Science’s COVID-19 reporting is supported by the Pulitzer Center.
America is first, and not in a good way. Last week, the United States set a grim record, surpassing all other nations in the reported number of people infected with the coronavirus that causes COVID-19. As of this morning, officials have documented nearly 190,000; the death toll neared 4100. Even President Donald Trump—who just 1 month ago claimed the virus was “very much under control”—has warned that the pandemic is about to get much worse.
To limit the damage, Trump announced on 29 March that federal recommendations to practice physical distancing would remain in place at least through the end of April, dropping his much-criticized push for a faster return to business as usual. In the meantime, officials across the nation are scrambling to find enough ventilators, protective gear, and supplies for hospitals overwhelmed with COVID-19 patients—or about to be. Many state governors ratcheted up restrictions intended to slow the pandemic, imposing stay-at-home orders that some said could last into June.
Despite such actions, the U.S. pandemic response remains a work in progress—fragmented, chaotic, and plagued by contradictory messaging from political leaders. “We don’t have a national plan,” says epidemiologist Michael Osterholm of the University of Minnesota, Twin Cities. “We are going from press conference to press conference and crisis to crisis … trying to understand our response.”
The United States is “in a reactive mode,” says Jeremy Konyndyk, a senior policy fellow at the Center for Global Development who headed the U.S. Agency for International Development’s disaster response efforts under former President Barack Obama. “This is a virus that punishes delay. … We’re still chasing the virus.”
To catch up, Osterholm and other researchers have released a flurry of battle plans in the past week. Many officials have welcomed the recommendations and signaled their support. But the question now is whether the United States—a patchwork of more than 50 state and territorial governments marked by political polarization and a history of fierce resistance to centralized authority—can follow through.
The urgency is great. A review of 12 mathematical models conducted by federal scientists concluded the United States is likely to see millions of people infected. The death toll is now likely to exceed 100,000 even with distancing and other measures, Deborah Birx, White House coronavirus response coordinator, has said repeatedly. Some experts fear even those numbers are too optimistic, given that outbreaks are now poised to explode in places—including Louisiana, Michigan, and Florida—that are ill-prepared for the surge of people needing hospitalization.
The new battle plans generally agree several moves need to be taken immediately. Federal, state, and local governments must consistently urge, if not order, most people to stay home and keep their distance from others. Federal officials must take a stronger role in directing medical supplies to areas most in need. Testing for the virus must accelerate and expand so that people who are infected can be quarantined.
But there are numerous obstacles. Testing could soon be hampered by a shortage of reagents, caused in part by the disruption of supply chains in Asia, Osterholm notes. Instead, health officials may have to rely on less precise illness surveillance—documenting the frequency of COVID-19 symptoms to estimate the number of cases.