What it would take to cure the world of COVID19

We are currently in the worst possible time in the USA for COVID19 infections. Every day, the number of daily infections is climbing at an exponential rate. However, I want to try to be optimistic. What are some of the best possible scenarios? Well, let's start with reality, then look at the worst-case, and then claw our way back to an optimistic scenario.

Reality is: China and South Korea have contained the virus. The US and many other countries have not, and as a result, the virus is running rampant. Due to the infection now being present in most countries, some of whose leaders (such as Bolsanaro of Brazil) are promoting public interactions and not even attempting containment, the possibility of worldwide containment is a near impossibility.  So based on this, I believe that the COVID19 virus will be around on planet Earth for a while, at least until a vaccine has been made. Within the US, the disease is now so prevalent, that containment seems impossible (https://jamanetwork.com/journals/jama/fullarticle/2763187). However, it is difficult to accept this reality. The difficulty in abandoning the idea of containment was expressed by a comment on the above article: "No! While mitigation must be done also, containment must not be abandoned! China has already shown that containment can be done at scale, with aggressive tracking, testing and isolation."


So that brings us to:

Optimistic scenario #1: the US aggressively pursues containment

The idea that we can start testing everyone, implement contact tracing, and the other steps of containment in the USA, when there are already 100,000 positive cases (and growing with 20,000 new cases per day), and currently little to no contact tracing infrastructure, seems unrealistic to me. However, let's try to stay positive. To get this done, President Trump would need to mobilize a WW2 level of effort and come out and say something like:

"America and the rest of the world are under attack by the COVID19 virus. In World War 2, American troops battled around the world to stop the Nazis. Now, we are going to fight around the world to stop the Coronavirus. We are going to lead the world in containment efforts. First, we are going to beat the virus in America, and then we are going to beat the virus in the rest of the world. Starting today, I am authorizing the FBI, CIA, and local police forces to have 5 experienced officers on every new COVID19 case, to find out everyone that they have been in contact with for the past 14 days, and they will all be on self-quarantine for 30 days. There will be a $10,000 fine for with-holding information, and possibly a one year prison sentence, or both. Those that participate in the self-quarantine program will receive their normal salary and any losses up to $10,000 covered by the federal government. Next, under the Wartime Production Act, and starting immediately, the Department of Defence is placing an order for 1 million rapid COVID-19 tests per day, provided by Abbott and other large biotech companies, which we will distribute to the states that are most in need. Finally, I am urging every American to stay at home for the next 60 days. If we work together, we can beat this virus. Once we beat the virus in America, we will beat the virus overseas also"

Then after the virus is beaten back and normalcy restored to the US, trade can be re-opened with countries that have taken similar measures. Then, to normalize trade relations, the US can send the cavalry (millions of tests and support with contact tracing) to countries in need.

Do I think the above containment scenario is realistic? No. But I like to dream big.

If we execute optimistic scenario #1 above, then we can keep the containment train running with allied countries, sending aid in the form of medical equipment and diagnostic tests, and possible contact-tracing support. Once a country has gotten rid of COVID-19, we can again have normal travel between the countries. There is this weird scenario possible where one country has contained the virus while another has not. For example, if South Korea has contained the virus but Brazil has not, I don't see how South Korea can let Brazilians into their country. They will effectively have to be an entire country in a plastic bubble.

Optimistic Scenario 2: In the long-run we will rid the world of COVID-19

For the next 18 months, we will have to deal with COVID19, until a vaccine is developed. Then, after many years of effort from some dedicated individuals and groups who makes it their mission to eradicate COVID19, hunting down every last pocket of infection, I believe it will eventually be eradicated, just like two strains of Polio have been (https://www.vox.com/2019/10/24/20930553/polio-outbreak-2019-eradication-who)

So in the long-term, we will beat this damned virus.

Optimistic Scenario 3: We can do local containment in the USA while other areas do mitigation.

The most recent modelling suggests that COVID19 will infect most of the population is left unchecked:

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-Global-Impact-26-03-2020.pdf

In the paper (not peer-reviewed), they show that if left unchecked, we will get 2.9 million deaths in the USA. However, if we do a triggered suppression (engage in a lockdown and extensive contact tracing) when the death rate increases above some threshold value, we can limit the damage to only 520,000 deaths.

There is another paper (single author, also not peer-reviewed) that is making the rounds that touts a very optimistic scenario of only 81,000 deaths in the USA:
http://www.healthdata.org/sites/default/files/files/research_articles/2020/covid_paper_MEDRXIV-2020-043752v1-Murray.pdf
However, in the paper they model the growth rate as an error function (with no justification), and an arbitrary inflection point beta is chosen, based on empirical fitting. Seems suspect to me.

There seems to be a lot of uncertainty in the number of deaths. Lower-end is 81,000, higher end is 2.9 million.

So what is the optimistic scenario in the medium term? Well, I think it is suppression (as indicated in the paper https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-Global-Impact-26-03-2020.pdf), but instead of triggering local lockdowns and contact tracing based on death rate, I propose that we can do better if we perform local lockdowns based on infection rate. In that case, I think we can get even further below the 520,000 deaths that are predicted. I'll take a wild guess and say only 200,000 (made up number). In this scenario, individual States would be placed under Federal Lockdown once infections climbed above a certain threshold. Until then, infections would be allowed to grow at the exponential doubling rate of 3 days. So a state with only 1 case, would turn into the threshold of 1000 within a matter of 3 weeks. Then the state would be locked down for 3 months. Hmm.. now that I think about it, this strategy sucks. So the idea of a middle-ground, where we just beat down pockets of infection when they arise, is basically equivalent to a permanent lockdown for 18 months. In comparison, (optimistic scenario #1) would be easier than this. So basically, option 3 is a shitty option.

Conclusion

The optimistic scenario is: we rapidly scale up testing, and implement containment and contact-tracing in the USA. If watching American movies growing up has taught me anything, beating the odds with a last-minute hail-mary is what the USA is all about. The US has done it before, being one of the last countries to enter WW2, and going for a hail-mary with developing nuclear weapons, but it paid off then, and it can pay off now. The alternative I see is that we spend the next 18 months doing a dance of releasing restrictions and then getting infections until a vaccine is developed. It would be easier to just go all-in now and get the damned virus contained.