There are limits to what ordinary people are willing to endure to secure their employers’ bottom line.
Chris Christie, a Trump supporter and a former New Jersey governor, pleaded with Americans on May 5 to risk disease and death by returning to work. “Everybody wants to save every life they can,” he said, but “we’ve got to let some of these folks get back to work.” Otherwise “we’re going to destroy the American way of life in these families.”
The “American way of life” is shaping up to be a battleground.
On one side is the working class. From Amazon warehouse workers to striking sanitation workers in New Orleans, there are limits to what ordinary people are willing to endure to secure their employers’ bottom line. Resistance to oppression and exploitation is a familiar experience for millions of workers in this country. And when workers have not found justice or relief in mainstream politics, they have turned to more combative ways of mobilizing to secure it.
On the other side is the Republican Party, led by the Trump administration, which has accelerated its call for states to “reopen” the economy by sending people back to work. While President Trump admits that some people will “be affected badly,” nonetheless “we have to get our country open.”
Public health experts disagree. Instead, they argue that testing rates must “double or triple” and that we need a more intense regime of “contact tracing” and isolation. This has been the established pattern in countries that managed the coronavirus with success. But without these measures, forecast models predict a sharp rise in fatalities. A conservative model that in mid-April predicted a ghastly death toll of 60,000 by August now estimates 147,000 fatalities by August. Just as the rate of infection drops in cities like New York and Detroit, new outbreaks threaten to emerge elsewhere where restrictions are being relaxed.
But if we expect tens of millions of people to stay at home for even longer, that is possible only if people have access to income, food, stable housing and reliable health care. If people cannot work, then these things will have to be provided by the federal government. It is that simple.
For Republicans, the “American way of life” as one with big government social welfare programs would be worse than the pandemic. At the core of their vision of the United States is a celebration of supposed rugged individualism and self-sufficiency where hard work is valorized and creates success. Of course, the contrapositive is also believed to be true, that when people have not been successful it is because they did not work hard enough.
Buried within this is the false notion that the U.S. is free from the hierarchies of class. Instead, Republicans and most mainstream Democrats would argue, America has fluid social mobility where a person’s fortitude determines the heights of his or her success. This powerful narrative has motivated millions to migrate to this country. But for tens of millions, this view of ‘the American way of life’ has no bearing on their lives.
Typically, the contradictions of our society are buried beneath the American flag, suffocating hubris and triumphalist claims of exceptionalism. But the pandemic has pushed all of the country’s problems to the center of American life. It has also highlighted how our political class, disproportionately wealthy and white, dithers for weeks, only to produce underwhelming “rescue” bills that, at best, do no more than barely maintain the status quo.
Themedian wealth of a U.S. senator was $3.2 million as of 2018, and $900,000 for a member of the House of Representatives. These elected officials voted for one-time stimulus checks of $1,200 as if that was enough to sustain workers, whose median income is $61,973 and who are now nearly two months into various mandates to shelter-in-place and not work outside their homes. As a result, a tale of two pandemics has emerged.
The crisis spotlights the vicious class divide cleaving through our society and the ways it is also permeated with racism and xenophobia. African-Americans endure disproportionate exposure to the disease, and an alarming number of videos show black people being brutalized by the police for not wearing masks or social distancing, while middle-class white people doing the same things are left in peace. In New York City, 92 percent of those arrested for violating rules regarding social distancing and 82 percent of those receiving summons for the same offense have been black or Latino.
Our society imagines itself to be impervious to the rigidities of class, but it is overwhelmed with suffering, deprivation and hunger. Food banks across the country report extraordinary demand, producing an almost shocking rebuke of the image of a country of universal abundance. According to one report, a food bank along the affluent New Jersey shore has set up a text service allowing people to discreetly pick up their food.
Elsewhere, the signs of a crisis that looks like the Great Depression are impossible to hide. In Anaheim, Calif., home to Disneyland, cars formed half-mile-long lines in two different directions, waiting to pick up free food. In San Antonio, 10,000 cars waited for hours to receive food from a food bank. Even still, Republicans balk at expanding access to food stamps while hunger is on the rise. Nearly one in five children 12 and younger don’t have enough to eat.
That “way of life” may also begin to look like mass homelessness. Through the first five days of April, 31 percent of tenants nationwide had failed to pay their rent. And while more people paid in May, continued payments seem unsustainable as millions fall into unemployment. Forty-three million households rent in the U.S., but there is no public rental assistance for residents who lose the ability to afford their rent. With only a few weeks left on many eviction moratoriums, there is a thin line between a place to shelter in and homelessness for tens of millions of Americans.
Many elected officials in the Republican Party have access to Covid-19 testing, quality health care and the ultimate cushion of wealth to protect them. Yet they suggest others take the “risk” of returning to work as an act of patriotism necessary to regenerate the economy. This is duplicitous and obscures the manipulation of U.S. workers.
While the recent stimulus bills doled out trillions of dollars to corporate America and the “financial sector,” the smallest allocations have provided cash, food, rent or health care for citizens. The gaps in the thin membrane of a safety net for ordinary Americans have made it impossible to do anything other than return to work.
This isn’t just malfeasance or incompetence. Part of the “American way of life” for at least some of these elected officials is keeping workers just poor enough to ensure that the “essential” work force stays shows up each day. In place of decent wages, hazard pay, robust distribution of personal protective equipment and the simplest guarantees of health and safety, these lawmakers use the threat of starvation and homelessness to keep the work force intact.
In the case of the meatpacking industry, there is not even a veil of choice, as those jobs are inexplicably labeled essential, as if life cannot go on without meat consumption. The largely immigrant and black meatpacking work force has been treated barely better than the carcasses they process. They are completely expendable.Thousands have tested positive, but the plants chug along, while employers offer the bare minimum by way of safety protections, according to workers. If there were any question about the conditions endured in meatpacking plants, consider that 145 meat inspectors have been diagnosed with Covid-19 and three have died.
The statements of the two senators from South Carolina, Lindsey Graham and Tim Scott, vociferously opposing the extension of $600 supplemental payments to unemployment insurance, offer another stark example of how workers are being compelled to return to unsafe work environments. Mr. Scott referred to the supplement as a “perverse incentive” to not work. He and Mr. Graham argued that the payments were more than some workers’ salaries, which is an indictment of the jobs and the companies, not the employees.
This is not the first time Southern politicians have complained that government aid to poor or working-class people would undermine their perverse reliance on low-wage labor. During the Great Depression, Southern leaders opposed new systems of social welfare over fear it would undermine “the civilization to which we are accustomed,” as a newspaper in Charleston, S.C., described it. The crude version came from an official in Alabama who insisted that welfare payments to African-Americans should be lower because, “Negroes just don’t want to work.” The logic was that if you could pay black men a nickel then white men would celebrate being paid a dime. Meanwhile, the prevailing wages elsewhere were significantly higher than both. This is why wages are still lower across the South than elsewhere in the country.
American progress means that Mr. Scott, an African-American senator from South Carolina, now voices these ideas. But then as now, complaints about social welfare are central to disciplining the labor force. Discipline in the U.S. has always included low and inconsistent unemployment and welfare combined with stark deprivation. Each has resulted in a hyper-productive work force with few benefits in comparison to America’s peer countries.
This is at the heart of the conflict over reopening the country or allowing people to continue to shelter-in-place to suppress the virus. But if the social distancing and closures were ever going to be successful, it would have meant providing all workers with the means to live in comfort at home while they waited out the disease. Instead, they have been offered the choice of hunger and homelessness or death and disease at work.
The governor of Iowa, Kim Reynolds, made this painfully clear when she announced that not only was Iowa reopening, but that furloughed workers in private or public employment who refused to work out of fear of being infected would lose current unemployment benefits. She described these workers’ choices as a “voluntary quit.”
The Ohio Department of Jobs and Family Services is alsoinstructing employers to report workers who refuse to go to work because of the pandemic. Part of what’s going on is the crush of people filing for benefits means state funds are shrinking. This is exacerbated by the reluctance of the Trump administration to bail out state governments. That the U.S. government would funnel trillions to corporate America but balk at sending money to state governments also appears to be part of “the American way of life” that resembles the financial sector bailout in 2008.
This cannot all be laid at the feet of the Trump administration, though it has undeniably made life worse for millions. These are also the bitter fruits of decades of public policies that have denigrated the need for a social safety net while gambling on growth to keep the heads of U.S. workers above water just enough to ward off any real complaints or protests.
The attacks on welfare, food stamps, public housing and all of the attendant programs that could mitigate the worst aspects of this disaster continue to be bipartisan. The loud praise of Gov. Andrew Cuomo of New York, in contrast to the poor performance of President Trump, has overshadowed protests against his $400 million cuts to hospitals in New York as the virus was raging through the city.
There will be many more examples of Democrats wielding the ax in response to unprecedented budget shortages in the coming months. With the increasing scale of the crisis — as unemployment grows to an otherworldly 36.5 million people while states run out of money and contemplate cutting Medicaid and other already meager kinds of social welfare — the vast need for government assistance will test the political class’s aversion to such intervention.
During the long and uneven recovery from the Great Recession, the warped distribution of wealth led to protests and labor organizing. The crisis unfolding today is already deeper and much more catastrophic to a wider swath of workers than anything since the 1930s. The status quo is untenable.
In the pandemic, “illegal” workers are now deemed “essential” by the federal government.
The other day, armed with a face mask, I was rushing through the aisles of an organic supermarket, sizing up the produce, squeezing the oranges and tomatoes, when a memory hit me.
Me — age 6 — stooping to pick these same fruits and vegetables in California’s San Joaquin Valley. I spent the spring weekends and scorching summers of my childhood in those fields, under the watchful eye of my parents. Once I was a teenager, I worked alongside them, my brothers and cousins, too, essential links in a supply chain that kept America fed, but always a step away from derision, detention and deportation.
Today, hundreds of thousands of immigrants from Mexico and Central America are doing that work. By the Department of Agriculture’s estimates, about half the country’s field hands — more than a million workers — are undocumented. Growers and labor contractors estimate that the real proportion is closer to 75 percent.
Suddenly, in the face of the coronavirus pandemic, these “illegal” workers have been deemed “essential” by the federal government.
Tino, an undocumented worker from Oaxaca, Mexico, is hoeing asparagus on the same farm where my family once worked. He picks tomatoes in the summer and melons in the fall. He told me his employer has given him a letter — tucked inside his wallet, next to a picture of his family — assuring any who ask that he is “critical to the food supply chain.” The letter was sanctioned by the Department of Homeland Security, the same agency that has spent 17 years trying to deport him.
“I don’t feel this letter will stop la migra from deporting me,” Tino told me. “But it makes me feel I may have a chance in this country, even though Americans may change their minds tomorrow.”
True to form, America still wants it both ways. It wants to be fed. And it wants to demonize the undocumented immigrants who make that happen.
Recently, President Trump tweeted that he would “temporarily suspend immigration into the United States” — a threat consistent with the hit-the-immigrant-like-a-piñata policy he spearheaded in his 2016 campaign. Less than 24 hours later, the president backed down in the face of business groups fearful of losing access to foreign labor, announcing that he’d keep the guest worker program.
In the past, the United States has rewarded immigrant soldiers who fought our wars with a path to citizenship. Today, the fields — along with the meatpacking plants, the delivery trucks and the grocery store shelves — are our front lines, and border security can’t be disconnected from food security.
It’s time to offer all essential workers a path to legalization.
It might seem hard to imagine this happening during the “Build the wall” presidency, when Congress can barely agree on emergency stimulus measures. Many Republicans no longer support even DACA, the program that protected Dreamers who grew up here and that could be revoked by the Supreme Court this week. But the pandemic scrambles our normal politics.
“We have started talking about essential workers as a category of superheroes,” said Andrew Selee, the president of the nonpartisan Migration Policy Institute and author of “Vanishing Frontiers.” If the pandemic continues for a year or two, he said, we should think “in a bold way about how do we deal with essential workers who have put their life on the line for all of us but who don’t have legal documents.”
Maybe, he said, “they should be in the pipeline for fast-track regularization, just like those with DACA” are, for now.
Of course, America has always been a fickle country. I learned that lesson as a crop-picking boy, when my aunt Esperanza, who ran the team of farmhands that included my mom, brothers and cousins, would yell: “Haganse arco.” Duck!
The workers without documents would stop hoeing and scramble. Run — if not for their lives, then almost certainly for their livelihoods. We’d watch as the vans of the Border Patrol came to a screeching halt, dust settling. The unlucky workers would make a beeline for the nearest ditch or canal. Some would simply drop to the ground, hoping for refuge amid the rows of sugar beets, tomatoes or cotton. Sometimes the agents gave chase. We’d always root for the prey.
On more than one occasion, agents took my mom and my aunt Teresa, locking them in the cages in the back of the van, because they didn’t have their green cards on them. We’d race home and fetch the cards and make a mad dash to the immigration offices in Fresno some 60 miles away from our farm camp in Oro Loma, praying we’d make it before they could be deported.
We were desperate to prove they had every right to be out in those desolate fields, as if they were taking a dream job away from somebody else.
One time, Aunt Teresa looked genuinely disappointed at the sight of our smiling faces. She was ticked off she hadn’t been deported.
“I miss Mexico,” she said.
Sometimes, the night after such raids, a puzzling thing would take place. A labor contractor or farmer would drive up as we’d gather for dinner of beef, green chile and potato caldillowashed down with tortillas. He’d compliment us for the hard work we had put in that day. And then he’d ask: Did we know anyone who might want to come and work alongside us?
He meant more Mexicans.
The instructions were simple: Get the word out, spread the farmer’s plea back in our towns in Mexico because plenty of rain had fallen that winter and now it was summer and everything around us was ripe, aching for that human touch. The season looked promising. Plenty of crops to pick.
Today not much has changed. The vulnerable — Dreamers working in health care; hotel maids; dairy and poultry plant workers; waiters, cooks and busboys in the $900 billion restaurant industry — still work to feed their families while feeling disposable, deportable by an ungrateful nation.
Tino, the farmworker in the San Joaquin Valley, is worried about the coronavirus. He wonders whether it’s best, after 17 years of hiding from immigration authorities, to return to Oaxaca, “where I’d rather die.”
But Tino’s dreams outweigh his fears. He wants the best for his family, including a son born in the United States, who’s looking at colleges in California. So, he continues in his $13.50-an-hour job.
He works for, among others, Joe L. Del Bosque of Del Bosque Farms, one of the largest organic melon growers in the country. Mr. Del Bosque employs about 300 people on hundreds of acres, and his fruits and vegetables are sold in just about every other organic supermarket across the country, including the place where I now shop in El Paso.
“Sadly, it’s taken a pandemic for Americans to realize that the food in their grocery stores, on their tables, is courtesy of mostly Mexican workers, the majority of them without documents,” Mr. Del Bosque told me. “They’re the most vulnerable of workers. They’re not hiding behind the pandemic waiting for a stimulus check.”
Along with other farmers, he has been pleading with Congress for the past few years to legalize farmworkers, if not as part of comprehensive immigration reform, then as a bill focused on farmworkers, because “you need these workers today, tomorrow and for a long time.”
“With or without Covid,” he added, “we need to constantly replenish our work force to ensure food supplies.”
Some Democratic lawmakers, including Representative Veronica Escobar of El Paso, are pushing to include legalization in any updated coronavirus relief package. “The hypocrisy within America is that we want the fruits of their undocumented labor, but we want to give them nothing in return,” she said.
Even with unemployment projected to be 15 percent or higher, Mr. Del Bosque told me he doubts he’ll ever see a line of job-seeking Americans flocking to his fields. The rare few who have shown up at 5:30 a.m. don’t come back. Some, he said, give up the backbreaking work before their first lunch break.
He fears looming labor shortages. That’s not because of raids by U.S. Immigration and Customs Enforcement resuming or a wall keeping workers out. He worries about a potential coronavirus outbreak, yes, but his most immediate concern is that his farmworkers are aging. Their average age is 40. My old school, Oro Loma Elementary School, which was once filled with Mexican children, closed down in 2010.
The fields are simply running out of Mexicans as fewer men and women migrate each year, either because they’re finding better jobs in Mexico or because of demographics. The Mexican birthrate is down from 7.3 children per woman in the 1960s to 2.1 in 2018. Those who do come want higher-paying jobs in other industries.
The best way to guarantee food security in the future is to legalize the current workers in order to keep them here, and to offer a pathway to legalization as an incentive for new agricultural workers to come. These people will be drawn not just from Mexico, but increasingly from Central and South America.
Del Bosque Farms have been dependent on Mexican workers since Mr. Del Bosque’s parents, also immigrants from Mexico, started hiring them in the 1950s under the Bracero Program, which began during World War II. The program issued some five million contracts to Mexicans, inviting them to come to the United States as guest workers to help fill labor shortages so Americans could fight overseas.
Hundreds of the workers who’ve toiled at Del Bosque Farms over the years have become legal residents, many more citizens, including my father, Juan Pablo.
For many years my father spent the springs and summers working in the United States, but every November he’d high-tail it back to his village in Mexico, where he played in a band called the Birds with his five brothers. He didn’t trust his American bosses to raise his pay, and always worried about the possibility of suddenly being deported, so he wouldn’t commit to them. The Texans especially, he thought, were prejudiced against Mexicans.
The boys from Mexico worked so hard, Texas ranchers argued during one of America’s cyclical anti-immigrant periods, that the hiring of Mexicans should not be considered a felony. Thus, the Texas Proviso was adopted in 1952, stating that employing unauthorized workers would not constitute “harboring or concealing” them. This helps explain why Americans call immigrants “illegal” but not the businesses that hire them.
When the Bracero Program ended in 1964, amid accusations of mistreatment against Mexicans, my father thought he had enough of plowing rows on a tractor and digging ditches. He dreamed of running a grocery store in Mexico, raising his kids out where mountains embraced us. But he was such a hard worker that his boss couldn’t fathom the idea of losing him. So he helped my father get a green card for every member of his family, including me. Later he began working for the Del Bosques.
Without legalization, he would have left and probably never come back.
As a 6-year-old immigrant, I’d cry at night under the California stars, homesick for Mexico, for my friends and cousins. Then one night, as my mother tucked me into bed, she caressed my face. “Shhhh,” she whispered, “they’re all here now.” And she was right.
Today my siblings include a lawyer, an accountant, a truck driver, a delivery manager, a security guard, an educational fund-raiser and a prosthetics specialist. Cousins went off to fight wars in Iraq and Afghanistan, or to help run medical centers and corporations, including Walmart in Arkansas. Others still grind away in the fields of California and meatpacking plants of Colorado, work in nursing homes or clean the houses of the rich. Many of us make an annual pilgrimage to our home village in the Mexican desert. But we’re firmly planted here.
Without being thanked for it, we’re replenishing America.
Scientists who have fought pandemics describe difficult measures needed to defend the United States against a fast-moving pathogen.
Terrifying though the coronavirus may be, it can be turned back. China, South Korea, Singapore and Taiwan have demonstrated that, with furious efforts, the contagion can be brought to heel.
Whether they can keep it suppressed remains to be seen. But for the United States to repeat their successes will take extraordinary levels of coordination and money from the country’s leaders, and extraordinary levels of trust and cooperation from citizens. It will also require international partnerships in an interconnected world.
There is a chance to stop the coronavirus. This contagion has a weakness.
Although there are incidents of rampant spread, as happened on the cruise ship Diamond Princess, the coronavirus more often infects clusters of family members, friends and work colleagues, said Dr. David L. Heymann, who chairs an expert panel advising the World Health Organization on emergencies.
No one is certain why the virus travels in this way, but experts see an opening nonetheless. “You can contain clusters,” Dr. Heymann said. “You need to identify and stop discrete outbreaks, and then do rigorous contact tracing.”
But doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace. Containment becomes realistic only when Americans realize that working together is the only way to protect themselves and their loved ones.
In interviews with a dozen of the world’s leading experts on fighting epidemics, there was wide agreement on the steps that must be taken immediately.
Those experts included international public health officials who have fought AIDS, malaria, tuberculosis, flu and Ebola; scientists and epidemiologists; and former health officials who led major American global health programs in both Republican and Democratic administrations.
Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home. Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.
But tactics like forced isolation, school closings and pervasive GPS tracking of patients brought more divided reactions.
It was not at all clear that a nation so fundamentally committed to individual liberty and distrustful of government could learn to adapt to many of these measures, especially those that smack of state compulsion.
“The American way is to look for better outcomes through a voluntary system,” said Dr. Luciana Borio, who was director of medical and biodefense preparedness for the National Security Council before it was disbanded in 2018.
“I think you can appeal to people to do the right thing.”
In the week since the interviews began, remarkable changes have come over American life. State governments are telling residents they must stay home. Nonessential businesses are being shuttered.
The streets are quieter than they have been in generations, and even friends keep a wary distance. What seemed unthinkable just a week ago is rapidly becoming the new normal.
What follows are the recommendations offered by the experts interviewed by The Times.
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Adm. Tim Ziemer, who led the National Security Council’s pandemic response unit until it was disbanded in 2018.Credit…Chris Kleponis/dpa, via Alamy
The White House holds frequent media briefings to describe the administration’s progress against the pandemic, often led by President Trump or Vice President Mike Pence, flanked by a rotating cast of officials.
Many experts, some of whom are international civil servants, declined to speak on the record for fear of offending the president. But they were united in the opinion that politicians must step aside and let scientists both lead the effort to contain the virus and explain to Americans what must be done.
Just as generals take the lead in giving daily briefings in wartime — as Gen. Norman Schwarzkopf did during the Persian Gulf war — medical experts should be at the microphone now to explain complex ideas like epidemic curves, social distancing and off-label use of drugs.
The microphone should not even be at the White House, scientists said, so that briefings of historic importance do not dissolve into angry, politically charged exchanges with the press corps, as happened again on Friday.
Instead, leaders must describe the looming crisis and the possible solutions in ways that will win the trust of Americans.
Above all, the experts said, briefings should focus on saving lives and making sure that average wage earners survive the coming hard times — not on the stock market, the tourism industry or the president’s health. There is no time left to point fingers and assign blame.
“At this point in the emergency, there’s little merit in spending time on what we should have done or who’s at fault,” said Adm. Tim Ziemer, who was the coordinator of the President’s Malaria Initiative from 2006 until early 2017 and led the pandemic response unit on the National Security Council before its disbanding.
“We need to focus on the enemy, and that’s the virus.”
The next priority, experts said, is extreme social distancing.
If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt.
The virus would die out on every contaminated surface and, because almost everyone shows symptoms within two weeks, it would be evident who was infected. If we had enough tests for every American, even the completely asymptomatic cases could be found and isolated.
The crisis would be over.
Obviously, there is no magic wand, and no 300 million tests. But the goal of lockdowns and social distancing is to approximate such a total freeze.
To attempt that, experts said, travel and human interaction must be reduced to a minimum.
Italy moved incrementally: Officials slowly and reluctantly closed restaurants, churches and museums, and banned weddings and funerals. Nonetheless, the country’s death count continues to rise.
The United States is slowly following suit. International flights are all but banned, but not domestic ones. California has ordered all residents to stay at home; New York was to shutter all nonessential businesses on Sunday evening.
On Friday, Dr. Anthony S. Fauci, chief medical adviser to the White House Coronavirus Task Force, said he advocated restrictive measures all across the country.
In contrast to the halting steps taken here, China shut down Wuhan — the epicenter of the nation’s outbreak — and restricted movement in much of the country on Jan. 23, when the country had a mere 500 cases and 17 deaths.
Its rapid action had an important effect: With the virus mostly isolated in one province, the rest of China was able to save Wuhan.
In a vast, largely closed society, it can be difficult to know what is happening on the ground, and there is no guarantee that the virus won’t roar back as the Chinese economy restarts.
But the lesson is that relatively unaffected regions of the United States will be needed to help rescue overwhelmed cities like New York and Seattle. Keeping these areas at least somewhat free of the coronavirus means enacting strict measures, and quickly.
Stop transmission within cities
Within cities, there are dangerous hot spots: One restaurant, one gym, one hospital, even one taxi may be more contaminated than many identical others nearby because someone had a coughing fit inside.
Each day’s delay in stopping human contact, experts said, creates more hot spots, none of which can be identified until about a week later, when the people infected there start falling ill.
To stop the explosion, municipal activity must be curtailed. Still, some Americans must stay on the job: doctors, nurses, ambulance drivers; police officers and firefighters; the technicians who maintain the electrical grid and gas and phone lines.
The delivery of food and medicine must continue, so that people pinned in their homes suffer nothing worse than boredom. Those essential workers may eventually need permits, and a process for issuing them, if the police are needed to enforce stay-at-home orders, as they have been in China and Italy.
People in lockdown adapt. In Wuhan, apartment complexes submit group orders for food, medicine, diapers and other essentials. Shipments are assembled at grocery warehouses or government pantries and dropped off. In Italy, trapped neighbors serenade one another.
It’s an intimidating picture. But the weaker the freeze, the more people die in overburdened hospitals — and the longer it ultimately takes for the economy to restart.
South Korea avoided locking down any city, but only by moving early and with extraordinary speed. In January, the country had four companies making tests, and as of March 9 had tested 210,000 citizens — the equivalent of testing 2.3 million Americans.
As of the same date, fewer than 9,000 Americans had been tested.
Everyone who is infected in South Korea goes into isolation in government shelters, and phones and credit card data are used to trace their prior movements and find their contacts. Where they walked before they fell ill is broadcast to the cellphones of everyone who was nearby.
Anyone even potentially exposed is quarantined at home; a GPS app tells the police if that person goes outside. The fine for doing so is $8,000.
A nasal swab taken last week at a drive-through testing site in Jericho, N.Y.Credit…Johnny Milano for The New York Times
Testing must be done in a coordinated and safe way, experts said. The seriously ill must go first, and the testers must be protected.
In China, those seeking a test must describe their symptoms on a telemedicine website. If a nurse decides a test is warranted, they are directed to one of dozens of “fever clinics” set up far from all other patients.
Personnel in head-to-toe gear check their fevers and question them. Then, ideally, patients are given a rapid flu test and a white blood cell count is taken to rule out influenza and bacterial pneumonia.
Then their lungs are visualized in a CT scanner to look for “ground-glass opacities” that indicate pneumonia and rule out cancer and tuberculosis. Only then are they given a diagnostic test for the coronavirus — and they are told to wait at the testing center.
The results take a minimum of four hours; in the past, if results took overnight, patients were moved to a hotel to wait — sometimes for two to three days, if doctors believed retesting was warranted. It can take several days after an exposure for a test to turn positive.
In the United States, people seeking tests are calling their doctors, who may not have them, or sometimes waiting in traffic jams leading to store parking lots. On Friday, New York City limited testing only to those patients requiring hospitalization, saying the system was being overwhelmed.
Isolate the infected
As soon as possible, experts said, the United States must develop an alternative to the practice of isolating infected people at home, as it endangers families. In China, 75 to 80 percent of all transmission occurred in family clusters.
That pattern has already repeated itself here. Seven members of a large family in New Jersey were infected; four have already died. After a lawyer in New Rochelle, N.Y., fell ill, his wife, son and daughter all tested positive.
Instead of a policy that advises the infected to remain at home, as the Centers for Disease and Prevention now does, experts said cities should establish facilities where the mildly and moderately ill can recuperate under the care and observation of nurses.
Wuhan created many such centers, called “temporary hospitals,” each a cross between a dormitory and a first-aid clinic. They had cots and oxygen tanks, but not the advanced machines used in intensive care units.
American cities now have many spaces that could serve as isolation wards. Already New York is considering turning the Jacob K. Javits Convention Center into a temporary hospital, along with the Westchester Convention Center and two university campuses.
Gov. Ron DeSantis of Florida said on Saturday that state officials were also considering opening isolation wards.
In China, said Dr. Bruce Aylward, leader of the World Health Organization’s observer team there, people originally resisted leaving home or seeing their children go into isolation centers with no visiting rights — just as Americans no doubt would.
In China, they came to accept it.
“They realized they were keeping their families safe,” he said. “Also, isolation is really lonely. It’s psychologically difficult. Here, they were all together with other people in the same boat. They supported each other.”
Find the fevers
Because China, Taiwan and Vietnam were hit by SARS in 2003, and South Korea has grappled with MERS, fever checks during disease outbreaks became routine.
In most cities in affected Asian countries, it is commonplace before entering any bus, train or subway station, office building, theater or even a restaurant to get a temperature check. Washing your hands in chlorinated water is often also required.
“They give you a sticker afterward,” said Dr. Heymann, who recently spent a week teaching in Singapore. “I built up quite a collection.”
In China, having a fever means a mandatory trip to a fever clinic to check for coronavirus. In the Wuhan area, different cities took different approaches.
Cellphone videos from China show police officers knocking on doors and taking temperatures. In some, people who resist are dragged away by force. The city of Ningbo offered bounties of $1,400 to anyone who turned in a coronavirus sufferer.
The city of Qianjiang, by contrast, offered the same amount of money to any resident who came in voluntarily and tested positive.
Some measures made Western experts queasy. It is difficult to imagine Americans permitting a family member with a fever to be dragged to an isolation ward where visitors are not permitted.
“A lot of people’s rights were violated,” Dr. Borio said.
Voluntary approaches, like explaining to patients that they will be keeping family and friends safe, are more likely to work in the West, she added.
Trace the contacts
Finding and testing all the contacts of every positive case is essential, experts said. At the peak of its epidemic, Wuhan had 18,000 people tracking down individuals who had come in contact with the infected.
At the moment, the health departments of some American counties lack the manpower to trace even syphilis or tuberculosis, let alone scores of casual contacts of someone infected with the coronavirus.
Dr. Borio suggested that young Americans could use their social networks to “do their own contact tracing.” Social media also is used in Asia, but in different ways.
China’s strategy is quite intrusive: To use the subway in some cities, citizens must download an app that rates how great a health risk they are. South Korean apps tell users exactly where infected people have traveled.
When he lectured at a Singapore university, Dr. Heymann said, dozens of students were in the room. But just before he began class, they were photographed to record where everyone sat.
“That way, if someone turns up infected later, you can find out who sat near them,” Dr. Heymann said. “That’s really clever.”
Contacts generally must remain home for 14 days and report their temperatures twice a day.
Make masks ubiquitous
American experts have divided opinions about masks, but those who have worked in Asia see their value.
There is very little data showing that flat surgical masks protect healthy individuals from disease. Nonetheless, Asian countries generally encourage people wear them. In some cities in China where masks are compulsory, the police even used drones to chase individuals down streets, ordering them to go home and mask up.
The Asian approach is less about data than it is about crowd psychology, experts explained.
All experts agree that the sick must wear masks to keep in their coughs. But if a mask indicates that the wearer is sick, many people will be reluctant to wear one. If everyone is required to wear masks, the sick automatically have one on and there is no stigma attached.
Also, experts emphasized, Americans should be taught to take seriously admonitions to stop shaking hands and hugging. The “W.H.O. elbow bump” may look funny, but it’s a legitimate technique for preventing infection.
“In Asia, where they went through SARS, people understand the danger,” Dr. Heymann said. “It’s instilled in the population that you’ve got to do the right thing.”
Preserve vital services
Federal intervention is necessary for some vital aspects of life during a pandemic.
Only the federal government can enforce interstate commerce laws to ensure that food, water, electricity, gas, phone lines and other basic needs keep flowing across state lines to cities and suburbs.
Mr. Trump has said he could compel companies to prioritize making ventilators, masks and other needed goods. Some have volunteered; the Hanes underwear company, for example, will use its cotton to make masks for hospital workers.
He also has the military; the Navy is committing two hospital ships to the fight. And Mr. Trump can call up the National Guard. As of Saturday evening, more than 6,500 National Guard members already are assisting in the coronavirus response in 38 states, Puerto Rico and the District of Columbia.
High-level decisions like these must be made quickly, experts said.
“Many Western political leaders are behaving as though they are on a tightrope,” said Dr. David Nabarro, a W.H.O. special envoy on Covid-19 and a veteran of fights against SARS, Ebola and cholera.
“But there is no choice. We must do all in our power to fight this,” he added. “I sense that most people — and certainly those in business — get it. They would prefer to take the bitter medicine at once and contain outbreaks as they start rather than gamble with uncertainty.”
Produce ventilators and oxygen
The roughly 175,000 ventilators in all American hospitals and the national stockpile are expected to be far fewer than are needed to handle a surge of patients desperate for breath.
The machines pump air and oxygen into the lungs, but they normally cost $25,000 or more each, and neither individual hospitals nor the federal emergency stockpile has ever had enough on hand to handle the number of pneumonia patients that this pandemic is expected to produce.
New York, for example, has found about 6,000 ventilators for purchase around the world, Governor Cuomo said. He estimated the state would need about 30,000.
The manufacturers, including a dozen in the United States, say there is no easy way to ramp up production quickly. But it is possible other manufacturers, including aerospace and automobile companies, could be enlisted to do so.
Ventilators are basically air pumps with motors controlled by circuits that make them act like lungs: the pump pushes air into the patient, then stops so the weight of the chest can push the air back out.
Automobiles and airplanes contain many small pumps, like those for oil, water and air-conditioning fluid, that might be modified to act as basic, stripped-down ventilators. On Sunday, Mr. Trump tweeted that Ford and General Motors had been “given the go-ahead” to produce ventilators.
Providers, meanwhile, are scrambling for alternatives.
The United States must also work to increase its supply of piped and tanked oxygen, Dr. Aylward said.
One of the lessons of China, he noted, was that many Covid-19 patients who would normally have been intubated and on ventilators managed to survive with oxygen alone.
Retrofit hospitals
Construction of one of two new hospitals to treat coronavirus patients in Wuhan, China, in January.Credit…Chinatopix, via Associated Press
Hospitals in the United States have taken some measures to handle surges of patients, such as stopping elective surgery and setting up isolation rooms.
To protect bedridden long-term patients, nursing homes and hospitals also should immediately stop admitting visitors and do constant health checks on their staffs, said Dr. James LeDuc, director of the Galveston National Laboratory at the University of Texas Medical Branch.
The national stockpile does contain some prepackaged military field hospitals, but they are not expected to be nearly enough for a big surge.
In Wuhan, the Chinese government famously built two new hospitals in two weeks. All other hospitals were divided: 48 were designated to handle 10,000 serious or critical coronavirus patients, while others were restricted to handling emergencies like heart attacks and births.
Wherever that was impractical, hospitals were divided into “clean” and “dirty” zones, and the medical teams did not cross over. Walls to isolate whole wards were built, and — as in Ebola wards — doctors went in one end of the room wearing protective gear and left by the other end, where they de-gowned under the eyes of a nurse to prevent infection.
Decide when to close schools
The closed Bear Creek Middle School in Fairburn, Ga.Credit…Melissa Golden for The New York Times
As of Saturday, schools in 45 states were closed entirely, but that is a decision that divided experts.
“Closing all schools may not make sense unless there is documented widespread community transmission, which we’re not seeing in most of the country,” said Dr. Thomas R. Frieden, a former C.D.C. director under President Barack Obama.
It is unclear how much children spread coronavirus. They very seldom get sick enough to be hospitalized, which is not true of flu. Current testing cannot tell whether most do not even become infected.
In China, Dr. Aylward said, he asked all of the doctors he spoke to whether they had seen any family clusters in which a child was the first to be infected. No one had, he said, which astonished him.
That leaves a quandary. Closing schools is a normal part of social distancing; after all, schools are the workplaces for many adults, too. And when the disease is clearly spreading within an individual school, it must close.
But closing whole school districts can seriously disrupt a city’s ability to fight an outbreak. With their children stuck at home, nurses, doctors, police officers and other emergency medical workers cannot come to work.
Also, many children in low-income families depend on the meals they eat at schools.
Cities that close all schools are creating special “hub schools” for the children of essential workers. In Ohio, the governor has told school bus drivers to deliver hot meals to children who normally got them at school.
Recruit volunteers
Residents received a delivery of food in Wuhan this month.Credit…Agence France-Presse — Getty Images
China’s effort succeeded, experts said, in part because of hundreds of thousands of volunteers. The government declared a “people’s war” and rolled out a “Fight On, Wuhan! Fight On, China!” campaign.
It made inspirational films that combined airline ads with 1940s-style wartime propaganda. The ads were somewhat corny, but they rallied the public.
Many people idled by the lockdowns stepped up to act as fever checkers, contact tracers, hospital construction workers, food deliverers, even babysitters for the children of first responders, or as crematory workers.
With training, volunteers were able to do some ground-level but crucial medical tasks, such as basic nursing, lab technician work or making sure that hospital rooms were correctly decontaminated.
Americans often step forward to help neighbors affected by hurricanes and floods; many will no doubt do so in this outbreak, but they will need training in how not to fall ill and add to the problem.
“In my experience, success is dependent on how much the public is informed and participates,” Admiral Ziemer said. “This truly is an ‘all hands on deck’ situation.”
Prioritize the treatments
Claire Liu, a postdoctoral student at the Icahn School of Medicine at Mount Sinai Hospital in Manhattan prepared cell samples for experimental infection with the coronavirus.Credit…Victor J. Blue for The New York Times
Clinicians in China, Italy and France have thrown virtually everything they had in hospital pharmacies into the fight, and at least two possibilities have emerged that might save patients: the anti-malaria drugs chloroquine and hydroxychloroquine, and the antiviral remdesivir, which has no licensed use.
There is not proof yet that any of these are effective against the virus. China registered more than 200 clinical trials, including several involving those treatments, but investigators ran out of patients in critical condition to enroll. Italy and France have trials underway, and hospitals in New York are writing trial protocols now.
One worry for trial leaders is that chloroquine has been given so much publicity that patients may refuse to be “randomized” and accept a 50 percent chance of being given a placebo.
If any drug works on critical cases, it might be possible to use small doses as a prophylactic to prevent infection.
An alternative is to harvest protective antibodies from the blood of people who have survived the illness, said Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston.
The purified blood serum — called immunoglobulin — could possibly be used in small amounts to protect emergency medical workers, too.
“Unfortunately, the first wave won’t benefit from this,” Dr. Hotez said. “We need to wait until we have enough survivors.”
Find a vaccine
Dr. Anthony Fauci, the Trump administration’s coronavirus task force infectious disease expert, this month during a White House briefing.Credit…Al Drago for The New York Times
The ultimate hope is to have a vaccine that will protect everyone, and many companies and governments have already rushed the design of candidate vaccines. But as Dr. Fauci has explained multiple times, testing those candidate vaccines for safety and effectiveness takes time.
The process will take at least a year, even if nothing goes wrong. The roadblock, vaccine experts explained, is not bureaucratic. It is that the human immune system takes weeks to produce antibodies, and some dangerous side effects can take weeks to appear.
After extensive animal testing, vaccines are normally given to about 50 healthy human volunteers to see if they cause any unexpected side effects and to measure what dose produces enough antibodies to be considered protective.
If that goes well, the trial enrolls hundreds or thousands of volunteers in an area where the virus is circulating. Half get the vaccine, the rest do not — and the investigators wait. If the vaccinated half do not get the disease, the green light for production is finally given.
In the past, some experimental vaccines have produced serious side effects, like Guillain-Barre syndrome, which can paralyze and kill. A greater danger, experts said, is that some experimental vaccines, paradoxically, cause “immune enhancement,” meaning they make it more likely, not less, that recipients will get a disease. That would be a disaster.
One candidate coronavirus vaccine Dr. Hotez invented 10 years ago in the wake of SARS, he said, had to be abandoned when it appeared to make mice more likely to die from pneumonia when they were experimentally infected with the virus.
In theory, the testing process could be sped up with “challenge trials,” in which healthy volunteers get the vaccine and then are deliberately infected. But that is ethically fraught when there is no cure for Covid-19. Even some healthy young people have died from this virus.
Reach out to other nations
Tedros Adhanom Ghebreyesus, director-general of the W.H.O., second from left, at a coronavirus briefing in Geneva in January.Credit…Denis Balibouse/Reuters
Wealthy nations need to remember that, as much as they are struggling with the virus, poorer countries will have a far harder time and need help.
Also, the Asian nations that have contained the virus could offer expertise — and desperately needed equipment. Jack Ma, the billionaire founder of Alibaba, recently offered large shipments of masks and testing kits to the United States.
Wealthy nations ignored the daily warnings from Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, that far more aggressive efforts at isolation and contact tracing were urgently needed to stop the virus.
“Middle income and poorer nations are following the advice of international organizations while the most advanced nations find it so hard to implement it,” Dr. Nabarro said. “That must change.”
In declaring the coronavirus a pandemic, Dr. Tedros called for countries to learn from one another’s successes, act with unity and help protect one another against a threat to people of every nationality.
