The most common question I am asked these days, in regard to COVID-19, is some version of, "What is going to happen in the months and years ahead?"

Before anyone tries to answer that question they should admit their answer is based on this: We know that the vast majority of people who have the disease recover without any problem, and they then have circulating antibodies which we believe will confer immunity that will persist for at least one year and probably several years. What we believe could be wrong, and if it is then all bets are off. As to what I think is likely to happen, the answer rests on "herd immunity." I have heard some people refer to this topic with the term, "herd mentality." Herd immunity and herd mentality are two very different things. To have herd mentality is to follow what others are doing, without thinking for oneself. Doing or thinking a thing just because everyone else is doing or thinking that thing is, as your parents may have pointed out, a bad thing. Herd immunity, on the other hand, is a very good thing. Herd immunity is the protection that is provided to a population when a large majority of the individuals within that population are immune to whatever agent is being considered. It’s probably a poor term, for talking about human populations, but that’s the term we have. As an example, imagine what would happen if all but a random one percent of a population were immune to measles, and then someone with measles traveled to the community. There is only a small chance that they would encounter one of those rare individuals who is not immune. Even if they did infect someone, there will be no significant community spread because the chance of these two contacting and infecting another one of the other rare non-immune individuals is quite small. If they do, the chance of any of these infected people passing their germs on to two people is vanishingly small. In order for a disease to have significant spread, some infected persons must infect more than one new person. In all probability the original infected traveler and the one or two sickened in the community will get well without infecting anyone else, and the measles "outbreak" will be over. That is herd immunity.

Today’s question is harder to answer than the questions from 2 months ago. Two months ago, in mid-February, the questions were, "Will it come here? and what will happen if it does come here?" it is easy to predict what will happen to a population with no effective immunity when a new virus is introduced, if the virus is easy to spread and nothing is done to mitigate the spread. As long as there are no other factors involved, the virus will spread just like a bacteria introduced into a culture dish. If just a few bacteria are placed in a culture dish containing a suitable medium, there will be some period of time during which the number of bacteria will double. The number of bacteria will be small at first, but it will increase, and it will grow exponentially until the bacteria runs out of available food. The number will then peak and decline. It usually stabilizes at some level that is relatively low, compared with the peak. In this analogy the number of coronavirus cases is like the number of bacteria, the world is the culture dish and all non-immune people are the food supply. If we used graph paper to plot the number of bacteria over time we would have a curve just like the curves we have all seen and have been working to flatten. And we have flattened them. If we had not done so, by the time we had reached the apex and were coming down the other side, we would have established a fair degree of herd immunity. Almost everyone in the population would have been infected and would be immune to the virus…. or dead. By flattening and lengthening the curve we have kept our healthcare system from being overwhelmed (hence we have saved lives), but we have also delayed the establishment of natural herd immunity. Until we have herd immunity, either by means of a vaccine or through widespread infection, we must continue to shelter the people who at high risk of complications and who have not been infected with COVID-19.

In communities that have seen few or no infections there remains the potential for rapid spread, but as long as people stay away from events like Mardi Gras and Chinese New Year, rapid spread – in my opinion – is unlikely if we do the things we have rehearsed: Wash your hands (for 20 seconds) before and after touching your face or another persons face. Stay home when you are sick. Wear a mask if you must be out and you think there is any chance you might be getting sick, or have recently gotten over being sick. Sneeze/cough into your elbow, or into tissue (then throw it in the trash and wash your hands for 20 seconds). Wear a mask if you must be near people who have a respiratory illness. Wipe frequently touched surfaces regularly, using a good disinfectant. It will also help if we become more meticulous about throwing our cups, cans, bottles and diapers into the trash. If we will do these things and are otherwise courteous and careful, most of us can return to most of the things we used to do. This virus will be with us forever. I see only two ways for the most vulnerable of our citizens to return to seeing their grandchildren etc. One way is to have widespread and readily available antibody testing. In that case we could see which of the vulnerable population has immunity to COVID-19, and they could go out without fear. For the vulnerable who have no immunity, we could test everyone who desired to visit them, and only allow visits from people who are immune to COVID-19, as they could not have an active infection. The other alternative is herd immunity, preferably through immunization with a vaccine.

Dr. Bradly Bundrant is a highly respected physician at Ballinger Memorial Hospital and the County Health Officer for Runnels County. Bundrant is also the founder of the Health & Wellness Coalition of Runnels County. If you have questions, you can contact the hospital at: 325-365-2531.