WASHINGTON — America is entering a disturbing new stage in the coronavirus outbreak. There has been community-spread in at least one and likely two locations in Washington state. And it appears the virus was being transmitted for several weeks before current cases were recognized. So we can expect dozens or hundreds of cases in those locations, unless contact tracing is especially efficient.
The disease is loose and easily transmitted.
The crucial issue now is the real mortality rate, which remains uncertain. The stated mortality is 2%. U.S. experts are hoping the rate turns out to be considerably lower. But the math remains troubling in any case. If only 5% of the U.S. population is eventually infected (which is on the low side of some estimates) and the mortality rate is 1%, there still would be more than 100,000 deaths.
At this stage, the main tool that public health experts have is social distancing — the attempt to keep as many people as possible in affected areas out of sneezing distance from one another. This means measures such as closing schools, canceling events in theaters and stadiums, and encouraging employees to telework. States and localities ultimately make these decisions rather than the federal government. But according to some health experts I consulted, Washington state should be taking such measures right now.
The goal of these policies is to keep the reproductive ratio as low as possible. When people are in proximity, a single infected person can spread the disease to several others, boosting the R0 of the disease to as high as 2 or 3 and causing an exponential increase in cases. If the R0 is less than one, the epidemic will gradually decline and stop on its own, with or without a vaccine.
A vaccine, however, would be tremendously helpful. At least 10 coronavirus vaccine development projects are underway, according to American health officials. But the one furthest along at the National Institutes of Health is still about six weeks away from starting the process of a phase 1 trial in human volunteers that will take three to four months to complete and to show (hopefully) that the vaccine is safe and produces specific antibodies. A phase 2 trial will follow and take at least six to eight months to determine if the vaccine is efficacious in people at risk for infection. Then production would need to be scaled up by a willing pharmaceutical company to deal with a global crisis. All this in total will take at least a year — assuming there are no unpredicted scientific obstacles in the way.
The United States is now faced with two related but distinct problems: dealing with the virus and dealing with the public panic the virus may spark. The current administration is well prepared to handle the virus, and spectacularly ill-prepared to handle the panic.
Upper-level health officials in the administration deserve our confidence. The Centers for Disease Control and Prevention has the world’s best public health professionals. The experts and researchers at the NIH are brilliant and tireless. The Food and Drug Administration will do what is required of it without cutting corners. And Health and Human Services Secretary Alex Azar is a mature adult who knows how to manage under stress. Below the level of the White House, the U.S. government is well suited to the difficult task before it.
But our country may be poorly prepared for the panic that is coming. “We are living at a nadir of trust in experts and public authorities,” Yuval Levin of the American Enterprise Institute told me, “and we are awash in channels for conspiracy and misinformation.” President Trump — given his own conspiratorial approach to facts — is perfectly unsuited to lead in a moment such as this. He has shown a strong tendency to trust outside information over inside information, and to interpret any difference between the two as evidence the insiders are lying to him. He might believe whatever he hears on Fox News and deny what he hears from public health professionals. And all this would happen in public view, creating dangerous confusion.
There is every reason to be concerned about how Trump will behave if and when the schools start closing, travel is restricted, big events such as the Olympics have to be canceled and the economy falls into recession. It is a test he is uniquely prepared to fail. His immediate tendency in such a crisis is to assume there is a plot against him and to search for scapegoats. And his flailing failure would only worsen the country’s general distrust of authority.
America is better prepared for the virus than for the panic, and the biggest obstacle to containing any panic may prove to be the president himself.
(Washington Post Writers Group)