Friday, March 27, 2020

How Will the Corona Virus End? - The Atlantic

The Atlantic looks at how the Covid-19 contagion will end for the United States. It won't be pretty.

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?”
...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.
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.
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 (82,000 today, one day later), 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.
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.
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.

...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.
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.
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.

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.
The aftermath or the legacy of Covid-19
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.


the salamander said...

.. WoW !! A WoW consolidation..
Its laced with optimism.. particularly within the 'legacy' section
that in North America, Recovery Appears Doable
and interlaced with what 'the needed doing' actually is or needs to be

Owen Gray said...

Let's hope the second alternative represents the future.

Trailblazer said...

The Corona virus will end with more of this!

The rich will inherit the earth?


Trailblazer said...

At the end of the day i have to wonder how much of what we now consider normal will disappear?
We have, very quickly , adapted to purchasing those items we need by necessity; no more shoppers browsing.
No need for those fancy coffees, no need for Toys are us and similar none essentials !
We communicate more on line both in work and play.
Many now work from home, will they go back to a physical workplace?
As has been mentioned, mass transportation for vacations is all but over for the foreseeable future.
What happens to the aircraft industry?
Alberta is about finished as a voice within Canada as is the oil industry.
Who will take up the slack of the void; farmers?
The list is endless.


The Disaffected Lib said...

Whether we care for it or not it does seem that society is in for a tide change. We've been asking for it by our acquiescence to what we should never have tolerated.

Look at Trump. He has horribly messed up the US government's response to coronavirus and yet his poll numbers are at an all time high.

Social Behaviour Observer said...

We shouldn't have opinions where we have no responsibility, we are looking too far ahead.

Northern PoV said...

Did anyone else catch the new Bob Dylan dirge?

imo, Bob is pointing to the place & time that America 'went wrong' and providing a cultural take on our fin-de-siecle.

That said I think Bob has lost a lot since he created, 'A Hard Rain', for example.

Anonymous said...

Canada is not informing the. General public in what areas this virus has been found. Why do you think that is.. In south. Korea it was published where these areas were and people stayed away. Officals disinfected immediately. I was there and it didn't take very long for Koreans to get this virus under control. Now people back to business as usual. Trump has asked China and South Korea for donations of medical equipment. Thing is trump did not have any trouble asking s.k. Even though it is a liberal government. Of course trump will brag he did this miraculous thing all on his own. Anyong

The Disaffected Lib said...

SBO - "we shouldn't have opinions where we have no responsibility" - why not? And how do you judge our responsibility - to our families, to our communities, to our countrymen?

Donald Trump says he accepts no responsibility for his administration's bungling of the Covid-19 contagion. By your argument he should STFU, no?

Wouldn't America be so much better off if only
Trump left it to the grownups?

The Disaffected Lib said...

Anyong, there's little to gain from scrutinizing Trump's pathologies. He is what Congress had in mind when it passed the 25th Amendment to the Constitution.

Anonymous said...

I 'd still like to know why Canada is not letting people know where out breaks of Clovis is located. These areas need to be disinfected...right? Anyong

The Disaffected Lib said...

Anyong, I don't think there's any distinction in what needs to be disinfected from one place to the next. What efforts have you made to discern information that is available on Covid-19 outbreaks?

Purple library guy said...

I'd be ecstatic if the Americans actually embraced isolationism. World would be way better off if they'd just leave us all the fuck alone--quit invading people, quit undermining people's economies, quit undermining the good international treaties and pushing for the bad ones, etc. Trump talks isolationism now and then, but unfortunately he doesn't mean it. There's no way a second Trump term would actually involve pulling out of NATO, for instance.

The Disaffected Lib said...

Dream on, PLG. They're not done with us yet. Not even close.

Anonymous said...

Covis was reported in SOuth Korea the first week of December. Anyong