Connecting state and local government leaders
COMMENTARY | There are two things the United States must do to beat the coronavirus.
We are engaged in an effort of social distancing—physically separating ourselves from one another. This is hard, and nearly everyone wants to know when we can stop. Beyond being personally painful, these actions take a massive economic toll: millions of lost jobs, billions if not trillions of dollars of wealth wiped away. It is tempting, at this point, to say that the cure is worse than the disease.
It isn’t. While the cure has large side effects, the disease is worse. The real problem is that we’re taking our medicine haphazardly—and as a result, experiencing all of the side effects and few of the benefits. That needs to change.
We can’t win the fight against COVID-19 just by wishing the virus away. Instead, we need to take two crucial steps. First, we need a true national pause, not the sporadic halts we’ve seen so far. And then, we need to follow it with massive, coordinated testing across the population.
Over the past week, more and more of the country has started committing to significant physical-distancing measures. Unfortunately, much of the country still has not done so. Spring-break revelers are still on the beaches, and all those partiers will be headed back home, potentially seeding tens of thousands of new infections across the whole country. Some states still haven’t closed schools, potentially allowing for asymptomatic spread through their communities. We still aren’t taking this virus seriously enough.
We are also woefully behind in building up our testing capacity. We can’t tell exactly how badly different areas of the country are being hit; we can only see for sure which hospital systems are being overrun. After infections run rampant, it can take a few weeks before the hospitals get overwhelmed. We saw that in Italy and we’re starting to see that in the U.S.
Worse, despite our inconsistent, at times half-hearted, efforts, some leaders are already losing their nerve. People without medical or public-health expertise are questioning whether physical distancing is worth it. They’re wondering whether it might be better to let this disease just run its course.
That’s a catastrophically bad idea. The human cost would be devastating, and the economic toll from that devastation might be even steeper than what we’re seeing right now. It’s hard for people to understand just how bad an unchecked pandemic could be. More people could die from COVID-19, the disease caused by the coronavirus, in just a few months than have died in every single war this country has fought since its inception. Such devastation would shut down our hospitals and the entire health-care system. Tens of thousands of doctors and nurses and other health-care professionals would likely get sick. The ripple effects on finances, and on human lives, would be massive and uncontrolled.
We understand the pain people are feeling now and appreciate that everyone wants to know when we can call off the distancing measures. Unfortunately, that’s the wrong question.
The right question is: What do we need to do to stop living like this?
Here’s the answer: First, we need a true national pause—a cessation of all nonessential activities. It has to last at least two weeks, and everyone needs to participate. If we all distanced ourselves from one another for that long, the outbreak would slow down significantly. Isolating individual family members may not be socially tenable. Because of that, infections are going to continue within families, but broader spread can be curtailed.
But here is the second part: We need massive, coordinated testing of the population. Even today, we don’t know how many people are infected in the community and how many people without symptoms are spreading the infection to others.
Such testing must be organized by epidemiologists experienced in this area, not by health-care providers. We need to know the full extent of those who are sick with COVID-19, but we also need to know where the virus is hiding. By setting up testing centers across the nation, we can avoid spreading the infection through our health-care system.
Once we have these data, and after a national pause, we can make informed decisions. In areas of the country where the community disease burden is low and the spread of the virus is slow, we could ease restrictions. We would still need to be vigilant in screening, to pick up on new cases early and isolate individuals before they’ve had the chance to fuel an outbreak. A vigorous testing infrastructure will allow us to do this; other countries are showing us the way.
In areas where community infections are rampant, we will need to continue isolating everyone until suppression has worked. But we know that if people stay away from one another, they can’t spread the disease to one another.
Americans are asking: When can we leave our homes and go back to work? That question makes sense. But we need to ask: When will we have the testing infrastructure we need to defeat the pandemic without freezing the economy?
“Soon” isn’t good enough. Americans are tired of empty promises that don’t materialize. We need answers that are based on science, evidence, and data. We need answers that are verifiable.
The United States is enormously rich—not just financially, but also with scientific and intellectual capacity. We can use our infectious-disease and public-health experts to create a testing scheme and implement it. We also need to create fast testing that the private sector can quickly scale up.
No one believes that these actions lack trade-offs. The economic costs of a pause are immense. We’re already experiencing them; we’re just not reaping the full rewards, because we have yet to do what’s really required.
Until we have a vaccine, we can’t expect to eradicate this disease. If we soften our distancing measures too early, we risk making things worse. But if we are willing to do what is necessary, we can get the disease under control, get our economy moving again, and give Americans hope that we will hold the line until a solution finally becomes available.
Aaron E. Caroll is a professor of pediatrics at Indiana University School of Medicine. Ashish Jha is the K.T. Li Professor of Global Health at Harvard University, Dean for Global Strategy at Harvard T.H. Chan School of Public Health and the Director of the Harvard Global Health Institute.