LONG ROAD TO RECOVERY: Getting back to normal, riddled with uncertainty

But, despite unprecedented efforts, no vaccine will be ready any time soon. “We’re all going to be wearing masks for a while,” Dr Rochelle Walensky, infectious diseases chief at Massachusetts General Hospital, predicted during a podcast with the Journal of the American Medical Association. These big unknowns top the worry list: Who’s contagious: “The really unknown in this, to be completely transparent,” is asymptomatic spread, said Dr Deborah Birx, the White House coronavirus task force coordinator. From the beginning, authorities have rightly told people to stay home if they’re sick. But according to Dr Anthony Fauci of the National Institutes of Health, somewhere between 25% and half of infected people might not show symptoms. There’s no way to tell if you’re standing next to someone who’s contagious in the checkout line. Even in people who eventually develop symptoms, it’s not clear exactly how soon after infection they can spread the virus. That’s one reason US officials recently encouraged people to wear cloth masks in public, even as they try to keep 6 feet away from others.

To reopen the economy, officials are emphasising the availability of more virus tests. That’s key to spotting and isolating the infected, and tracing and quarantining the people they may have exposed. But it’s not a panacea.

“If you get a test today, that does not mean that tomorrow or the next day as you get exposed, perhaps from someone who may not even know they’re infected, that means ‘I’m negative,’” Fauci said at a recent White House briefing.

Who’s immune: Doctors assume people who had COVID-19 will have some immunity against a repeat infection. But they don’t know how much protection or how long it will last. Another key question: Do people who survive a severe infection have stronger immunity than those who had mild symptoms — or those who had no obvious symptoms at all? To tell, scientists are rolling out blood tests that look for antibodies, proteins that the immune system makes to fight off infection. They don’t detect active infection like the tests needed for the currently sick.

They’re intended to tell who already was infected whether they knew it or not — including those who had few or no symptoms and those who were sick but couldn’t get a diagnostic test.

As they test more people, researchers will look for the level of antibodies that seems to be the key threshold for protection. They’re also trying to tell if having certain types of antibodies are more critical than an overall count.

“How long is the protection — one month, three months, six months, a year?” Fauci said. “We need to be humble and modest that we don’t know everything.” Another hurdle: Dozens of antibody tests are being sold without proof that they work as promised. Some countries have reported inaccurate results from certain tests. Among other things, scientists must prove the tests don’t confuse antibodies against another respiratory bug for COVID-19 protection. The situation is so worrisome that FDA Commissioner Stephen Hahn recently warned that his agency has given “emergency use authorization” backing to just four tests — and that urgent work to validate others is under way.

Associated Press