The physical distancing that has been imposed in Vermont to challenge the spread of COVID-19 has so far had a good effect. Unlike the situation in states like New York and New Jersey, the curve of spread of the novel coronavirus that causes the disease has already begun to flatten.
According to recent statistics provided by the Vermont Department of Health, fewer than 900 people have been diagnosed with COVID-19, out of more than 11,000 people tested. In Windham County, just 63 cases have been confirmed, and two people have died.
The key element in understanding the impact COVID-19 can have on a community is to look at the rate at which the virus spreads.
In places that have been hardest hit, like Wuhan in China or New York City, the rate of growth in the spread of the virus was exponential, with a doubling rate of diagnosed infections in less than two or three days.
But in Vermont, the rate of the spread of diagnosed infections with the virus has been linear rather than exponential - so far at least. The curve on the graph provided by the state Department of Health is actually a flat line, with a doubling rate of more than 10 days. About 2 percent of the population has been tested.
This good news undoubtedly has to do with the rural nature of the state, where social isolation at this time of year is actually the norm. A 14-day quarantine imposed on out-of-state second-home owners who have traveled here to ride out the pandemic undoubtedly has had a positive effect. Rules regarding physical distancing were imposed early on, and most businesses and activities are shuttered in towns like Brattleboro.
It is difficult to know when businesses will reopen and Windham County will be open for business again. Governor Phil Scott has set June 15 as the re-opening date for tourist businesses like hotels and motels, and the state is essentially on lockdown in the meantime.
Although local police are not acting to enforce the rules of physical distancing, sheltering in place, and wearing masks or scarves whenever one goes out, they do have the power to do so.
Most people are obeying the rules. In the local food stores the guidelines are in force, with markers on the floor at Hannaford to show people how to walk the aisles safely, and long lines outside the Brattleboro Food Co-op, with people wearing masks and separating from one another by the requisite 6 feet of distance.
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The challenge of COVID-19 is mainly a physical health issue, and a great deal of the purpose of physical distancing is to prevent emergency rooms and hospital beds from being overwhelmed. The disease is manageable, even in severe cases, but not when hospitals are overwhelmed and forced to triage patients.
Some people with COVID-19 have died waiting in emergency rooms in places like northern Italy and New York City. The ravages that the disease has brought to nursing homes and other confined spaces like prisons have been widely reported.
Preventing these sorts of tragedies is the purpose behind what has been called “social distancing,” but slowing the spread of this highly contagious virus really is a matter of maintaining physical distance, wearing masks in public, and being mindful of basic hygiene like washing hands thoroughly and not touching one's face.
At the same time, the social and economic costs of the nation-wide quarantine have been enormous, with unemployment rates that have not been seen since the Great Depression and the lowest-paid workers in American society working on the front lines behind store counters or delivering food.
Impatience with the enforced shutdowns has caused protests in various cities, and while President Trump has supported the approach advised by his medical and scientific advisors in his daily press conferences, he has also taken to Twitter to support those who oppose the regime imposed by the virus.
The question of economic harm rivals the question of the toll on health and the death rates that the virus may bring, and it is natural for people in a state like Vermont, which knows nothing like the suffering and overwhelmed health care systems that some other states have experienced, to chafe against the rules.
Although the federal government has promised trillions of dollars in aid to various sectors, including payroll protection grants, small business loans, and a $1,200 check to most individuals, the process of making funds available has been slow, and the need is starting to be felt hard in a nation where 40 percent of the citizens do not have enough savings or wealth to handle any sort of unexpected financial challenge.
According to published reports, about one third of U.S. renters did not pay rent for April. The most recent employment statistics are that 22 million Americans are newly unemployed. Businesses in places like Brattleboro and Wilmington are mainly shuttered, though some restaurants offer pick-up food, and the governor has begun cautiously relaxing some public closure restrictions on professionals and municipalities.
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All of the economic circumstances argue for opening the nation for business as soon as possible, and the right-wing protests underscore the sense of need. At the same time, the novel coronavirus is insidious and not yet well understood by science, and it is clear that contracting COVID-19 is a death sentence for some part of the population.
Countries that dealt well with the virus, like Germany, Iceland, South Korea, and Taiwan used a variety of approaches but mainly relied on having good testing in place along with adequate and readily available health care for those who get sick, and in some cases, like Taiwan, on a measure of surveillance of individuals that most Americans would find repugnant.
The novel coronavirus is still poorly understood. It appears that its incubation period is 14 days, which means that someone can have the virus and spread it without knowing that they are sick. Many had (and spread) the coronavirus but were not sick. For many people, having COVID-19 is not much worse than having a bad cold.
It is clear that COVID-19 is deadly within vulnerable populations, especially when medical care is not quickly available. Older people, people with compromised immune systems, people who smoke cigarettes, or people who live in cities with air pollution are much more likely to die.
But the virus is also indiscriminate in how it affects people, and many otherwise healthy, younger people have also died from its complications.
At this point in the United States, the availability of testing is still limited compared to that in some other nations. The federal administration has essentially left states on their own to manage the challenge. There has been a flurry of activity to create tests for the antibodies that might indicate one has already had the virus, but these tests are still unreliable, and it is not clear yet whether having had the virus actually confers immunity.
Pandemics run a natural course and, by the time this one ends, hundreds of thousands of people will have died. The tragedy of the moment cannot be overstated, nor can the economic impact, where an essentially fragile global economy has basically been shut down.
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The ultimate answer to a pandemic is “herd immunity,” in which a majority of the population has had some exposure to the virus and can withstand it. The obvious need is for a vaccine, as we have for the annual epidemic of flu season. Creating a vaccine is on a fast track, but to have a vaccine that has been well-tested and is broadly reliable may take several more months at least.
The reality is that much more is known about COVID-19 than is understood.
We know the disease can be deadly. We know that it can be carried invisibly by people with no obvious symptoms. We can assume that the actual death rate is fairly low - perhaps 3 in 100, or maybe even less. At this point, we know how many people died from the disease globally, but we don't know how many people have actually had it, so estimates of mortality rates vary widely.
Vermont is a small state with sound management, and so far it has followed best practices for dealing with the virus. It is already clear from the experience of the virus in other nations and states that enforcing rules of physical distance and self-isolation works.
Ultimately, these rules need to be paired with ready access to testing and also a system in which new cases of the virus are followed up through what is called “contact tracing” - where anyone who has come in contact with someone who has tested positive for COVID-19 is tracked down and advised to stay in quarantine and to seek medical assistance if necessary.
For Vermont to open safely after June 15, as the Scott administration has proposed, both adequate testing and good contact-tracing systems will need to be in place, according to the best scientific information. Contact tracing is labor-intensive, and health care systems are not prepared in most places to do the sort of work that helped stem the Ebola virus in African nations or that has been used with HIV/AIDS or sexually transmitted infections in the United States.
As we know from the experience of other places, the COVID-19 virus can erupt quickly in places that are densely populated. Its toll is heartbreaking and savage. One of the challenges to any sort of reopening of social behavior and Vermont's tourist-driven economy is the potential for a rebound effect, in which a virus that seems quelled for a time suddenly resurges in a way that once again taxes local health care systems.
According to projections made earlier this month, Vermont is still two or three weeks away from seeing the peak of the virus. At this point, actual statistics demonstrate that physical distancing is working, and should be continued.
The challenge with the pandemic is that everyone wants it to just be over. The economic toll of the virus cannot be overstated. It is difficult to know what a place like downtown Brattleboro will look like once the virus has run its course.
And it will end - once a vaccine is tested and made reliable and readily available, and once herd immunity is in place.
Optimistic projections have this happening before the fall, and it is obvious to anyone who reads or watches the news how politicized this current crisis has become, with a national election scheduled for November.
More realistic projections suggest that the virus will be with us for at least a year, and that a vaccine will not be available until 2021 at the earliest.
Social isolation is hard work, and for some people who work on the front lines, it is impossible.
The good news is that the virus does not kill most people, and that when good testing and medical care are readily available, most people are OK in the end.
The bad news is that this virus will be here with us for a long time, and it will change the nature of how we live and interact with one another for months or years to come.