Six to eight weeks. That’s how long some of the nation’s leading public health experts say it would take to finally get the United States’ coronavirus epidemic under control. If the country were to take the right steps, many thousands of people could be spared from the ravages of Covid-19. The economy could finally begin to repair itself, and Americans could start to enjoy something more like normal life.
Six to eight weeks. For proof, look at Germany. Or Thailand. Or France. Or nearly any other country in the world.
In the United States, after a brief period of multistate curve-flattening, case counts and death tolls are rising in so many places that Dr. Deborah Birx, the Trump administration’s coronavirus response coordinator, described the collective uptick as a sprawling “new phase” of the pandemic. Rural communities are as troubled as urban ones, and even clear victories over the virus, in places like New York and Massachusetts, feel imperiled.
At the same time, Americans are fatigued from spending months under semi-lockdown. Bars and restaurants are reopening in some places, for indoor service — and debates are underway over if and when and how to do the same for schools — even as the virus continues to spread unchecked. Long delays in testing have become an accepted norm: It can still take up to two weeks to get results in some places. As the national death toll climbs above 160,000, mask wearing is still not universal.
It’s no mystery how America got here. The Trump administration’s response has been disjointed and often contradictory, indifferent to science, suffused with politics and eager to hand off responsibility to state leaders. Among the states, the response has also been wildly uneven.
It’s also no surprise where the country is headed. Unless something changes quickly, millions more people will be sickened by the virus, and well over a million may ultimately die from it. The economy will contract further as new surges of viral spread overwhelm hospitals and force further shutdowns and compound suffering, especially in low-income communities and communities of color.
The path to avoiding those outcomes is as clear as the failures of the past several months.
Scientists have learned a lot about this coronavirus since the first cases were reported in the United States earlier this year. For instance, they know now that airborne transmission is a far greater risk than contaminated surfaces, that the virus spreads through singing and shouting as much as through coughing, and that while any infected person is a potential vector, superspreading events — as in nursing homes, meatpacking plants, churches and bars — are major drivers of the pandemic. By most estimates, just 10 to 20 percent of coronavirus infections account for 80 percent of transmissions.
Covid Update: Don’t Rush the Vaccine
We’re developing a coronavirus vaccine with historic speed, but we can’t skip steps.
You can’t rush a vaccine. Hi guys. I’m Jeneen Interlandi. I am back in New York City. And I’m here to give you an update on the coronavirus pandemic. So here’s where we’re at this week, we are getting close to the 5 million mark on national case count, and we have almost 160,000 coronavirus deaths. The daily average of new cases is actually down from just two weeks ago. But the daily death toll is still quite high. And we have to keep in mind that the virus is still spreading uncontrolled through too many parts of the country. But there’s still some cause for hope. “We hope that as the time we get into the late fall and early winter, we will have, in fact, a vaccine that we can say would be safe and effective.” A couple months ago, I was actually not that optimistic about the prospects for a coronavirus vaccine this year. But now I’m actually inclined to agree with Dr. Fauci. No. 1, there’s so many candidates moving through the pipeline. No. 2, several of those candidates are already in late-stage clinical trials. And No. 3, there’s already production facilities being planned for and built so that if one of these vaccines does prove safe and effective, we’ll be able to manufacture it very quickly. This is really actually quite extraordinary, right? If we get a vaccine within the next several months. It’s going to be one of the fastest vaccine development projects like in human history if not the fastest. It normally takes a long, long time to develop a vaccine. We test it in a small batch of humans, then a larger group of humans and then an even larger group of humans. So some people have begun to suggest that we should potentially perhaps skip these Phase 3 trials and just make the vaccine available to anybody who wants it right now, you know, while the Phase 3 trials are being done in the background. That’s a terrible idea. We cannot skip Phase 3 trials. Phase 3 is especially important for detecting, like, rare side effects. Right? So if it’s very rare, it’s only going to show up in a small portion of the population. That means you have to test a lot of people to detect it. And then the other problem is vaccine hesitancy, which is if you start skipping steps now, when you do have something that works and you try to get people to take it, you’re increasing the likelihood that people are not going to trust it later on. And that’s a problem. While I do feel optimistic about a vaccine, and that’s certainly a bright spot, everything else is still pretty grim. A thousand people or so are dying every single day in this country. We’re still not doing all of the things that we can and should be doing to stop that from happening, to stop the virus from spreading and to get it under control. Sorry to end on a depressing note, guys. But that’s where things are. In the meantime, mask up, stay safe.
Experts have also learned a lot about what it takes to get a coronavirus outbreak under control. Most of the necessary steps are the same ones public health experts have been urging for months.
Just because America has largely bungled these steps so far doesn’t mean it can’t turn things around. The nation can do better. It must.
Clear, Consistent Messaging
President Trump and his closest advisers have repeatedly contradicted the scientific evidence, and even themselves, on the severity of the pandemic and the best ways to respond to it. They’ve sown confusion on the importance of mask wearing, the dangers of large gatherings, the potential of untested treatments, the availability of testing and the basic matter of who is in charge of what in the pandemic response.
That confusion seems to have bred a national apathy — and a dangerous partisanship over public health measures — that will be difficult to undo. But leaders at every level can improve the situation by coordinating their messaging: Masks are essential and will be required in all public places. Social distancing is a civic responsibility. The virus is not going away anytime soon, but we can get it under control quickly if we work together.
Such messaging works best when it comes from the very top, but state and local leaders don’t have to wait for federal leaders to step up.
Better Use of Data
As Dr. Tom Frieden, the former director of the Centers for Disease Control and Prevention, has noted: The United States has a glut of data and a dearth of information.
Data on who is getting sick and where is not being used to guide interventions, and crucial figures like test result times and the portion of new cases that were found through contact tracing are not consistently or routinely reported. If scientists had better access to such figures, they could use it to forecast Covid-19 conditions the same way they forecast the weather: warning when a given outbreak is spreading and advising people to adjust their plans accordingly. State and local leaders can make all their data public, and the C.D.C. ought to help them get that data into a usable form.
In places like Melbourne, Australia, and Harris County, Texas, health officials have created numerical and color-coded threat assessments that tell officials and citizens exactly what to do, based on how extensively the coronavirus is spreading in their communities. The highest alert levels call for full-on shelter in place, while the lowest call for careful monitoring of high-risk establishments.
It would behoove the C.D.C. to create a similar, evidence-based scale and work with state and local leaders to employ it in individual communities. In places where the virus is still rampant, that would mean much more aggressive shutdowns than have been carried out in the past. (The United States has not had a true national lockdown, shuttering only about half the country, compared with 90 percent in other countries with more successful outbreak control.)
Smarter shutdowns may also mean closing bars and indoor dining in many places so schools there can reopen more safely; closing meat processing plants until better protections are in place; and tightening state borders in a sensible, as-needed fashion.
Testing, Tracing, Isolation and Quarantine
The most consistent mantra of experts trying to get the coronavirus pandemic under control has been that the nation needs much better testing, tracing, isolation and quarantine protocols. Despite examples across the globe for how to achieve all four, the United States has largely failed on these fronts. Testing delays make contact tracing — not to mention isolation and quarantine — impossible to execute.
To resolve the crisis, federal officials need to commandeer the intellectual property of companies that have developed effective rapid diagnostics and utilize the Defense Production Act to make and distribute as many of those tests as possible. As testing is brought up to speed, officials also need to expand contact tracing and quarantine programs so that once outbreaks are brought under control, states are prepared to keep them in check.
The causes of America’s great pandemic failure run deep, exacerbated by innumerable longstanding problems, from a weak public health infrastructure to institutional racism to systemic inequality in health care, housing and employment. If the pandemic forces the nation to meaningfully grapple with any of those issues, then perhaps all this suffering will not have been in vain. But that work can’t really begin until Americans solve the problem that’s right in front of them, with the tools that are already at their disposal.