an infected person. Characteristics that increase R0 include a longer (potentially contagious) latent period and the ability to s

You’re an alien on another planet and you walk into the local joint hoping that maybe you’ll meet someone toIt is hard to believe how much life has changed in just a few weeks. With unprecedented economic collateral damage as states issue stay-at-home orders, we all recognize that the end to this global nightmare cannot come soon enough. The trillion-dollar question is how and how quickly — what will it take to stop COVID-19?
In my analysis, there are 4 possible ways to stop COVID-19:
1. A treatment.
2. A vaccine.
3. Herd immunity.
4. Breaking the chain of transmission.
First, a word on the fundamental epidemiology of a viral epidemic. The basic reproduction number of a virus, R0 (R-naught), is the average number of people each infected person infects. It is a measure of transmissibility — how easy it is to catch the virus from an infected person. Characteristics that increase R0 include a longer (potentially contagious) latent period and the ability to survive on surfaces outside of the body — both present in COVID-19. When R0 is greater than 1, a virus ultimately spreads; when R0 is less than 1, a virus eventually disappears. The R0 of COVID-19 has been estimated to be between 2–2.5 based on WHO observation in China. By comparison, the R0 of seasonal flu generally hovers around 1.3.
Fortunately, the R0 of a virus is not entirely determined by the virus itself. R0 can be modified by societal interventions and personal precautions. What we are looking for, therefore, is any intervention that will bring the R0 of COVID-19 below 1. As we explore the options, the reality of why the globe has embarked on such aggressive social distancing measures becomes clear.
A treatment
Timeline estimate: uncertain, possibly within the next few months to a year

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Let me acknowledge that finding a treatment will not stop the spread of COVID-19. If a treatment emerges, it may lessen the fear of mass casualties and an overwhelmed healthcare system enough to lessen the need for social distancing measures. We are hoping to find a treatment that drastically reduces respiratory symptoms or shortens the average ICU stay. While the timeline is potentially the closest to a treatment out of the four options, there are caveats. There is no guarantee we find an effective drug, and we should not hold our breathes for a miracle drug. Clinical trials take time to ensure safety and efficacy, and it takes time to mass produce quantities to supply the global need. Hydroxychloroquine +/- azithromycin is one combination receiving media attention but there remains limited data in favor of its use.
A vaccine
Timeline estimate: uncertain, likely 12–18 months
It is a safe bet to expect a vaccine at some point in the future. The question, however, is whether it come quickly enough. Even rushing through the normal developmental cycle of a vaccine, we are being cautioned to expect a timeline of 12–18 months. Once a target is identified, researchers must develop and refine a molecule to attack the target, prove the safety and efficacy of the drug in human subjects, obtain regulatory approval, and finally manufacture the vaccine in mass quantities. It will not be ready in the next two weeks to save us from the current wave of COVID-19 cases. It may not be ready to prevent a feared “second wave” in the fall as occurred in the 1918 influenza pandemic. In other words, we should not count on a vaccine to save the day.
Herd immunity
Timeline estimate: 3–6 months
Herd immunity will stop the spread of any viral epidemic, but it is generally a bad outcome. In the case of COVID-19, it could be a catastrophic outcome. The concept is simple: assuming anyone infected with COVID-19 is now immune and cannot be re-infected, once enough of the popu