope is that researchers will have developed a vaccine by the end of 2020, which could protect the vulnerable from getting the virus, Ribner says.

This is especially important if the virus becomes endemic, he says. One day, we may get a COVID-19 shot on top of our annual flu shot.

Ultimately, people should have the same concerns about COVID-19 as they have about a seasonal influenza outbreak, Ribner says.

“Most people will have mild disease, but those who are very young, very old, or have other medical illnesses are at risk of more severe outcomes," he says.

In the meantime, here are the steps we can take to protect ourselves from the virus now:

• Keep infected people away from children, the elderly, and people with compromised immune systems.
• Recognize the signs and symptoms of COVID-19, and take steps to avoid catching it. The CDC has a handy guide. Frequent hand washing, wiping down public surfaces, and cleaning your phone all help.