The numbers don’t tell the whole story. Nine Americans have died of Covid-19, and the Centers for Disease Control and Prevention confirms more than 100 cases in 15 states. But there are probably already several thousand Americans who have been infected. For now, the average person’s risk is low in a nation of 330 million, but that may soon change. The highest risk is for those who live in regional hot zones such as Washington state or Northern California.
Measures that limit social activity may soon be in place. China tried to curb transmission by shutting down entire cities and mandatory mass quarantines. That won’t fly in the U.S., socially or legally. Iran is taking the opposite approach amid what may be a wider epidemic. Tehran appears resigned to letting the virus rage through the country’s population. Iran’s official reports say there are 2,300 cases in the country with 77 deaths, but the true number is likely much higher.
There’s still a chance to delay an American epidemic, though full containment is no longer possible. The key is to develop a strategy of mitigation, which will buy time to prepare hospitals, expand testing, and develop vaccines and therapies. This doesn’t mean the U.S. needs to ban people from moving freely in the country, which has happened in China and even Italy. Public-health authorities must develop an approach suited to American law, technology and social structures.
The original priority was tightening travel to and from China. But travel restrictions and advisories will become obsolete as the number of affected countries grows. Any of the thousands of airplanes that land in the U.S. each day could be carrying people who are infected. Airports should remind incoming travelers to isolate themselves and seek medical care if they develop symptoms. Decisions to travel outside the U.S. will largely depend on factors such as individual’s risk tolerance, health status, and the ability to access medical care in a foreign country.
As the number of cases expands, other time-worn public-health measures for containing disease—detecting infected individuals and tracing their contacts—will no longer be enough. Slowing down community spread may require aggressive steps aimed at “social distancing”—keeping people who are sick away from others. The CDC provides guidance to help states and cities put these measures into place—for example, canceling mass gatherings or closing schools and conducting classes online. But it’s up to local authorities to decide what measures to implement. A patchwork of policies may initially confuse the public.
The usual flu-season advice applies: Wash your hands frequently, avoid handshakes, and try not to touch your face. Most important, stay home when you or someone in your household is sick. For home isolation and quarantine to work, employers need to be as understanding and flexible as possible. They can help by holding videoconferences instead of meetings and letting employees work from home. Some may consider alternative schedules or staggered shifts.
These measures will be most effective if applied early and widely. Singapore suspended mass gatherings at schools and eldercare facilities immediately after detecting local disease transmission. This appears to have slowed the number of new infections. But it is important to acknowledge that these measures can cost workers money and even their jobs.
The coming weeks will be hard as more Americans become infected and some die of the disease. Mitigation efforts will be disruptive. But these steps are the best defense until innovation can produce an effective treatment or vaccine that can arrest the virus’s spread.
Dr. Borio is a vice president at In-Q-Tel and was director for medical and biodefense preparedness policy at the National Security Council, 2017-19. Dr. Gottlieb is a resident fellow at the American Enterprise Institute and a partner at New Enterprise Associates. He was commissioner of the Food and Drug Administration, 2017-19.
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