Following a week when the United States went from 1,200 confirmed cases to more than 32,000, largely due to expanded but still-inadequate COVID-19 testing, the nation’s health care system is not prepared for the wave of sickness that’s about to hit, experts say. And while more states and cities impose stay-at-home orders, not enough people are heeding them in order to minimize the spread of the virus.
Even if the U.S. followed the path of South Korea and Japan, which imposed a near lockdown on movement—and it’s unlikely to do so—emergency health experts say it wouldn’t be enough to slow the spread of the virus.
“What we really need to focus on is finding those who are sick, those who have the virus, and isolate them, find their contacts and isolate them,” said Mike Ryan, M.D., executive director of the World Health Organization’s Health Emergencies Program, in an interview Sunday on the BBC’s Andrew Marr Show.
The United States has tested about 250,000 people, three months into the crisis. Germany now tests 100,000 a week. There is no plan at the federal level to do aggressive contact tracing, which proved effective with the Ebola crisis.
Two reports that were not meant for wide distribution were leaked to the press last week—one from the U.S. Department of Health and Human Services and one from Imperial College London. These reports reach similar conclusions: The actions taken in the U.S. so far have been inadequate to “flatten the curve.” They also suggest that life will not get back to normal for at least a year, until a vaccine is widely available.
Health care workers are reporting shortages of masks and other protective equipment, and the director of the Federal Emergency Management Agency (FEMA), Peter Gaynor, could not give a timeline on the availability of masks.
On Sunday, March 22, Surgeon General Jerome Adams, M.D., M.P.H., offered a frank assessment, based on the lack of measures being taken to stop the spread of the virus: “This week, it’s going to get bad.”
A Tale of Two Countries
The United States and South Korea reported their first COVID-19 cases on the same day. South Korea quickly created an effective test and used it widely. The country has seen cases reduced by more than 90% from the peak. The U.S., however, rejected an available test from the World Health Organization, instead opting to develop its own test—one that was unusable because it resulted in nearly 50% false positives. Until mid-March, President Trump repeatedly dismissed the threat of coronavirus, saying it was “totally under control” and would “disappear soon.” A report released last week by Mitre, a nonprofit health care research company, determined that coronavirus cases are doubling faster in the U.S. than any other country it analyzed.
As of Monday, March 23, 250,000 tests had been completed in the U.S., according to the COVID Tracking Project, a database created by Related Sciences and The Atlantic. South Korea, a country with a much smaller population, can test 10,000 people every day.
The U.S. has not imposed a stay-at-home order as strict as those in South Korea or Singapore, and as of last week, spring break partiers were still reveling in Florida, ignoring social distancing recommendations. On Monday, President Trump signaled that he might walk back his 15-day isolation proposal to prevent damage to the economy and sent a late-night, all-caps tweet about not letting the “CURE BE WORSE THAN THE PROBLEM ITSELF.”
Governors, however, have been imposing stay-at-home orders, though in too many cases, these are going unheeded. Germany, to prevent virus transmission by social interaction, banned gatherings of more than two people.
Misleading Statements From the White House
By now, the daily press briefings by the Coronavirus Task Force are familiar: the president touting unproven and possibly dangerous treatments, bragging about supplies and testing that isn’t actually happening—often being corrected moments later by National Institutes of Health scientist Anthony Fauci, M.D.—and encouraging praise for his efforts while attacking reporters who ask even the softest of softball questions. Some commentators are calling for the end of such pressers, based on the confusion they create. On March 22, fact checkers at CNN tallied up 33 false claims about the COVID-19 crisis by the president in the first two weeks of March alone.
Gregg Gonsalves, Ph.D., an epidemiologist and assistant professor at Yale School of Public Health who is also a veteran HIV activist, has a harsh assessment of the national response. “We are going through a cataclysm with a clown as our president,” Gonsalves told TheBody. “There could have been mobilization early at the national level, but nobody wanted to tell Trump bad news.”
Gonsalves went as far as suggesting a tribunal once the pandemic has ebbed. “The career civil servants at the CDC are among the best in the world. But the problem starts with [Centers for Disease Control and Prevention director] Redfield and goes straight up to the White House. They all need to be compelled in by an independent panel with subpoena power to get to the truth of what happened, something like Warren Commission and 9/11 Commission. This catastrophe is self-inflicted, and we need to get to the bottom of the failure.”
What Has to Happen Now
The time for containing the new coronavirus in the U.S. has passed. Now, the goal is to flatten the curve, or slow the inevitable spread.
Scott Gottlieb, M.D., former commissioner of the Food and Drug Administration, speaking on CBS’ Face the Nation on March 22, said that universal testing and tracking of all people who’ve contracted coronavirus is crucial, and he had a grim assessment of the near term.
“The scenes out of New York are going to be shocking,” he said. “I think that the hospitals in the next two weeks are going to be at the brink of being overwhelmed. ... The time to hospitalization is nine to 12 days. I think there’s other cities that are at extreme risk.”
Scientists with expertise in fighting pandemics say the virus can only be stopped with harsh and difficult measures, including a rapid increase in testing, making masks ubiquitous, isolation of people with the virus, contact tracing, and even spot temperature checks of citizens in public.
Most of those measures are not being taken. Instead, we have the policy of social distancing. Carlos Del Rio, M.D., a prominent HIV researcher and chair of the Hubert Department of Global Health at Emory University’s Rollins School of Public Health, said social distancing is a key strategy, but not the only strategy.
“It will buy us some time. It can help slow the rate of transmissions, and it does work.” But Del Rio also said that contact tracing would help too. “But we can’t do that until we scale up testing, big time. That way, we can identify and isolate those infected. But social distancing, it isn’t hard. All we’re asking is for people to stay home on their sofas.”
Nevertheless, it appears that some Americans may not fully grasp the concept of social distancing or are ignoring the orders. Unlike self-quarantining, which requires staying at home without visitors, social distancing generally involves staying at least six feet from other people, working at home, closing schools, and canceling or postponing large meetings.
Social distancing also can prevent the health care system from being overwhelmed, Gonsalves said.
“Most hospitals are about to hit a surge this week in the New York City area. The demand for ICU beds will exceed availability by five or six times. And at that point, people will start to make decisions about who lives and who dies. Social distancing alone won’t get us out of this, we’ll need a scale up of testing to start with, but we simply don’t have that capacity right now. Social distancing is all we have at the moment.”
Gonsalves also has recommendations for information intake during this crisis.
“Listen to the governors, not the White House. Watch [New York State Governor Andrew] Cuomo. He’s been fact-based, evidence-based, and expanding what needs to be done, with the latest reports. [California] Governor Newsom and [Washington Governor] Inslee and [Kentucky Governor] Beshear have also been effective. The governors have to deal with the shit hitting the fan.” And beware of people who say efforts to slow the spread of coronavirus are overreactions, he said. “These people are not epidemiologists.”