There are two reports that have been driving much of the government response to coronavirus over the past week—the Imperial College report report from the U.K. and the HHS Report from the U.S. The best word to describe the projections from both of these reports is dire, with each report suggesting that life will not return to anything approaching “normal” until a vaccine for novel coronavirus is widely available, and that all mitigation efforts now under way will not be sufficient to prevent the healthcare system from being overrun, the economy from being devastated, and significant shortages for the average citizen of both countries. And to complete the hope-sapping, market-crushing effect of these reports, they suggest that even the best efforts will only buy time in a epidemic that could peak again and again.
Around the world, when nations have been able to keep the number of cases within the bearing capacity of their healthcare systems, the number of deaths from COVID-19 has hovered around 1%. However, 15-20% of all those infected require critical care. When that care is not available, the rate of death moves quickly upward to enclose all those untreated cases. The only available response, with millions of lives on the line, is to limit the spread of the virus. That means locking down now—the sooner the better, the harder the better. Because if all we’re buying is time … that’s exactly the point. Time is everything. Time is life. And every minute counts.
One glance at the chart of novel coronavirus cases in the United States is enough to see where this is going under current circumstances.
This is an exponential curve, one where the number of cases each day is not only increasing, but the rate of increase is also increasing. Should the United States continue to follow this curve, we’re not a week behind Italy, because we will pass Italy’s current numbers in less than four days. Italy itself took a week to close that distance, but Italy’s curve was less steep than that of the United States. Italy has gone from 15,000 cases to over 40,000 cases, while under a strict national lockdown. The United States is passing that starting number today with many fewer social distancing procedures in place across much of the nation, with many fewer tests having been done to define the edges of the outbreak, and with much less federal guidance on every issue.
In terms of mitigation strategies, United States is much closer to where Italy was on March 4, the date it closed all schools and extended regional lockdowns that had already been in place since the country passed just 50 cases two weeks earlier. Should the United States issue a nationwide shelter-in-place order today, it would be unlikely to see any relief in the numbers until it had accumulated more cases than Italy and China—combined. Which would be almost certain to generate the kind of localized healthcare collapse, and overall system stress, experienced in Hubei at its peak and in Italy at this moment.
The sooner the United States imposes uniform, tight, and extensive restrictions, the better, where better is measured in many, many lives. Even at this late date officials from Washington to Local Town USA are worried about overreacting. Don’t be. There is no overreacting, and just because we’ve waited far too late doesn’t mean that it shouldn’t be done. It only makes it more critical.
An enforced, extended period of national quarantine is absolutely necessary. But it is far from sufficient.
Watching the numbers continue to soar upward, even as people are locked in their homes and worried over much, much more than what’s up next in their Netflix queue, is … frustrating doesn’t cover it. We may need to send to Germany for a new word. However, it is absolutely necessary—even if it doesn’t appear to be generating an immediate benefit and even if it is wholly insufficient, as well as unsustainable, as a long-term solution. Because it buys minutes.
Every minute gained is a minute in which:
- Production lines can be turned over to the manufacture of protective gear, respirators, and other badly needed medical supplies.
- Therapeutic drugs which have been suggested as possible treatments can be given larger trials, and more potential treatments identified.
- Field hospitals and pop-up facilities can be created to address urgent needs in cities that are hard hit now, and rural areas that will be highly stressed in a week.
- Strategies can be formulate to deal with potential issues of transport and distribution, ensuring that what is now an erratic supply of toilet paper doesn’t become a national scramble for the last can of beans.
And, of course, every minute is another minute toward what both the Imperial College and HHS reports present as the only thing that can get the nation back on its feet—a widely available and effective vaccine.
But there is a step that is even more vital, and which is absolutely necessary to avoid the shocking numbers for both illness and deaths that are included in the reports: widespread testing, home isolation of those infected, and backtracking sources and contacts. It means that we should follow a national plan of screening and testing, especially among people not showing symptoms. Every county in America should repeat the experiment of San Miguel County, Colorado, where everyone, whether or not they are showing symptoms, and whether or not they believe they have been exposed, is now being offered two free tests, two weeks apart.
There is really only one thing wrong with the testing plan in San Miguel: it’s not being funded by either the state or federal government. The tests are being provided by the CEO of an international biotech firm who just happens to have a vacation home in the county that includes the wealthy ski-resort town of Telluride. Not every county is so lucky. They should not need to be.
In South Korea and Singapore, widespread testing followed by isolation of the infected, trace-back of sources, and quarantine of associates has proven to be an effective means of not just lowering the spread of COVID-19, but actually driving the case load down, preserving the healthcare system, and saving lives by the millions. It can do the same in America. In fact, nothing else will. Just because the U.S. completely screwed the pooch on testing to this point doesn’t make it any less vital. It is just as important, if not more so, that production lines and labs be dedicated to producing and processing tests, as it is that they build more respirators, or even vaccines.
Without widespread testing and isolation, the number of deaths in the United States can be expected to be in the hundreds of thousands. Widespread testing and isolation can take the “hundreds of” out of that phrase. But that testing has to be drastically more aggressive than what’s being carried out in the United States at the moment.
The effort to suppress the transmission of novel coronavirus has an incredibly high price tag, and the immediate effect can be hard to see. But it buys time. That’s not a small thing—it’s everything.