To date, there have been approximately 100,000 documented cases in nearly 100 countries, and 3,500 deaths. Hawaii joined California and Washington this week in declaring a state of emergency. The U.S. stock market has flirted with a 10% correction since its record high on Feb. 19. Oil prices are in free fall while OPEC’s demand estimate has been cut in half and yields on U.S. government bonds hit an all-time low. What might we expect moving forward?

COVID-19 will continue to spread. Because access to test kits remains extremely limited, the number of confirmed cases is probably just the tip of the iceberg. Mortality rates will remain relatively low and are likely far lower than the current estimate of roughly 2% because there are so many mild and unreported cases. Eventually, between one- and three-quarters of the global population may be exposed. The virus can be slowed by quarantines, travel restrictions, closures of schools and major public events, but it cannot be contained. This slowing is imperative to prevent the rapid accumulation of severe cases, as 14% of all diagnosed cases in China required hospital admission. Overburdening our medical systems is a distinct possibility. Still, attempts at containment must be selective and reasonable so as to minimize collateral damage.

COVID-19 might trigger the next recession. The virus will continue to have a pervasive and adverse impact on the global economy as the visitor industry slows, supply chains are interrupted and attendance at public events and facilities is curtailed. While first-quarter data will show deceleration, second-quarter data will confirm a downward trend. The recent emergency rate cut of 50 basis points by the Federal Reserve had no appreciable impact on the markets. If the virus is not the last straw that turns the sugar high from the 2016 tax cuts to sugar blues, the longest economic expansion in U.S. history will not withstand another assault.

Leaders will need to err on the side of caution. Remain calm because that is their job. Political and health care leadership at all levels will be hard-pressed to thread the needle between the optics of complacency and generating unfounded fear. Perceived management and ability to handle the virus will political decision-making at every level. In fact, Gov. Ige’s decision to declare a state of emergency is not because there is an emergency per se, but because he wants to have funding and authority as a precaution in the event of an emergency. The problem with erring on the side of caution is the potential for increased uncertainty and public fear resulting in damage to the economy. However, if we are unprepared, outcomes could be worse.

COVID-19 will normalize … kind of. The virus will continue to spread, regardless of the degree to which it may be slowed by efforts at containment. Sadly, it won’t be treated like influenza A, which has already affected 15 million people with 15,000 deaths in the U.S. this year. The reason is that the mortality rate of influenza is 0.06%, much lower than COVID-19. Ready access to test kits, a vaccine and clearer protocols for treatment will also allay fears. It is difficult to predict when fear and uncertainty will settle, but COVID-19 and its ripple effects will be felt for years. Along with growing impacts of climate change, waves of hard-to-predict infectious disease are the new normal. In fact, this is a practice run. Compared with a disease with, say, a 20% mortality rate, we are getting off easy. Still, with COVID-19 more than 80% will have mild disease only, but many will be hospitalized.

COVID-19 will bring us together. As people respond to the virus by traveling less, avoiding large public gatherings and working more from home, there will be a tendency to binge more on gaming, streaming and social media and, as a result, to become more isolated. In response, we will feel that deep human need to come together in relationship as ohana and community. Face-to-face time may become more important than FaceTime, and we will have an opportunity to rekindle some of what we have lost in the Information Age where our personal data profile is used to drive behavior and deliver surgically customized fake news. We will be able to revel in what we have to be grateful for and pull together, share and be of service. We must be practical and pragmatic and seize the moment to nourish our social fabric and prepare to be strong together to meet environmental challenges whether in the form of infectious diseases or hurricanes. While likely not a direct effect of climate change, COVID-19 shows how human health, animals and our ecosystem are interconnected, and underscores our vulnerability, especially in Hawaii. COVID-19 is a wake-up call to cultivate resilience.

Ira Zunin is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.