America's Coronavirus Endurance TestRoundup
tags: public health, pandemics, COVID-19, epidemiology
Howard Markel is the George E. Wantz Distinguished Professor of the History of Medicine and Director of the Center for the History of Medicine at the University of Michigan.
In retrospect, one of the biggest weaknesses in our pandemic planning was that many infectious-disease experts, including me, focussed on the threat posed by a novel strain of influenza. We feared a repeat of 1918—and yet, because we now have the technology to create and mass-produce a new flu vaccine in only a few months’ time, a flu pandemic isn’t necessarily the worst-case scenario. As we are currently discovering, designing and testing an entirely new vaccine against a never-before-seen infectious disease is a far more uncertain and daunting task. The fact that the novel coronavirus is RNA-based, like H.I.V., intensifies the difficulty. It’s possible that a vaccine will arrive this year—but many experts think that it could be two years or even longer before a safe and effective shot has been developed, tested, manufactured, and made widely available.
The challenge, therefore, isn’t just flattening the curve but keeping it flat—holding the line not for months but for years. In a study published in Science in April, researchers at the Harvard T. H. Chan School of Public Health estimated that, in the absence of a vaccine for the coronavirus, periods of social distancing would be necessary into the year 2022. (Their analysis was, in its own way, optimistic: it incorporated the possibilities of new treatments for covid-19, increases in I.C.U. capacity, and the spread of durable immunity over time.) The researchers noted that, even after social distancing lets up, governments will need to continue tracking the virus and addressing occasional outbreaks. In that sense, there’s a good chance that the pandemic may not be over until 2024.
Some countries have adjusted their plans to match these timelines. The German government has established a standard that allows communities to reopen, close up again, and then re-reopen. If, in the course of a week, a community detects more than fifty new coronavirus cases per hundred thousand people, then social distancing measures are reinstated; the same thing happens if the virus’s “reproduction number”— which measures the average number of non-immune individuals whom someone with the coronavirus is likely to infect—exceeds one. This plan allows Germany to reopen in a measured, cautious, data-driven way, and to retreat when the virus threatens to reach an inflection point, beyond which it will begin spreading so fast that it becomes nearly impossible to contain. Most Germans accept that this system, and the restrictions it requires, will remain in place until there is a vaccine or another transformative treatment.
And yet, here in the United States, keeping our curve flat will require more than the establishment of a conservative target for new cases. The challenges facing us are vast and, in some respects, unique. Unlike New Zealand, Iceland, Taiwan, and the other island nations that have succeeded in controlling the virus, ours is a huge country with decentralized political and public-health systems. A state that succeeds in containing the virus can be reinfected by its less successful neighbors. Our politics are divisive, our President is obstructionist, and a wide swath of Americans doubt what scientists say and resist public-health mandates as a matter of principle. Even those Americans who take the virus seriously are not accustomed to thinking about disease as a social issue. During flu epidemics, Japanese citizens are quick to self-isolate, put on masks, keep their children out of school, and stay home from work. In the U.S., we’re used to going to work even when we’re sick and to sending our sniffling children off to school. Scattered, leaderless, and misinformed, we are not necessarily in a position to succeed.
To meet these geographic, political, and cultural challenges, the United States needs not just an adequate pandemic response but an extraordinary one. We need a plan directed by experts who are trained in controlling epidemics; those experts, in turn, require a centralized data-collection center managed by skilled epidemiologists at the C.D.C., capable of insuring accurate reporting from state and municipal health departments. Across the country, we need to start tracking and tracing new cases on a vast scale and analyzing information about which communities are most vulnerable, who is most likely to get sick and die, and the efficacy of medical treatments. In sum, we need a government that collects information, makes decisions based on it, and then collects more.
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