President Trump on coronavirus testing: “I said to my people, slow the testing down, please." pic.twitter.com/d2nrpxYyzw
— NBC News (@NBCNews) June 21, 2020
we’re all thinking about our hands and
right now we’ll need them more than ever
America’s factories power plants
government military data transportation
water waste national security hospitals
are all fighting they need people on the
ground to keep them functioning which is
why we are working hands on around the
supporting the larger efforts in every
state and county because our technology
is only as powerful as the people
deploying and maintaining it keeping
America moving takes more than
technology alone it takes a human touch
we’re watching certain metrics and
looking at a pattern of numbers before
we make any kind of decisions everything
is going to be based on the numbers and
the science we’re not going to do
anything that’s that’s going to put
anybody in in more danger
welcome to Washington Post live I’m Bob
Costas an a tional political reporter at
The Washington Post this morning we
continue our leadership during crisis
series as the corona virus pandemic up
ends all aspects of American life our
guest today is a state executive on the
frontlines Larry Hogan Maryland’s
Republican governor he is chairman of
the National Governors Association
governor Hogan welcome good morning Bob
thanks for having me
good morning so governor what is the
latest in Maryland in terms of cases and
the death toll well so we were still
kind of climbing that curve in Maryland
we were a couple of weeks behind some of
the other states because of some of the
early and aggressive action we took we
just surpassed 21,000 cases and sadly we
just went over a thousand deaths here in
the state but we’re we’re certainly in a
much better position than we would have
been we not taking aggressive action so
you’re in a much better position but are
you ready to set a date about reopening
your state so we laid out a very
detailed plan just last week and we’ve
had a coronavirus response team made up
of some of the smartest scientists and
epidemiologists and public health
officials in our state from places like
Johns Hopkins and some of the leaders of
this pandemic response really nationally
advising us we developed a plan that
took into consideration the president’s
own corrupt coronavirus plan the mga
plan that we put out the week before for
the recommendations for all the
governor’s along with some Hopkins
reopening plan and the American
Enterprise Institute plan put together
by dr. Scott Godley who was the former
FDA commissioner and our plan is as soon
as we see a flattening or a plateauing
of these key numbers like
hospitalizations and ICU bets or the
things that we’re really focused on the
number of cases is going to rise as we
do more testing and so and and sadly the
deaths lag a couple of weeks behind
what’s actually happening now and so the
most closely following on a daily basis
our hospitalizations in ICU beds and
we’re not seeing as much of a spike
we’ve got a couple of days up a little
bit but it’s a it seems to be leveling
out which is a good sign it seems to be
leveling out so you’re still in a
wait-and-see period about those metrics
we’re looking at those metrics and we
wanted to make sure that we before kind
of key building blocks that we wanted to
have in place we want to make sure we
had robust testing which we have ramped
up dramatically we want to make sure we
can do contact tracing we have a enough
of a supply of PPE which has been a
difficult thing for most of the states
to deal with and we’re constantly
bringing in more and more supplies to
support our hospitals and and then you
know the last thing we’re dealing with
is hospital surge and we’ve added six
thousand beds to our hospital capacity
and have been acquiring ventilators to
make sure that we can be prepared so
those things in place we have a phased
plan to start implementing just as soon
as we can because we’re anxious to get
our economy back on track and put people
back to work but we want to make sure we
do so in a safe effective and gradual
way let’s talk about the supplies you
just mentioned last week it was big news
Marilyn bought 500,000 tests from South
Korea but you saw the Washington Post
this morning they have not been used yet
what’s the holdup well I announced when
we acquired the test a little over a
week ago it was a it was a huge
accomplishment it’s like this more than
a month after the president said the
states were kind of on their own and had
to go out and get their own testing we
searched all over the country to find
tests and we finally through some
international diplomacy we were able to
get this half a million tests in from
Korea at the time when that plane landed
that half a million tests was more than
the all of the testing added together
for four out of the top five states in
America it was quite a step but when I
announced it 10 days ago I said it was
still only a part of the puzzle because
we still needed swabs and reagents there
are about nine different steps in this
that was a big chunk of it the rest of
it we’re continuing to work on and prove
on but the story really wasn’t you know
I hate to take a shot at the Washington
Post but it really wasn’t that accurate
of a story because we are utilizing the
tests we have thousands of them that are
being deployed but we have to ramp up
our lab capacity which we’ve been
working with the federal government on
trying to get some assistance on there
had been a shortage of lab of swabs all
across the country which the president
just instituted the defense production
act on all of these things are part of
being able to deploy those half-million
tests but we have a poultry outbreak on
the Eastern Shore we have thousands of
those tests over there now and produce
stadium in Salisbury we’re putting them
out in our we put out a report yesterday
that we’re going to do mandatory testing
of every single patient in every single
nursing home first state in America in
America to do that and we’re doing that
with those Korean tests that we’re just
talking about to the point about the
Washington Post story I’ve heard from
Governor Pritzker of Illinois for
example a similar point that you just
made that it’s not just enough to have
the test you have to have the supplies
that go along with the test when are you
going to feel comfortable that Marilyn
has those supplies to use the tests you
got from South Korea well so we’re using
as many of them as we can and as the
additional supplies come in we’re
utilizing more of them but when we when
we acquired the test we said that was
helping us on a long-term strategy so we
always intended this to be over several
months that we would utilize those
half-million tests not in the first week
that we acquired them so but where it
all depends on the ability of to get the
swabs the reagents all of the steps in
the process and the lab capacity so you
know we’ve got private labs involved
that have to get it ramped up we’ve got
the University of Maryland where we
invested in robotics just so that they
can produce 20,000 tests per week which
is a major improvement we’ve been
getting reagents we were able to ramp up
I think you know 40,000 more tests as
about a week or so ago and swabs
continues to be a problem but it seems
like and that is something that the
federal government is helping with and
hopefully we’re gonna get more supplies
in but right now we’re using all we can
possibly use and we’re hoping to be able
to keep up with demand as we need them
you say the federal government you want
it to be a partner with Maryland
but based on my own reporting you had
some concerns about whether the feds
would cease these tests when you brought
them over from South Korea is that true
were you concerned that the federal
government would try to take those tests
out of your hands was a little bit of a
concern about trying to get these things
and it was a very complicated process
you know we we spent about 22 days and
nights dealing with this whole
transaction with Korea dealt with the
Korean embassy and folks at the State
Department in Korea eight different
state agencies and our scientists on
both sides trying to you know figure out
these tests and that at the last moment
I think 24 hours before we got sign-off
from the FDA and border and customs to
try to make sure that we landed this
plane safely we made sure it landed at
BWI Airport instead of Dulles so the
first time a Korean Air passenger plane
has ever landed at Baltimore Washington
International Airport we landed it there
with a large contingent of Maryland
National Guard and Maryland State Police
because this was an enormous ly valuable
payload it was like it was like Fort
Knox to us because gonna save the lives
of thousands of our citizens and there
had been reports of for example in
Massachusetts governor Charlie Baker
told the story of his plane load that
came in with with masks was basically
confiscated by the federal government
and he had to then get Robert Kraft the
owner of the Patriots to fly a second
mission with a private plane to try to
bring some of that equipment in for a
couple of other states that had similar
stories so we were just making sure that
that was so important to us that we
wanted to make sure that that plane took
off from Korea safely landed here in
America safely and that we guarded that
cargo from whoever might interfere with
the US getting that to our folks that
needed it the national guard protecting
test is the National Guard in Maryland
still protecting those tests they are
the National Guard and the State Police
are both guarding these tests at an
undisclosed location these things are
being distributed they’re helping us
distribute the test they’re also helping
in all kinds of other humanitarian
we have about 1,300 members of the
Maryland National Guard who have been
activated another 800 that are kind of
on standby ready for activation within
an eight-hour period but they were just
tremendous they’re helping us distribute
supplies and PPE helping us with the
distribution of those tests they’re
helping provide meals for hungry kids I
mean they’ve just done an incredible job
and we were utilizing them these are
citizen soldiers that are really
stepping up to help their says there’s
fellow citizens in need are we seeing in
Maryland a racial disparity in access to
testing generally not access to testing
in fact we’re actually most of our tests
are deployed in our high population
areas which also happen to be more
racially diverse so we’re doing more
testing in the areas with higher
concentrations of minorities but we’re
also there is a disparity in I mean
there’s no question that that minorities
are more impact they didn’t have a
higher percentage of people that are
that are both getting the virus and
dying from the virus and so it has to do
with you know our population centers and
in in the inner Beltway and the
Washington suburbs and in Baltimore City
where we have highly dense populations
and people that are you know riding
public transportation or working and
living in closed environments and
there’s definitely there we published
all the racial data which does show that
that minorities are more impacted by the
virus but we’ve spent more time more
resources and done more testing and put
more of a focus on those areas than
anywhere else people in minority
communities people across Maryland
they’re also struggling not only with
access to testing but access to
unemployment benefits and you’ve
apologized acknowledged problems in that
effort the beacon portal so what are you
doing right now today to speed up access
to debit cards and checks well so this
has just been an enormous first of all
my heart goes out to all the people that
are struggling and suffering there’s so
many so much unemployment I think
nationally as of today you know 30
million people filing for unemployment
some of these benefits are brand-new
I want to thank the federal government
and Congress and everybody for moving so
quickly to add these additional benefits
folks that are not w-2 employees but gig
workers and 1099 none of the websites
could handle these types of these new
types of benefits number one and the
volume was so unprecedented we had in a
five-day period something like 250,000
people try to file which was more than
the entire year of 2019 we created a
brand-new website for this brand-new
program to try to handle that and we
were one of the first in the country to
do so in many places they aren’t even
able to provide the benefit so you can’t
get through on a phone a couple of
states their entire system crashed and
it’s been down for days ours has
continued to run and we’ve been able to
help a couple of hundred thousand people
but it’s frustrating to me that some
people were waiting way too long and the
system was not able to help handle the
speed so I you know I said look this
it’s unacceptable as the governor of the
state I you know I have higher standards
of that and I’ve been demanding from the
contractors that are developed aside
from our all of our state workers we’ve
brought in hundreds of people to try to
fix it working around the clock 24 hours
a day as of this morning it’s working
and functioning much better you have
about a three minute wait rather than
waiting for hours but we expect that
volume when people start filing if the
file every week so Sunday and Monday the
massive volumes are gonna come in again
we’re hoping it’s gonna work much better
but it’s a difficult every state in
America is having difficulties
processing the massive volume and we’re
trying to get people every penny of the
money that they deserve and that they
desperately need as quickly as we can
speaking of speed another tragedy in
your state in other states
nursing homes and you’ve now mandated
testing for residents staff at nursing
homes the question is though how soon
can that be done
so the nursing homes as you know if you
remember Bob when we first started
hearing about this in America was that
focus in Washington state of Washington
with that nursing home and I remember
vividly seeing those those images it’s
been probably the biggest problem that
every state has had nursing homes
because we have that’s our most
vulnerable population and they’re in
such a vulnerable position so what when
the the very first day of our crisis
they we got our first case in Maryland I
called in all of the long-term care
facility operators the nursing homes the
assisted living all of these folks and
weeks we brought them in we took really
aggressive action on day one to lay out
protocols we didn’t know we cut down
access so there were no visitors allowed
this was fifty fifty two days ago we we
said that staff had to be checked
temperature checks as they came and went
no travel for your staff but all kinds
of protocols we put in place together
with the industry in spite of all those
things a symptomatic staff who didn’t
have a temperature didn’t show any signs
of anything and there were no visitors
coming a symptomatic staff would would
come to work with the virus unknowingly
and it just went through these nursing
homes like wildfire we now have over
4,000 cases in our nursing homes we have
we have about 130 some nursing home
centers with outbreaks or clusters and
sadly 46 percent of all of our deaths
our nursing home patients so we’ve taken
further steps to now not wait until
somebody’s showing signs of symptoms and
and but we’re testing every single staff
member and every single patient in all
those there’s 24,000 of them in our
state so it takes a while to get it done
we’re prioritize just started yesterday
this new program we’re with our new
tests from Korea but we’re prioritizing
the ones where we have the outbreaks and
where we have threats of potential
clusters where we’ve got a case where we
already have somebody that tested
positive and we’re gonna work our way
down that list until we get to every
those folks what about prisons should
testing be mandated there as well we are
where we’ve taken all kinds of steps to
reduce our prison population we’ve set
up triage centers we’ve set up isolation
sections in the hospitals and we’re
doing testing of hospital staff that’s
one of our top priorities and that’s
included in our kind of clusters and
hotspots where we’re focusing some of
these tests first so it’s things like
prisons it’s things like nursing homes
also on health care workers they’re
gonna get prioritized for tests and then
this issue like I talked about today we
have a big poultry industry on our
Maryland’s Eastern Shore we have a major
outbreak there and interruption of the
food chain so we’re we’re setting up
this new thing there for the for the
workers in the poultry industry at
Perdue at the Perdue plant and at
Purdue’s Stadium in Salisbury let’s
pause on that food issue we got an email
from one of our readers of the post Milo
Williams from Maryland she said quote I
heard there’s no risk to Maryland’s food
supply train but grocery stores are
still out of stock of many items I
switch to having my groceries delivered
but a lot of times my delivery is not
arriving because things are out of stock
what’s being done yeah I think that’s
there there is no interruption in the
food chain and that’s not sort of
unrelated to what I we do have a concern
with this poultry industry issue that
same you’ve heard about it nationally
with pork producers and beef producers
and now poultry producers to make sure
there’s no interruption in that food
chain which is a big national issue here
locally we’re concerned about the
workers and the spreading this into the
community and about our poultry farmers
and what it does to our economy on the
this issue that your your reader is
asking about the stocks not being filled
that’s a problem that’s we’re continuing
to try to work with all of these supply
chain folks to make sure they keep being
filled some of it is a problems with
distribution but some of it is simply
people rushing out and and hoarding
because of concern about things running
out so they’re buying too much and
clearing out their shelves and but it’s
an issue that we continue to work with
all the stores in the supply
to try to improve upon to make sure that
this shelves remain stocked but there if
there isn’t a concern so people should
just buy what they need and not be you
know wiping out the shelves and taking
everything we just have a couple more
minutes here Governor Hogan so maybe for
some brief answers one we got a note
from Steve Larson from Maryland will the
beaches be open in Ocean City this
summer I know that the Ocean City mayor
and city council have been meeting and
talking about this it’s really it’s
really too early to tell I think there
probably will be some hope for some kind
of a season in Ocean City but whether
it’ll be normal that’s a big question
about how they’re gonna go about opening
opening opening beaches in a safe way
what would you mandate face coverings
masks during a reopening of Maryland is
certainly it depends on that’s one of
the things that our plan and visions
were working with industry sectors
depending on what the work is and how
closely their affiliates certain and
certainly in some places you are gonna
have to wear masks until we find a
vaccine or a cure homelessness is an
issue rent and mortgage payments are an
issue 50 Democratic lawmakers on
Wednesday praised you they also called
on you to cancel rent and mortgage
payments for residents and businesses
hurt by the pandemic will you do that
haven’t seen the letter yet from the
legislature legislatures I just I saw
that clip this morning in the news but
we have worked very closely to make sure
that people are suffering during this
time and we put a pause on evictions it
was one of the first things I did on
addictions and foreclosures so that
nobody came and nobody can have their
utilities cut off nobody can be evicted
nobody can be foreclosed on and we’re
gonna try to work with the lenders and
with landlords or at work through this
as we come out of this crisis because
certainly everybody’s been hurt
economically you just had a special
congressional election on Tuesday in
your state what was that experience like
and do you would you like to see all
mail-in voting this fall I just had a
good call yesterday with Congressman to
be kwazy and fumet who was elected to
fill the seat of Elijah Cummings the
election went very well I was sort of
surprised it was all done by mail with a
few exceptions of
people that didn’t have fixed addresses
or people that needed to go out in
person and it went if it came off
surprisingly well without a glitch and
you know we’re going to encourage people
in the June primary that that’s coming
up for the rest of the state to vote by
mail there will be the opportunity for
those who can’t have one polling place
each county for folks that for example
like they’re blind or don’t have a fixed
address that need to get out but most
people we want them to vote by mail it’s
the we want to have every vote counted
but we want people to be expressing
their vote and making their decisions in
a safe way final question here the last
time I visited with you in Annapolis it
was a for a political story you decided
not to run for president you were
thinking through the idea at the time
this week it was just announced that
congressman Justin Amash of Michigan is
considering a third party run would you
be willing to support him are you
leaning toward Vice President Biden or
President Trump you know in the middle
of the pandemic you know I haven’t quite
frankly Bob spent a lot of time thinking
about politics I think I know there’s an
election going on but my focus is on
trying to keep the people in my safe
state and running the NGA which is a
nonpartisan organization that requires
me to stay out of politics for a while
so I’ll pass on that question and we’ll
figure that out in November I’ll ask you
about that at some point though in the
coming months I’m sure about it I’m sure
you worried Thank You Governor Hogan for
joining us here at Washington Post live
we appreciate your time thank you Bob
thank you and thank all of you for
watching tune in tomorrow at Washington
Post live at 11:00 a.m. Eastern to catch
Post columnist David Ignatius he’s gonna
be in conversation with Ford Motor
Company CEO Jim Hackett for more
information on that and other programs
go to Washington Post live.com and
register but for now I’m Bob Costas
stay well and stay safe
The coronavirus is spreading from America’s biggest cities to its suburbs, and has begun encroaching on the nation’s rural regions. The virus is believed to have infected millions of citizens and has killed more than 34,000.
Yet President Trump this week proposed guidelines for reopening the economy and suggested that a swath of the United States would soon resume something resembling normalcy. For weeks now, the administration’s view of the crisis and our future has been rosier than that of its own medical advisers, and of scientists generally.
In truth, it is not clear to anyone where this crisis is leading us. More than 20 experts in public health, medicine, epidemiology and history shared their thoughts on the future during in-depth interviews. When can we emerge from our homes? How long, realistically, before we have a treatment or vaccine? How will we keep the virus at bay?
Some felt that American ingenuity, once fully engaged, might well produce advances to ease the burdens. The path forward depends on factors that are certainly difficult but doable, they said: a carefully staggered approach to reopening, widespread testing and surveillance, a treatment that works, adequate resources for health care providers — and eventually an effective vaccine.
Still, it was impossible to avoid gloomy forecasts for the next year. The scenario that Mr. Trump has been unrolling at his daily press briefings — that the lockdowns will end soon, that a protective pill is almost at hand, that football stadiums and restaurants will soon be full — is a fantasy, most experts said.
“We face a doleful future,” said Dr. Harvey V. Fineberg, a former president of the National Academy of Medicine.
He and others foresaw an unhappy population trapped indoors for months, with the most vulnerable possibly quarantined for far longer. They worried that a vaccine would initially elude scientists, that weary citizens would abandon restrictions despite the risks, that the virus would be with us from now on.
“My optimistic side says the virus will ease off in the summer and a vaccine will arrive like the cavalry,” said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University medical school. “But I’m learning to guard against my essentially optimistic nature.”
Most experts believed that once the crisis was over, the nation and its economy would revive quickly. But there would be no escaping a period of intense pain.
Exactly how the pandemic will end depends in part on medical advances still to come. It will also depend on how individual Americans behave in the interim. If we scrupulously protect ourselves and our loved ones, more of us will live. If we underestimate the virus, it will find us.
More Americans may die than the White House admits.
Covid-19, the illness caused by the coronavirus, is arguably the leading cause of death in the United States right now. The virus has killed more than 1,800 Americans almost every day since April 7, and the official toll may be an undercount.
By comparison, heart disease typically kills 1,774 Americans a day, and cancer kills 1,641.
Yes, the coronavirus curves are plateauing. There are fewer hospital admissions in New York, the center of the epidemic, and fewer Covid-19 patients in I.C.U.s. The daily death toll is still grim, but no longer rising.
The epidemiological model often cited by the White House, which was produced by the University of Washington’s Institute for Health Metrics and Evaluation, originally predicted 100,000 to 240,000 deaths by midsummer. Now that figure is 60,000.
While this is encouraging news, it masks some significant concerns. The institute’s projection runs through Aug. 4, describing only the first wave of this epidemic. Without a vaccine, the virus is expected to circulate for years, and the death tally will rise over time.
The gains to date were achieved only by shutting down the country, a situation that cannot continue indefinitely. The White House’s “phased” plan for reopening will surely raise the death toll no matter how carefully it is executed. The best hope is that fatalities can be held to a minimum.
Reputable longer-term projections for how many Americans will die vary, but they are all grim. Various experts consulted by the Centers for Disease Control and Prevention in March predicted that the virus eventually could reach 48 percent to 65 percent of all Americans, with a fatality rate just under 1 percent, and would kill up to 1.7 million of them if nothing were done to stop the spread.
By comparison, about 420,000 Americans died in World War II.
The limited data from China are even more discouraging. Its epidemic has been halted — for the moment — and virtually everyone infected in its first wave has died or recovered.
China has officially reported about 83,000 cases and 4,632 deaths, which is a fatality rate of over 5 percent. The Trump administration has questioned the figures but has not produced more accurate ones.
Fatality rates depend heavily on how overwhelmed hospitals get and what percentage of cases are tested. China’s estimated death rate was 17 percent in the first week of January, when Wuhan was in chaos, according to a Center for Evidence-Based Medicine report, but only 0.7 percent by late February.
In this country, hospitals in several cities, including New York, came to the brink of chaos. Officials in both Wuhan and New York had to revise their death counts upward this week when they realized that many people had died at home of Covid-19, strokes, heart attacks or other causes, or because ambulances never came for them.
In fast-moving epidemics, far more victims pour into hospitals or die at home than doctors can test; at the same time, the mildly ill or asymptomatic never get tested. Those two factors distort the true fatality rate in opposite ways. If you don’t know how many people are infected, you don’t know how deadly a virus is.
Only when tens of thousands of antibody tests are done will we know how many silent carriers there may be in the United States. The C.D.C. has suggested it might be 25 percent of those who test positive. Researchers in Iceland said it might be double that.
China is also revising its own estimates. In February, a major study concluded that only 1 percent of cases in Wuhan were asymptomatic. New research says perhaps 60 percent were. Our knowledge gaps are still wide enough to make epidemiologists weep.
“All models are just models,” Dr. Anthony S. Fauci, science adviser to the White House coronavirus task force, has said. “When you get new data, you change them.”
There may be good news buried in this inconsistency: The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually faded into the seasonal H1N1 flu.
At the moment, however, we do not know exactly how transmissible or lethal the virus is. But refrigerated trucks parked outside hospitals tell us all we need to know: It is far worse than a bad flu season.
The lockdowns will end, but haltingly.
Until a vaccine or another protective measure emerges, there is no scenario, epidemiologists agreed, in which it is safe for that many people to suddenly come out of hiding. If Americans pour back out in force, all will appear quiet for perhaps three weeks.
Then the emergency rooms will get busy again.
“There’s this magical thinking saying, ‘We’re all going to hunker down for a while and then the vaccine we need will be available,’” said Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
In his wildly popular March 19 article in Medium, “Coronavirus: The Hammer and the Dance,” Tomas Pueyo correctly predicted the national lockdown, which he called the hammer, and said it would lead to a new phase, which he called the dance, in which essential parts of the economy could reopen, including some schools and some factories with skeleton crews.
Every epidemiological model envisions something like the dance. Each assumes the virus will blossom every time too many hosts emerge and force another lockdown. Then the cycle repeats. On the models, the curves of rising and falling deaths resemble a row of shark teeth.
Surges are inevitable, the models predict, even when stadiums, churches, theaters, bars and restaurants remain closed, all travelers from abroad are quarantined for 14 days, and domestic travel is tightly restricted to prevent high-intensity areas from reinfecting low-intensity ones.
The tighter the restrictions, experts say, the fewer the deaths and the longer the periods between lockdowns. Most models assume states will eventually do widespread temperature checks, rapid testing and contact tracing, as is routine in Asia.
Even the “Opening Up America Again” guidelines Mr. Trump issued on Thursday have three levels of social distancing, and recommend that vulnerable Americans stay hidden. The plan endorses testing, isolation and contact tracing — but does not specify how these measures will be paid for, or how long it will take to put them in place.
On Friday, none of that stopped the president from contradicting his own message by sending out tweets encouraging protesters in Michigan, Minnesota and Virginia to fight their states’ shutdowns.
China did not allow Wuhan, Nanjing or other cities to reopen until intensive surveillance found zero new cases for 14 straight days, the virus’s incubation period. Compared with China or Italy, the United States is still a playground.
Americans can take domestic flights, drive where they want, and roam streets and parks. Despite restrictions, everyone seems to know someone discreetly arranging play dates for children, holding backyard barbecues or meeting people on dating apps.
Partly as a result, the country has seen up to 30,000 new case infections each day. “People need to realize that it’s not safe to play poker wearing bandannas,” Dr. Schaffner said.
Even with rigorous measures, Asian countries have had trouble keeping the virus under control.
China, which has reported about 100 new infections per day, recently closed all the country’s movie theaters again. Singapore has closed all schools and nonessential workplaces. South Korea is struggling; Japan recently declared a state of emergency.
Resolve to Save Lives, a public health advocacy group run by Dr. Thomas R. Frieden, the former director of the C.D.C., has published detailed and strict criteria for when the economy can reopen and when it must be closed.
Reopening requires declining cases for 14 days, the tracing of 90 percent of contacts, an end to health care worker infections, recuperation places for mild cases and many other hard-to-reach goals.
“We need to reopen the faucet gradually, not allow the floodgates to reopen,” Dr. Frieden said. “This is a time to work to make that day come sooner.”
Immunity will become a societal advantage.
Imagine an America divided into two classes: those who have recovered from infection with the coronavirus and presumably have some immunity to it; and those who are still vulnerable.
“It will be a frightening schism,” Dr. David Nabarro, a World Health Organization special envoy on Covid-19, predicted. “Those with antibodies will be able to travel and work, and the rest will be discriminated against.”
Already, people with presumed immunity are very much in demand, asked to donate their blood for antibodies and doing risky medical jobs fearlessly.
Soon the government will have to invent a way to certify who is truly immune. A test for IgG antibodies, which are produced once immunity is established, would make sense, said Dr. Daniel R. Lucey, an expert on pandemics at Georgetown Law School. Many companies are working on them.
The California adult-film industry pioneered a similar idea a decade ago. Actors use a cellphone app to prove they have tested H.I.V. negative in the last 14 days, and producers can verify the information on a password-protected website.
As Americans stuck in lockdown see their immune neighbors resuming their lives and perhaps even taking the jobs they lost, it is not hard to imagine the enormous temptation to join them through self-infection, experts predicted. Younger citizens in particular will calculate that risking a serious illness may still be better than impoverishment and isolation.
“My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,” said Dr. Michele Barry, who directs the Center for Innovation in Global Health at Stanford University.
It has happened before. In the 1980s, Cuba successfully contained its small AIDS epidemic by brutally forcing everyone who tested positive into isolation camps. Inside, however, the residents had their own bungalows, food, medical care, salaries, theater troupes and art classes.
Dozens of Cuba’s homeless youths infected themselves through sex or blood injections to get in, said Dr. Jorge Pérez Ávila, an AIDS specialist who is Cuba’s version of Dr. Fauci. Many died before antiretroviral therapy was introduced.
It would be a gamble for American youth, too. The obese and immunocompromised are clearly at risk, but even slim, healthy young Americans have died of Covid-19.
The virus can be kept in check, but only with expanded resources.
The next two years will proceed in fits and starts, experts said. As more immune people get back to work, more of the economy will recover.
But if too many people get infected at once, new lockdowns will become inevitable. To avoid that, widespread testing will be imperative.
Dr. Fauci has said “the virus will tell us” when it’s safe. He means that once a national baseline of hundreds of thousands of daily tests is established across the nation, any viral spread can be spotted when the percentage of positive results rises.
Detecting rising fevers as they are mapped by Kinsa’s smart thermometers may give an earlier signal, Dr. Schaffner said.
To keep the virus in check, several experts insisted, the country also must start isolating all the ill — including mild cases.
In this country, patients who test positive are asked to stay in their homes but keep away from their families.
Television news has been filled with recuperating personalities like CNN’s Chris Cuomo, sweating alone in his basement while his wife left food atop the stairs, his children waved and the dogs hung back.
But even Mr. Cuomo ended up illustrating why the W.H.O. strongly opposes home isolation. On Wednesday, he revealed that his wife had the virus.
“If I was forced to select only one intervention, it would be the rapid isolation of all cases,” said Dr. Bruce Aylward, who led the W.H.O. observer team to China.
In China, anyone testing positive, no matter how mild their symptoms, was required to immediately enter an infirmary-style hospital — often set up in a gymnasium or community center outfitted with oxygen tanks and CT scanners.
There, they recuperated under the eyes of nurses. That reduced the risk to families, and being with other victims relieved some patients’ fears. Nurses even led dance and exercise classes to raise spirits, and help victims clear their lungs and keep their muscle tone.
Still, experts were divided on the idea of such wards. Dr. Fineberg co-wrote a New York Times Op-Ed article calling for mandatory but “humane quarantine processes.”
By contrast, Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health, opposed the idea, saying: “I don’t trust our government to remove people from their families by force.”
Ultimately, suppressing a virus requires testing all the contacts of every known case. But the United States is far short of that goal.
Someone working in a restaurant or factory may have dozens or even hundreds of contacts. In China’s Sichuan Province, for example, each known case had an average of 45 contacts.
China hired and trained 9,000 in Wuhan alone. Dr. Frieden recently estimated that the United States will need at least 300,000.
There will not be a vaccine soon.
All the experts familiar with vaccine production agreed that even that timeline was optimistic. Dr. Paul Offit, a vaccinologist at the Children’s Hospital of Philadelphia, noted that the record is four years, for the mumps vaccine.
Researchers differed sharply over what should be done to speed the process. Modern biotechnology techniques using RNA or DNA platforms make it possible to develop candidate vaccines faster than ever before.
But clinical trials take time, in part because there is no way to rush the production of antibodies in the human body.
Also, for unclear reasons, some previous vaccine candidates against coronaviruses like SARS have triggered “antibody-dependent enhancement,” which makes recipients more susceptible to infection, rather than less. In the past, vaccines against H.I.V. and dengue have unexpectedly done the same.
A new vaccine is usually first tested in fewer than 100 young, healthy volunteers. If it appears safe and produces antibodies, thousands more volunteers — in this case, probably front-line workers at the highest risk — will get either it or a placebo in what is called a Phase 3 trial.
It is possible to speed up that process with “challenge trials.” Scientists vaccinate small numbers of volunteers, wait until they develop antibodies, and then “challenge” them with a deliberate infection to see if the vaccine protects them.
Challenge trials are used only when a disease is completely curable, such as malaria or typhoid fever. Normally, it is ethically unthinkable to challenge subjects with a disease with no cure, such as Covid-19.
But in these abnormal times, several experts argued that putting a few Americans at high risk for fast results could be more ethical than leaving millions at risk for years.
“Fewer get harmed if you do a challenge trial in a few people than if you do a Phase 3 trial in thousands,” said Dr. Lipsitch, who recently published a paper advocating challenge trials in the Journal of Infectious Diseases. Almost immediately, he said, he heard from volunteers.
Others were deeply uncomfortable with that idea. “I think it’s very unethical — but I can see how we might do it,” said Dr. Lucey.
The hidden danger of challenge trials, vaccinologists explained, is that they recruit too few volunteers to show whether a vaccine creates enhancement, since it may be a rare but dangerous problem.
“Challenge trials won’t give you an answer on safety,” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “It may be a big problem.”
Dr. W. Ian Lipkin, a virologist at Columbia University’s Mailman School of Public Health, suggested an alternative strategy. Pick at least two vaccine candidates, briefly test them in humans and do challenge trials in monkeys. Start making the winner immediately, even while widening the human testing to look for hidden problems.
As arduous as testing a vaccine is, producing hundreds of millions of doses is even tougher, experts said.
Most American vaccine plants produce only about 5 million to 10 million doses a year, needed largely by the 4 million babies born and 4 million people who reach age 65 annually, said Dr. R. Gordon Douglas Jr., a former president of Merck’s vaccine division.
But if a vaccine is invented, the United States could need 300 million doses — or 600 million if two shots are required. And just as many syringes.
“People have to start thinking big,” Dr. Douglas said. “With that volume, you’ve got to start cranking it out pretty soon.”
Flu vaccine plants are large, but those that grow the vaccines in chicken eggs are not suitable for modern vaccines, which grow in cell broths, he said.
European countries have plants but will need them for their own citizens. China has a large vaccine industry, and may be able to expand it over the coming months. It might be able to make vaccines for the United States, experts said. But captive customers must pay whatever price the seller asks, and the safety and efficacy standards of some Chinese companies are imperfect.
India and Brazil also have large vaccine industries. If the virus moves rapidly through their crowded populations, they may lose millions of citizens but achieve widespread herd immunity well before the United States does. In that case, they might have spare vaccine plant capacity.
Alternatively, suggested Arthur M. Silverstein, a retired medical historian at the Johns Hopkins School of Medicine, the government might take over and sterilize existing liquor or beer plants, which have large fermentation vats.
“Any distillery could be converted,” he said.
Treatments are likely to arrive first.
In the short term, experts were more optimistic about treatments than vaccines. Several felt that so-called convalescent serum could work.
The basic technique has been used for over a century: Blood is drawn from people who have recovered from a disease, then filtered to remove everything but the antibodies. The antibody-rich immunoglobulin is injected into patients.
The obstacle is that there are now relatively few survivors to harvest blood from.
In the pre-vaccine era, antibodies were “farmed” in horses and sheep. But that process was hard to keep sterile, and animal proteins sometimes triggered allergic reactions.
The modern alternative is monoclonal antibodies. These treatment regimens, which recently came very close to conquering the Ebola epidemic in eastern Congo, are the most likely short-term game changer, experts said.
The most effective antibodies are chosen, and the genes that produce them are spliced into a benign virus that will grow in a cellular broth.
But, as with vaccines, growing and purifying monoclonal antibodies takes time. In theory, with enough production, they could be used not just to save lives but to protect front-line workers.
Antibodies can last for weeks before breaking down — how long depends on many factors, Dr. Silverstein noted — and they cannot kill virus that is already hidden inside cells.
Having a daily preventive pill would be an even better solution, because pills can be synthesized in factories far faster than vaccines or antibodies can be grown and purified.
But even if one were invented, production would have to ramp up until it was as ubiquitous as aspirin, so 300 million Americans could take it daily.
Mr. Trump has mentioned hydroxychloroquine and azithromycin so often that his news conferences sound like infomercials. But all the experts agreed with Dr. Fauci that no decision should be made until clinical trials are completed.
Some recalled that in the 1950s inadequate testing of thalidomide caused thousands of children to be born with malformed limbs. More than one hydroxychloroquine study has been halted after patients who got high doses developed abnormal heart rhythms.
“I doubt anyone will tolerate high doses, and there are vision issues if it accumulates,” Dr. Barry said. “But it would be interesting to see if it could work as a PrEP-like drug,” she added, referring to pills used to prevent H.I.V.
Others were harsher, especially about Mr. Trump’s idea of combining a chloroquine with azithromycin.
“It’s total nonsense,” said Dr. Luciana Borio, a former director of medical and biodefense preparedness at the National Security Council. “I told my family, if I get Covid, do not give me this combo.”
Chloroquine might protect patients hospitalized with pneumonia against lethal cytokine storms because it damps down immune reactions, several doctors said.
That does not, however, make it useful for preventing infections, as Mr. Trump has implied it would be, because it has no known antiviral properties.
Several antivirals, including remdesivir, favipiravir and baloxavir, are being tested again the coronavirus; the latter two are flu drugs.
Trials of various combinations in China are set to issue results by next month, but they will be small and possibly inconclusive because doctors there ran out of patients to test. End dates for most trials in the United States are not yet set.
Goodbye, ‘America First.’
Stimulus checks, intended to offset the crisis, began landing in checking accounts this week, making much of America, temporarily, a welfare state. Food banks are opening across the country, and huge lines have formed.
A public health crisis of this magnitude requires international cooperation on a scale not seen in decades. Yet Mr. Trump is moving to defund the W.H.O., the only organization capable of coordinating such a response.
And he spent most of this year antagonizing China, which now has the world’s most powerful functioning economy and may become the dominant supplier of drugs and vaccines. China has used the pandemic to extend its global influence, and says it has sent medical gear and equipment to nearly 120 countries.
A major recipient is the United States, through Project Airbridge, an air-cargo operation overseen by Mr. Trump’s son-in-law, Jared Kushner.
This is not a world in which “America First” is a viable strategy, several experts noted.
“If President Trump cares about stepping up the public health efforts here, he should look for avenues to collaborate with China and stop the insults,” said Nicholas Mulder, an economic historian at Cornell University. He has called Mr. Kushner’s project “Lend-Lease in reverse,” a reference to American military aid to other countries during World War II.
Dr. Osterholm was even blunter. “If we alienate the Chinese with our rhetoric, I think it will come back to bite us,” he said.
“What if they come up with the first vaccine? They have a choice about who they sell it to. Are we top of the list? Why would we be?”
Once the pandemic has passed, the national recovery may be swift. The economy rebounded after both world wars, Dr. Mulder noted.
Even political perspectives may shift. Initially, the virus heavily hit Democratic cities like Seattle, New York and Detroit. But as it spreads through the country, it will spare no one.
Even voters in Republican-leaning states who do not blame Mr. Trump for America’s lack of preparedness or for limiting access to health insurance may change their minds if they see friends and relatives die.
In one of the most provocative analyses in his follow-up article, “Coronavirus: Out of Many, One,” Mr. Pueyo analyzed Medicare and census data on age and obesity in states that recently resisted shutdowns and counties that voted Republican in 2016.
He calculated that those voters could be 30 percent more likely to die of the virus.
In the periods after both wars, Dr. Mulder noted, society and incomes became more equal. Funds created for veterans’ and widows’ pensions led to social safety nets, measures like the G.I. Bill and V.A. home loans were adopted, unions grew stronger, and tax benefits for the wealthy withered.
If a vaccine saves lives, many Americans may become less suspicious of conventional medicine and more accepting of science in general — including climate change, experts said.
For now, social distancing is the best America can do to contain the Covid-19 pandemic. But if the U.S. truly mobilizes, it can soon deploy better weapons—advanced tests—that will allow the country to shift gradually to a protocol less disruptive and more effective than a lockdown.
Instead of ricocheting between an unsustainable shutdown and a dangerous, uncertain return to normalcy, the U.S. could mount a sustainable strategy with better tests and maintain a stable course for as long as it takes to develop a vaccine or cure. The country will once more be able to plan for the future, get back to work safely and avoid an economic depression. This will require massive investment to ramp up production and coordinate the construction of test centers. But the alternatives are even more costly.
Two types of testing will be essential. The first test, which relies on a technology known as the polymerase chain reaction, or PCR, can detect the virus even before a person has symptoms. It is the best way to identify who is infected. The second test looks not for the virus but for the antibodies that the immune system produces to fight it. This test isn’t so effective during the early stages of an infection, but since antibodies remain even after the virus is gone, it reveals who has been infected in the past.
Together, these two tests will give policy makers the data to make smarter decisions about who needs to be isolated and where resources need to be deployed. Instead of firing blindly, this data will let the country target its efforts.
Here’s a simple illustration of how test data can save lives. Every day millions of health-care professionals go to work without knowing whether they are infectious and might spread the virus to their colleagues. We both have close relatives on the front lines. As soon as one of them developed a cough, she pulled herself out of service. But at that point she may have been infectious for several critical days. If she and her colleagues had all been tested every day, her infection would have been caught earlier and she would have isolated herself sooner.
To be used as a screening mechanism at the beginning of a shift, the test would need to be able to give a result within minutes. Developers are making progress on speeding up these PCR tests—so much so that the aforementioned physician received the results from her second test, conducted five days after the first, before those from the first test. Abbott and Roche, two pharmaceutical companies, are moving forward with tests that can decrease reporting times from days or hours to minutes. Now that the doctor has recovered, an antibody test could help determine when she can return to the frontlines of patient care.
As testing capacity expands, the same tests could be offered to all essential workers, such as police officers and emergency technicians, and then to other overlooked but critical workers—pharmacists, grocery clerks, sanitation staff. The next step would be to test people throughout the country at random to get up-to-date information about who is infected now and who has ever been infected.
For those who are currently infected, governments can provide immediate assistance to make sure they don’t infect anyone else, especially family members. Those infected before who now have antibodies may be less susceptible to reinfection. If that is proved in the weeks to come, they could also return to work.
Putting this system in place will take resources, creativity and hard work. Test developers will have to increase the production rate of kits by an order of magnitude. In his work fighting Ebola in West Africa, Dr. Shah saw how a virus can cause a 30% reduction in economic output. Mr. Romer’s back-of-the-envelope calculation is that the recession caused by the coronavirus pandemic has already caused a 20% reduction in U.S. output, which means the country is losing about $350 billion in production each month. If a $100 billion investment in a crash program to make antibody and PCR tests ubiquitous brought a recovery one month sooner, it would more than pay for itself.
Building this testing system would be complicated and require the best of American science, business and philanthropy working together. But it is the type of challenge that the U.S. has overcome before. It isn’t viable to wait a year or two for a vaccine before getting people back to work safely. To save lives and prevent a depression, testing on a massive scale is essential.
The U.S. may end up with the worst COVID-19 outbreak in the industrialized world. This is how it’s going to play out.
Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nation’s psyche.
A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. In October, the Johns Hopkins Center for Health Security war-gamed what might happen if a new coronavirus swept the globe. And then one did. Hypotheticals became reality. “What if?” became “Now what?”
So, now what? In the late hours of last Wednesday, which now feels like the distant past, I was talking about the pandemic with a pregnant friend who was days away from her due date. We realized that her child might be one of the first of a new cohort who are born into a society profoundly altered by COVID-19. We decided to call them Generation C.As we’ll see, Gen C’s lives will be shaped by the choices made in the coming weeks, and by the losses we suffer as a result. But first, a brief reckoning. On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.
“No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems,” says Nahid Bhadelia, an infectious-diseases physician at the Boston University School of Medicine. More transmissible and fatal than seasonal influenza, the new coronavirus is also stealthier, spreading from one host to another for several days before triggering obvious symptoms. To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.
As my colleagues Alexis Madrigal and Robinson Meyer have reported, the Centers for Disease Control and Prevention developed and distributed a faulty test in February. Independent labs created alternatives, but were mired in bureaucracy from the FDA. In a crucial month when the American caseload shot into the tens of thousands, only hundreds of people were tested. That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,” says Alexandra Phelan of Georgetown University, who works on legal and policy issues related to infectious diseases.
The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases. None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country. Overstretched hospitals became overwhelmed. Basic protective equipment, such as masks, gowns, and gloves, began to run out. Beds will soon follow, as will the ventilators that provide oxygen to patients whose lungs are besieged by the virus.
With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency. That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition; some worried hospitals have bought out large quantities of supplies, in the way that panicked consumers have bought out toilet paper.Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear. Instead of springing into action, America sat idle.
Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,” said Ron Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014. “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”
I. The Next Months
Having fallen behind, it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April. As of last weekend, the nation had 17,000 confirmed cases, but the actual number was probably somewhere between 60,000 and 245,000. Numbers are now starting to rise exponentially: As of Wednesday morning, the official case count was 54,000, and the actual case count is unknown. Health-care workers are already seeing worrying signs: dwindling equipment, growing numbers of patients, and doctors and nurses who are themselves becoming infected.
Italy and Spain offer grim warnings about the future. Hospitals are out of room, supplies, and staff. Unable to treat or save everyone, doctors have been forced into the unthinkable: rationing care to patients who are most likely to survive, while letting others die. The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one. By the end of the summer, the pandemic will have directly killed 2.2 million Americans, notwithstanding those who will indirectly die as hospitals are unable to care for the usual slew of heart attacks, strokes, and car accidents. This is the worst-case scenario. To avert it, four things need to happen—and quickly.
The first and most important is to rapidly produce masks, gloves, and other personal protective equipment. If health-care workers can’t stay healthy, the rest of the response will collapse. In some places, stockpiles are already so low that doctors are reusing masks between patients, calling for donations from the public, or sewing their own homemade alternatives. These shortages are happening because medical supplies are made-to-order and depend on byzantine international supply chains that are currently straining and snapping. Hubei province in China, the epicenter of the pandemic, was also a manufacturing center of medical masks.In the U.S., the Strategic National Stockpile—a national larder of medical equipment—is already being deployed, especially to the hardest-hit states. The stockpile is not inexhaustible, but it can buy some time. Donald Trump could use that time to invoke the Defense Production Act, launching a wartime effort in which American manufacturers switch to making medical equipment. But after invoking the act last Wednesday, Trump has failed to actually use it, reportedly due to lobbying from the U.S. Chamber of Commerce and heads of major corporations.
Some manufacturers are already rising to the challenge, but their efforts are piecemeal and unevenly distributed. “One day, we’ll wake up to a story of doctors in City X who are operating with bandanas, and a closet in City Y with masks piled into it,” says Ali Khan, the dean of public health at the University of Nebraska Medical Center. A “massive logistics and supply-chain operation [is] now needed across the country,” says Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That can’t be managed by small and inexperienced teams scattered throughout the White House. The solution, he says, is to tag in the Defense Logistics Agency—a 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.
This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests. Those tests have been slow to arrive because of five separate shortages: of
- masks to protect people administering the tests; of
- nasopharyngeal swabs for collecting viral samples; of
- extraction kits for pulling the virus’s genetic material out of the samples; of
- chemical reagents that are part of those kits; and of
- trained people who can give the tests.
Many of these shortages are, again, due to strained supply chains. The U.S. relies on three manufacturers for extraction reagents, providing redundancy in case any of them fails—but all of them failed in the face of unprecedented global demand. Meanwhile, Lombardy, Italy, the hardest-hit place in Europe, houses one of the largest manufacturers of nasopharyngeal swabs.
Some shortages are being addressed. The FDA is now moving quickly to approve tests developed by private labs. At least one can deliver results in less than an hour, potentially allowing doctors to know if the patient in front of them has COVID-19. The country “is adding capacity on a daily basis,” says Kelly Wroblewski of the Association of Public Health Laboratories.
On March 6, Trump said that “anyone who wants a test can get a test.” That was (and still is) untrue, and his own officials were quick to correct him. Regardless, anxious people still flooded into hospitals, seeking tests that did not exist. “People wanted to be tested even if they weren’t symptomatic, or if they sat next to someone with a cough,” says Saskia Popescu of George Mason University, who works to prepare hospitals for pandemics. Others just had colds, but doctors still had to use masks to examine them, burning through their already dwindling supplies. “It really stressed the health-care system,” Popescu says. Even now, as capacity expands, tests must be used carefully. The first priority, says Marc Lipsitch of Harvard, is to test health-care workers and hospitalized patients, allowing hospitals to quell any ongoing fires. Only later, once the immediate crisis is slowing, should tests be deployed in a more widespread way. “This isn’t just going to be: Let’s get the tests out there!” Inglesby says.
These measures will take time, during which the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. Its course—and the nation’s fate—now depends on the third need, which is social distancing. Think of it this way: There are now only two groups of Americans. Group A includes everyone involved in the medical response, whether that’s treating patients, running tests, or manufacturing supplies. Group B includes everyone else, and their job is to buy Group A more time. Group B must now “flatten the curve” by physically isolating themselves from other people to cut off chains of transmission. Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediately, before they feel proportionate, and they must continue for several weeks.Persuading a country to voluntarily stay at home is not easy, and without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps. Some states have banned large gatherings or closed schools and restaurants. At least 21 have now instituted some form of mandatory quarantine, compelling people to stay at home. And yet many citizens continue to crowd into public spaces.
In these moments, when the good of all hinges on the sacrifices of many, clear coordination matters—the fourth urgent need. The importance of social distancing must be impressed upon a public who must also be reassured and informed. Instead, Trump has repeatedly played down the problem, telling America that “we have it very well under control” when we do not, and that cases were “going to be down to close to zero” when they were rising. In some cases, as with his claims about ubiquitous testing, his misleading gaffes have deepened the crisis. He has even touted unproven medications.
Away from the White House press room, Trump has apparently been listening to Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. Fauci has advised every president since Ronald Reagan on new epidemics, and now sits on the COVID-19 task force that meets with Trump roughly every other day. “He’s got his own style, let’s leave it at that,” Fauci told me, “but any kind of recommendation that I have made thus far, the substance of it, he has listened to everything.”But Trump already seems to be wavering. In recent days, he has signaled that he is prepared to backtrack on social-distancing policies in a bid to protect the economy. Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a person’s risk, and to somehow wall off the ‘high-risk’ people from the rest of society. It underestimates how badly the virus can hit ‘low-risk’ groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.
A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care. There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.
If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it won’t be quick. “It could be anywhere from four to six weeks to up to three months,” Fauci said, “but I don’t have great confidence in that range.”
II. The Endgame
Even a perfect response won’t end the pandemic. As long as the virus persists somewhere, there’s a chance that one infected traveler will reignite fresh sparks in countries that have already extinguished their fires. This is already happening in China, Singapore, and other Asian countries that briefly seemed to have the virus under control. Under these conditions, there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.
- The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.
- The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting. But it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems. The United Kingdom initially seemed to consider this herd-immunity strategy, before backtracking when models revealed the dire consequences. The U.S. now seems to be considering it too.
- The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.
It depends, for a start, on making a vaccine. If this were a flu pandemic, that would be easier. The world is experienced at making flu vaccines and does so every year. But there are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch. The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the virus’s genes for the first time and doctors injecting a vaccine candidate into a person’s arm. “It’s overwhelmingly the world record,” Fauci said.
But it’s also the fastest step among many subsequent slow ones. The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.
“Even if it works, they don’t have an easy way to manufacture it at a massive scale,” said Seth Berkley of Gavi. That’s because Moderna is using a new approach to vaccination. Existing vaccines work by providing the body with inactivated or fragmented viruses, allowing the immune system to prep its defenses ahead of time. By contrast, Moderna’s vaccine comprises a sliver of SARS-CoV-2’s genetic material—its RNA. The idea is that the body can use this sliver to build its own viral fragments, which would then form the basis of the immune system’s preparations. This approach works in animals, but is unproven in humans. By contrast, French scientists are trying to modify the existing measles vaccine using fragments of the new coronavirus. “The advantage of that is that if we needed hundreds of doses tomorrow, a lot of plants in the world know how to do it,” Berkley said. No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms.It’s likely, then, that the new coronavirus will be a lingering part of American life for at least a year, if not much longer. If the current round of social-distancing measures works, the pandemic may ebb enough for things to return to a semblance of normalcy. Offices could fill and bars could bustle. Schools could reopen and friends could reunite. But as the status quo returns, so too will the virus. This doesn’t mean that society must be on continuous lockdown until 2022. But “we need to be prepared to do multiple periods of social distancing,” says Stephen Kissler of Harvard. Much about the coming years, including the frequency, duration, and timing of social upheavals, depends on two properties of the virus, both of which are currently unknown.
- First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect. “Much of the world is waiting anxiously to see what—if anything—the summer does to transmission in the Northern Hemisphere,” says Maia Majumder of Harvard Medical School and Boston Children’s Hospital.
- Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer. Assuming that SARS-CoV-2 lies somewhere in the middle, people who recover from their encounters might be protected for a couple of years. To confirm that, scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. They’ll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.
Scientists can use the periods between those bouts to develop antiviral drugs—although such drugs are rarely panaceas, and come with possible side effects and the risk of resistance. Hospitals can stockpile the necessary supplies. Testing kits can be widely distributed to catch the virus’s return as quickly as possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be. As Aaron E. Carroll and Ashish Jha recently wrote, “We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.”Whether through accumulating herd immunity or the long-awaited arrival of a vaccine, the virus will find spreading explosively more and more difficult. It’s unlikely to disappear entirely. The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. “But my hope and expectation is that the severity would decline, and there would be less societal upheaval,” Kissler says. In this future, COVID-19 may become like the flu is today—a recurring scourge of winter. Perhaps it will eventually become so mundane that even though a vaccine exists, large swaths of Gen C won’t bother getting it, forgetting how dramatically their world was molded by its absence.
III. The Aftermath
The cost of reaching that point, with as few deaths as possible, will be enormous. As my colleague Annie Lowrey wrote, the economy is experiencing a shock “more sudden and severe than anyone alive has ever experienced.” About one in five people in the United States have lost working hours or jobs. Hotels are empty. Airlines are grounding flights. Restaurants and other small businesses are closing. Inequalities will widen: People with low incomes will be hardest-hit by social-distancing measures, and most likely to have the chronic health conditions that increase their risk of severe infections. Diseases have destabilized cities and societies many times over, “but it hasn’t happened in this country in a very long time, or to quite the extent that we’re seeing now,” says Elena Conis, a historian of medicine at UC Berkeley. “We’re far more urban and metropolitan. We have more people traveling great distances and living far from family and work.”
After infections begin ebbing, a secondary pandemic of mental-health problems will follow. At a moment of profound dread and uncertainty, people are being cut off from soothing human contact. Hugs, handshakes, and other social rituals are now tinged with danger. People with anxiety or obsessive-compulsive disorder are struggling. Elderly people, who are already excluded from much of public life, are being asked to distance themselves even further, deepening their loneliness. Asian people are suffering racist insults, fueled by a president who insists on labeling the new coronavirus the “Chinese virus.” Incidents of domestic violence and child abuse are likely to spike as people are forced to stay in unsafe homes. Children, whose bodies are mostly spared by the virus, may endure mental trauma that stays with them into adulthood.
After the pandemic, people who recover from COVID-19 might be shunned and stigmatized, as were survivors of Ebola, SARS, and HIV. Health-care workers will take time to heal: One to two years after SARS hit Toronto, people who dealt with the outbreak were still less productive and more likely to be experiencing burnout and post-traumatic stress. People who went through long bouts of quarantine will carry the scars of their experience. “My colleagues in Wuhan note that some people there now refuse to leave their homes and have developed agoraphobia,” says Steven Taylor of the University of British Columbia, who wrote The Psychology of Pandemics.
But “there is also the potential for a much better world after we get through this trauma,” says Richard Danzig of the Center for a New American Security. Already, communities are finding new ways of coming together, even as they must stay apart. Attitudes to health may also change for the better. The rise of HIV and AIDS “completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic,” Conis says. “The use of condoms became normalized. Testing for STDs became mainstream.” Similarly, washing your hands for 20 seconds, a habit that has historically been hard to enshrine even in hospitals, “may be one of those behaviors that we become so accustomed to in the course of this outbreak that we don’t think about them,” Conis adds.
Pandemics can also catalyze social change. People, businesses, and institutions have been remarkably quick to adopt or call for practices that they might once have dragged their heels on, including working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements. “This is the first time in my lifetime that I’ve heard someone say, ‘Oh, if you’re sick, stay home,’” says Adia Benton, an anthropologist at Northwestern University. Perhaps the nation will learn that preparedness isn’t just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose America’s social immune system, and that this system has been suppressed.Aspects of America’s identity may need rethinking after COVID-19. Many of the country’s values have seemed to work against it during the pandemic. Its individualism, exceptionalism, and tendency to equate doing whatever you want with an act of resistance meant that when it came time to save lives and stay indoors, some people flocked to bars and clubs. Having internalized years of anti-terrorism messaging following 9/11, Americans resolved to not live in fear. But SARS-CoV-2 has no interest in their terror, only their cells.
Years of isolationist rhetoric had consequences too. Citizens who saw China as a distant, different place, where bats are edible and authoritarianism is acceptable, failed to consider that they would be next or that they wouldn’t be ready. (China’s response to this crisis had its own problems, but that’s for another time.) “People believed the rhetoric that containment would work,” says Wendy Parmet, who studies law and public health at Northeastern University. “We keep them out, and we’ll be okay. When you have a body politic that buys into these ideas of isolationism and ethnonationalism, you’re especially vulnerable when a pandemic hits.”
Veterans of past epidemics have long warned that American society is trapped in a cycle of panic and neglect. After every crisis—anthrax, SARS, flu, Ebola—attention is paid and investments are made. But after short periods of peacetime, memories fade and budgets dwindle. This trend transcends red and blue administrations. When a new normal sets in, the abnormal once again becomes unimaginable. But there is reason to think that COVID-19 might be a disaster that leads to more radical and lasting change.
The other major epidemics of recent decades either barely affected the U.S. (SARS, MERS, Ebola), were milder than expected (H1N1 flu in 2009), or were mostly limited to specific groups of people (Zika, HIV). The COVID-19 pandemic, by contrast, is affecting everyone directly, changing the nature of their everyday life. That distinguishes it not only from other diseases, but also from the other systemic challenges of our time. When an administration prevaricates on climate change, the effects won’t be felt for years, and even then will be hard to parse. It’s different when a president says that everyone can get a test, and one day later, everyone cannot. Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines, testing positive, and losing loved ones. Senators are falling sick. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are no longer manifesting as angry opinion pieces, but as faltering lungs.
After 9/11, the world focused on counterterrorism. After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies. Expect pandemics to top the agenda at the United Nations General Assembly. Anthony Fauci is now a household name. “Regular people who think easily about what a policewoman or firefighter does finally get what an epidemiologist does,” says Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.Such changes, in themselves, might protect the world from the next inevitable disease. “The countries that had lived through SARS had a public consciousness about this that allowed them to leap into action,” said Ron Klain, the former Ebola czar. “The most commonly uttered sentence in America at the moment is, ‘I’ve never seen something like this before.’ That wasn’t a sentence anyone in Hong Kong uttered.” For the U.S., and for the world, it’s abundantly, viscerally clear what a pandemic can do.
The lessons that America draws from this experience are hard to predict, especially at a time when online algorithms and partisan broadcasters only serve news that aligns with their audience’s preconceptions. Such dynamics will be pivotal in the coming months, says Ilan Goldenberg, a foreign-policy expert at the Center for a New American Security. “The transitions after World War II or 9/11 were not about a bunch of new ideas,” he says. “The ideas are out there, but the debates will be more acute over the next few months because of the fluidity of the moment and willingness of the American public to accept big, massive changes.”
One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trump’s approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero. During the second term of his presidency, the U.S. turns further inward and pulls out of NATO and other international alliances, builds actual and figurative walls, and disinvests in other nations. As Gen C grows up, foreign plagues replace communists and terrorists as the new generational threat.One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of “America first” politics. The nation pivots, as it did after World War II, from isolationism to international cooperation. Buoyed by steady investments and an influx of the brightest minds, the health-care workforce surges. Gen C kids write school essays about growing up to be epidemiologists. Public health becomes the centerpiece of foreign policy. The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.
In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.
Prime Minister Benjamin Netanyahu has mobilized Israel’s intelligence agencies to help contain the new coronavirus, an effort that has involved an undercover purchase of testing kits from abroad and the use of antiterrorism phone-tracking technology to map infections.
An undisclosed number of testing kits acquired Thursday by the foreign spy agency Mossad will be deployed to nationwide drive-in testing locations as Israel seeks to carry out thousands of tests a day, the prime minister said in a broadcast late Thursday.
Mr. Netanyahu’s office called the equipment “required and vital” but declined to say how many kits had been ordered and from which countries. “We are fully utilizing all the state’s capabilities to assist in dealing with the coronavirus, including the Mossad and other bodies,” his office said.
Israel’s Channel 13 and the Jerusalem Post reported that the agency had arranged for 100,000 kits from countries that lack diplomatic relations with Israel and expected to bring millions more.
Those reports couldn’t be confirmed independently. Mossad often handles secret diplomacy with countries such as the Gulf Arab states that don’t formally recognize Israel but work with it on regional security challenges.
Itamar Grotto, the deputy health minister, said the imported kits lack a swab component but indicated the problem could be overcome. Mr. Netanyahu said Israel’s testing capacity would grow from several hundred a day to several thousand by next week.
Warning of an outbreak on a par with Italy’s, Mr. Netanyahu ordered Israel into lockdown late Thursday. The country’s nine million people are allowed to leave their homes only for vital missions such as buying food or getting medical treatment. The number of Israelis known to have contracted the virus rose to 705 on Friday morning, up from 427 on Wednesday morning.
Along with testing kits, health officials say Israel will need more ventilators as the number of patients sickened by Covid-19, the illness caused by the coronavirus, grows. The Defense Ministry said it has purchased 2,500 ventilators but delivery will take months.
To help meet demand, a team in Israel’s military intelligence branch known as the Technological Unit, or Unit 81, is working with medical professionals to upgrade household BiPap ventilators, which help patients with sleep apnea and other breathing difficulties, into hospital-quality ventilators.
“A prototype is being manufactured in the unit at this moment in order to study it and bring it to wide use,” the Israeli military said in a statement.
Israel’s domestic intelligence agency, the Shin Bet, is retooling its spyware to meet the medical emergency. In recent days it has deployed a nationwide digital-surveillance program, using technology designed for counterterrorism, to locate people at risk of infection. The program uses cellphone data of people known to be infected to identify who else was close enough to catch the virus.
As a result of the surveillance, the health ministry said 400 Israelis received a text message Wednesday asking them to enter quarantine.
“According to an epidemiological survey, you were near someone sick from coronavirus. You must immediately enter Quarantine for 14 days to protect your relatives and the public,” the text message said.
Shin Bet’s program, authorized by the attorney general and supported by health ministry officials, was criticized by privacy advocates and some lawmakers. The supreme court, acting on a petition by two civil-rights groups, issued an injunction ordering a halt to the program by next Tuesday unless parliament establishes the relevant oversight committees. The parliament was shut Wednesday by its speaker, an ally of Mr. Netanyahu, in a dispute with opposition parties over control of its committees.
Authorities in some Asian countries have deployed similar surveillance methods and said they contributed to containing the virus. South Korean health authorities can sift through credit-card records, CCTV footage, mobile-phone location services, public-transport cards and immigration records to pin down the travel histories of those infected or at risk. China monitors individuals with data provided by telecom firms, the railway bureau and airlines. Hong Kong monitors families quarantined at home with electronic wristbands. Taiwan tracks people who are under home quarantine using their mobile-phone signals.