The Pandemic Could Get Much, Much Worse. We Must Act Now.
A comprehensive shutdown may be required in much of the country.
When
you mix science and politics, you get politics. With the coronavirus,
the United States has proved politics hasn’t worked. If we are to fully
reopen both the economy and schools safely — which can be done — we have
to return to science.
To understand
just how bad things are in the United States and, more important, what
can be done about it requires comparison. At this writing, Italy,
once the poster child of coronavirus devastation and with a population
twice that of Texas, has recently averaged about 200 new cases a day
when Texas
has had over 9,000. Germany, with a population four times that of
Florida, has had fewer than 400 new cases a day. On Sunday, Florida reported over 15,300, the highest single-day total of any state.
The
White House says the country has to learn to live with the virus.
That’s one thing if new cases occurred at the rates in Italy or Germany,
not to mention South Korea or Australia or Vietnam (which so far has
zero deaths). It’s another thing when the United States has the highest growth rate of new cases in the world, ahead even of Brazil.
Italy,
Germany and dozens of other countries have reopened almost entirely,
and they had every reason to do so. They all took the virus seriously
and acted decisively, and they continue to: Australia just issued fines
totaling $18,000 because too many people attended a birthday party in
someone’s home.
In
the United States, public health experts were virtually unanimous that
replicating European success required, first, maintaining the shutdown
until we achieved a steep downward slope in cases; second, getting
widespread compliance with public health advice; and third, creating a
work force of at least 100,000 — some experts felt 300,000 were needed —
to test, trace and isolate cases. Nationally we came nowhere near any
of those goals, although some states did and are now reopening carefully
and safely. Other states fell far short but reopened anyway. We now see
the results.
While New York City just recorded its first day in months without a Covid-19 death, the pandemic is growing
across 39 states. In Miami-Dade County in Florida, six hospitals have
reached capacity. In Houston, where one of the country’s worst outbreaks
rages, officials have called on the governor to issue a stay-at-home
order.
As if explosive growth in too
many states isn’t bad enough, we are also suffering the same shortages
that haunted hospitals in March and April. In New Orleans, testing
supplies are so limited that one site started testing at 8 a.m. but had
only enough to handle the people lined up by 7:33 a.m.
And
testing by itself does little without an infrastructure to not only
trace and contact potentially infected people but also manage and
support those who test positive and are isolated along with those urged
to quarantine. Too often this has not been done; in Miami, only 17 percent
of those testing positive for the coronavirus had completed
questionnaires to help with contact tracing, critical to slowing spread.
Many states now have so many cases that contact tracing has become
impossible anyway.
What’s the answer?
Social
distancing, masks, hand washing and self-quarantine remain crucial. Too
little emphasis has been placed on ventilation, which also matters.
Ultraviolet lights can be installed in public areas. These things will
reduce spread, and President Trump finally wore a mask publicly, which
may somewhat depoliticize the issue. But at this point all these things
together, even with widespread compliance, can only blunt dangerous
trends where they are occurring. The virus is already too widely
disseminated for these actions to quickly bend the curve downward.
To
reopen schools in the safest way, which may be impossible in some
instances, and to get the economy fully back on track, we must get the
case counts down to manageable levels — down to the levels of European
countries. The Trump administration’s threat to withhold federal funds
from schools that don’t reopen won’t accomplish that goal.
To do that,
only decisive action will work in places experiencing explosive growth —
at the very least, limits even on private gatherings and selective
shutdowns that must include not just such obvious places as bars but churches, also a well-documented source of large-scale spread.
Depending
on local circumstances, that may prove insufficient; a comprehensive
April-like shutdown may be required. This could be on a county-by-county
basis, but half-measures will do little more than prevent hospitals
from being overrun. Half-measures will leave transmission at a level
vastly exceeding those of the many countries that have contained the
virus. Half-measures will leave too many Americans not living with the
virus but dying from it.
During the
1918 influenza pandemic, almost every city closed down much of its
activity. Fear and caring for sick family members did the rest;
absenteeism even in war industries exceeded 50 percent and eviscerated
the economy. Many cities reopened too soon and had to close a second
time — sometimes a third time — and faced intense resistance. But lives
were saved.
Had we done it right the
first time, we’d be operating at near 100 percent now, schools would be
preparing for a nearly normal school year, football teams would be
preparing to practice — and tens of thousands of Americans would not
have died.
This is our second chance.
We won’t get a third. If we don’t get the growth of this pandemic under
control now, in a few months, when the weather turns cold and forces
people to spend more time indoors, we could face a disaster that dwarfs
the situation today.
John M. Barry
is a professor at the Tulane University School of Public Health and
Tropical Medicine and the author of “The Great Influenza: The Story of
the Deadliest Pandemic in History.”