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For the past month, American journalists and public health experts have praised the response of coronaviruses from South Korea and Singapore above all. Singapore will close its schools and most businesses on Tuesday to guard against an out of control epidemic; South Korea has just extended its policy of social distancing. In the early months of this pandemic, the most developed regions of Asia visibly outperformed the rest of the world – a differential that produced a series of viral graphics showing the benefits of universal mask and testing. But in recent days, Hong Kong and Taiwan, noting an increase in new cases arriving via international visitors, have closed their borders. Cases are increasing in Japan and a second wave of infections is also feared in China. Which means that, all things considered, many desperate countries in the United States have spent the past few months renting out because exemplary models of public health management don’t really have the virus under control – or at least not in the to the extent that it appeared a few weeks ago, or to the extent that you might hope if you expected a (relatively) quick end to quarantine measures and an economic stop followed by a (relatively) quick return to “normal” life and economic recovery.
If the countries that have established themselves as models on how to proceed cannot understand this, what does this mean for the United States, which is struggling with broken institutions and has already missed and delayed their response at almost all stages? Here in New York, we are about to enter our third week of shelter there; in San Francisco and Seattle, social distancing orders have been in effect for even longer. However, there is no clarity to be found at the federal, state or local level as to the duration of these measures. And there is no public or concrete plan, and few visible discussions on what it would mean to remove them: how and when and in what ways we will try to get out of this temporary but indefinite national bunkering of type war for almost 330 million of us are found now. What exactly is the final phase here?
Part of this ambiguity is inevitable – it can be difficult to remember, given how the coronavirus has distended our sense of time, but this crisis is only a few months old and scientific and public health wisdom just as preliminary . But although it is not possible to determine a date or a month, when we can expect to leave the bunker, no one seems to have an idea of how we will arrive at this determination, of how many wanted to contain the epidemic, at what levels, before moving forward, and what would be the steps to follow. That there is no coherent federal plan to deal with the epidemic as it stands now is pretty gruesome – an absolute evacuation of the presidential leadership which has already cost thousands of lives and will likely cost dozens thousands of others. But the fact that there are also no plans to talk about how we might leave the current crisis means that all we can look forward to since the dark – it’s more dark.
Last week, Helen Branswell from Stat news reported that public health experts in the US are increasingly concerned that the public is underestimating the duration of coronavirus “disruptions” – many Americans assuming that some sort of national reopening will begin in early May , and most public health experts expect at least a month beyond that. Maybe more, if not much more.
But the biggest question is not how long our stop will last, this is what will follow. In theory, blockages like those currently in place in much of the country are designed to contain an epidemic before it gets out of hand – which is why China shutdown in January. But even a relatively modest spread of a disease requires more than just locking in; an aggressive program is needed to identify infected people, isolate them and monitor those with whom they may have been in contact, to be sure that these people do not spread the disease themselves. This is the “test and trace” method of containing a pandemic; among public health experts, this is ideal. But in the United States, and across Europe as well, the pandemic has progressed far too far for this approach to work. And so – again, in theory – the current bottlenecks could also offer another opportunity: to give the country time to set up a comprehensive testing regime. We stayed there until such a program was ready to start, then we found a “normal” life through this medical surveillance portal. This program would be a dramatic change in American life – mandatory temperature controls, intrusive testing and compulsory isolation in quarantine camps for anyone who is even in contact with a positive case – but it’s the quickest way out of our current situation. Beyond Twitter, the periodic suggestion from Trump’s executive buddies that we should “reopen” the economy, and a few pages of opinion sketching out vague paths, there is no sign of a real plan to do so. at any level of government.
Nobel laureate economist Paul Romer has suggested that, although imperfect, a “tracing” aggressive testing regime would also be effective at the population level, allowing a country like the United States to exit of closure without imposing such an aggressive medical surveillance system. This is potentially promising, as it would be extremely difficult logistically, legally and culturally here. But the United States is a long way from establishing this type of testing regime as well. The only COVID-19 test in the country is for symptomatic patients coming to the doctor and hospital. Nowhere do we do the kind of “community” testing envisioned by Romer, nor do we test anti-coronavirus antibodies to confirm how many people have ever had cases of COVID-19 otherwise not detected. And since we are still desperately short of the test equipment necessary to test even all patients complaining of symptoms, we are very, very far from being able to even imagine a massive deployment of tests on a national scale which would allow us not to simply swab everyone, but continue to trade everyone fairly regularly over the next few months. On top of that, the tests we use can have a failure rate of around 30%. This means that about one in three people tested could get the wrong result. You cannot create a public health intervention in addition to the wrong information.
In this context, the total lack of federal leadership that I spoke of before is particularly noticeable. The White House has offered no meaningful guidance, advice on best practices, or coordinated support to states and communities across the country already living in fear of or in the grip of the coming pandemic. In the absence of a federal policy or public plan, all we have are vague and uninformed hopes: a vaccine, which can take a year or more, although tests are already underway (no vaccine against any coronavirus has ever been created before, and 18 months would mark the fastest production of any vaccine of any kind in medical history); for treatment (currently, we have no drugs proven to help cure the disease, despite the premature approval of the President of Chloroquinine); for collective immunity (which can take as long to develop as a vaccine); and for seasonality (which could slow the spread next summer, but which, according to most epidemiologists, will not radically change the course of the disease).
So we don’t know how long “it” will last and how it will end. In the meantime, all we have is a daily White House press conference featuring a short-sighted, uninformed and contradictory showman of a president, with several competing response teams sometimes emerging from the shadows to reveal ignorance basic on the meaning of federalism. Neither Jared Kushner nor Donald Trump seem to understand what it means for the federal government to act as a back-stop, or what the objectives of a federal stock of medical supplies might be (given the relatively small size of this government ), and how few medical supplies might be needed for his workforce.
“The notion of federal stock was, it is supposed to be our stock,” Kushner said Thursday. “It’s not supposed to be the state stock, which they can then use. “
The most troubling interpretation of this statement is that it is not ignorant but strategic and sadistic. The White House’s continuing message is that at every stage of this pandemic, states and governors will be left to do their own work, rather than relying on federal support and, critically, on advice. Speaking of a particular untested treatment, the president literally said on Friday, “What do you have to lose? Take it. I really think they should take it. But it’s their choice. … Try it, if you wish. »Those rolling eyes this weekend about the fact that the Republican Governor of Georgia and the Democratic Mayor of New York seem only to have learned in recent days that asymptomatic people can still spread the disease – a fact familiar to anyone who has been following the story since January – is less an indictment of these two men than the emptiness of the leadership of Washington, which obliges each state and each local leader to reconstitute their own understanding of the disease.
To the extent that Washington provides aid, it already provides it disproportionately: more aid to states considered friendly to the president, and less to those viewed as hostile. As the crisis increases, this leverage will become even more brutal, that is, for a president like Trump, even more tempting – medical resources used to punish and torture rather than cure. It is hoped that the White House will not be as naked or as extreme in treating desperate states and municipalities as political hostages in the midst of a deadly and economically devastating pandemic. But it is, at present, the closest that the White House seems to be to an exit or endgame strategy.