COVID-19: The Future of Social Interaction (April 28, 2020)

COVID-19 continues to spread around our world rapidly. 

As of April 28, 2020, confirmed worldwide cases increased to ~3 million, up over a million in the past two weeks. Eight weeks ago, there were only 93,000 cases, mostly in China. 85 countries have more than 1,000 cases of which 35 have more than 10,000. The United States leads the world with over 1 million cases. The actual number of worldwide cases is much higher as many infected people have not been tested. Tests of wastewater systems affirm this.

~900,000 people have recovered including 100,000 in the United States. 

Over 200,000 people have died. The fatality rate of tracked known cases ranges from 10-18% across ten countries with higher median population ages such as the United Kingdom, France, Italy, Sweden, Spain and the Netherlands. The corresponding fatality rate in the United States is between 5 and 6%. As noted above, the actual fatality rate is lower because of insufficient testing.

Social distancing has slowed the pandemic, but not stopped the virus spread. Willpower to shelter at home and avoid contact with others is fading as the mental health and economic effects take their toll. Social distancing scores tracking non-essential visits and human encounters across the United States have moved from “C” grades to “D” grades. An upcoming new wave of infections appears likely.

So why is it so difficult for humans to maintain social distancing given the consequences of not doing so? 

In our post covering 20 Key Health Factors for 2020, social interaction ranks third because studies show that active social relationships increase health and longevity by improving key biomarkers of physical health. Lack of social interaction causes cravings similar to hunger. Even worse, it is associated with health risk factors including increases in inflammation and hypertension (high blood pressure), both comorbidities for COVID-19. Additionally, studies of hypertension show that it causes a subtle decline in mental health by reducing attention, learning, memory and decision-making skills.

In short, our bodies reward us for social interaction and punish us for isolation by negatively impacting mental and physical health. Similarly, our bodies reward us for daily exercise and degrade without it.

For many, social interaction comes from their work environments. Job loss and the resulting financial concerns negatively impact mental health and increase substance abuse. With unemployment levels likely heading to 25%, midwestern states are seeing a threefold increase in drug use. Their analysts’ models indicate a much higher rate of deaths as a result of despair than from COVID-19.

As a result, midwestern governors are considering reopening the economy in gradual waves to people with low risk of death from COVID-19 who choose to begin intermingling again. There would be waiting periods between each wave to make sure that hospitalizations and infection rates are not significantly increasing. It would look something like this:

Wave 1 would be under 50 with no existing COVID-19 comorbidities. Primary high risk comorbidities are vascular risk factors resulting from diabetes, obesity, age and hypertension. Surprisingly those with pre-existing respiratory diseases such as asthma are not appearing in high numbers in ICUs. 

Wave 2 would be healthy 50-65 year olds and those under 50 with lower-risk comorbidities. 

Wave 3 would be 50-65 with lower risk comorbidities. 

Wave 4 would be healthy 65-80 year olds with no major comorbidities. 

Wave 5 would be all those at high risk who will require vaccines.

Although initially it sounds good, what could possibly go wrong?

1. The virus will spread quickly through Group 1. There is an emerging risk of Group 1 members dying or becoming permanently disabled from strokes.
2. There will be an increased burden on hospitals and health workers. There is not yet a standard best practice treatment regime for those who become ill. As a result, the low death rate for younger people will increase. Society will react negatively to the initial wave of young deaths. 
3. Group 1 members live in the same dwellings as Group 2-5 members without living space to isolate themselves.
4. People who get the virus and survive, can still sustain permanent physical impairment. Here’s how COVID-19 damages the body from the brain to the toes. Mental impairment from post-ventilator delirium is nasty, too.
5. Those in higher risk groups experience discrimination as social outcasts.
6. Further unexpected consequences including potentially dangerous mutations as the virus acquires more hosts before we have treatments and vaccines. (Vaccines are at least 12 months away and at least two years away for most of the population. 6-12 months of vaccine testing is required for safety.)

On the positive side, COVID-19 may encourage people to pursue healthy habits to avoid comorbidities such as obesity and type-2 diabetes.

So far, in the United States, ~5.5 million people have been tested with ~18% being positive, ~130,000 hospitalized and ~60,000 deaths. The number of tests has risen to about 250,000 per day. Experts believe that needs to at least double to consider opening the markets. So far, about 1.7% of US residents have been tested. The number of daily new cases is still growing much faster than those who reach recovered status.

The Future of Social Interaction

So what will social interaction look like in the future?

Here’s the White House Reopening America Plan and some thoughtful perspectives:

• What Life After Corona Could Look Like?
• Get Ready for the Masked Economy
• Challenges in Reopening Schools
• Reopening Has Begun. No One is Sure What Happens Next
• As States Push to Reopen, Business Leaders Say Not So Fast

In Keep Health’s editorial opinion, a full lockdown for a couple months would be most effective, but there appears to be a lack of collective political and social willpower for that. Reopening the economy early will cause a spike in cases and more economic damage, potentially requiring a second shutdown. At a minimum before reopening, everyone should be wearing high quality masks in public and a standard approach for best practice treatment should be established to minimize damage to the severely infected. Waiting a few months to allow hospitals and drug treatment companies enough time to figure out what works seems reasonable. Then perhaps a phased in approach by groups.

For those interested, here’s our updated draft of Drug Treatment and Vaccine Companies. Hopefully good solutions arrive soon. Here’s one of the more promising vaccine candidates.

This concludes this article. As your reward for reading, we recommend setting up a regular weekly video conference with a group of friends who bring you joy and happiness. COVID-19 gives us time to reach out to those we don’t usually see because of distance. It is a great time to re-establish those relationships. You can still get together (remotely) to share stories and experiences with high school and college friends, sports teammates as well as friends from work. And if you want to go a bit crazy, perhaps add a llama or a goat to your call.