Tornado Alley (PROG)

[BOREALIS]

How the Pandemic Will End

The U.S. may end up with the worst COVID-19 outbreak in the industrialized world. This is how it’s going to play out.

Story by Ed Yong
March 25, 2020

Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers.
Find the collection here.
"What You Need to Know About the Coronavirus"
https://www.theatlantic.com/category/what-you-need-know-coronavirus/

Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nation’s psyche.

A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility.
Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk... https://www.ted.com/talks/bill_gates_the_next_outbreak_we_re_not_ready?language=en ..

In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come.
'The Next Plague Is Coming. Is America Ready?'
https://www.theatlantic.com/magazine/archive/2018/07/when-the-next-plague-hits/561734/

In October, the Johns Hopkins Center for Health Security war-gamed what might happen if a new coronavirus swept the globe.
"The Event 201 scenario"
http://www.centerforhealthsecurity.org/event201/scenario.html
And then one did. Hypotheticals became reality. “What if?” became “Now what?”

So, now what? In the late hours of last Wednesday, which now feels like the distant past, I was talking about the pandemic with a pregnant friend who was days away from her due date. We realized that her child might be one of the first of a new cohort who are born into a society profoundly altered by COVID-19. We decided to call them Generation C.

As we’ll see, Gen C’s lives will be shaped by the choices made in the coming weeks, and by the losses we suffer as a result. But first, a brief reckoning. On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.

-=-=-=-=-=-
[Anne Applebaum: The coronavirus called America’s bluff]
https://www.theatlantic.com/ideas/archive/2020/03/coronavirus-showed-america-wasnt-task/608023/
=-=-=-=-==-

“No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems,” says Nahid Bhadelia, an infectious-diseases physician at the Boston University School of Medicine. More transmissible and fatal than seasonal influenza, the new coronavirus is also stealthier, spreading from one host to another for several days before triggering obvious symptoms. To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.

[...]

Read: The people ignoring social distancing
https://www.theatlantic.com/family/archive/2020/03/coronavirus-social-distancing-socializing-bars-restaurants/608164/

Derek Thompson: America is acting like a failed state
https://www.theatlantic.com/ideas/archive/2020/03/america-isnt-failing-its-pandemic-testwashington-is/608026/

[...]

I. The Next Months

Having fallen behind, it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April. As of last weekend, the nation had 17,000 confirmed cases, but the actual number was probably somewhere between 60,000 and 245,000. Numbers are now starting to rise exponentially: As of Wednesday morning, the official case count was 54,000, and the actual case count is unknown. Health-care workers are already seeing worrying signs: dwindling equipment, growing numbers of patients, and doctors and nurses who are themselves becoming infected.

Italy and Spain offer grim warnings about the future. Hospitals are out of room, supplies, and staff. Unable to treat or save everyone, doctors have been forced into the unthinkable: rationing care to patients who are most likely to survive, while letting others die. The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one. By the end of the summer, the pandemic will have directly killed 2.2 million Americans, notwithstanding those who will indirectly die as hospitals are unable to care for the usual slew of heart attacks, strokes, and car accidents. This is the worst-case scenario. To avert it, four things need to happen—and quickly.

Read: All the president’s lies about the coronavirus
https://www.theatlantic.com/politics/archive/2020/03/trumps-lies-about-coronavirus/608647/

[...]

Read: Why the coronavirus has been so successful
https://www.theatlantic.com/science/archive/2020/03/biography-new-coronavirus/608338/

Juliette Kayyem: The crisis could last 18 months. Be prepared.
https://www.theatlantic.com/ideas/archive/2020/03/there-isnt-going-be-all-clear-signal/608512/

Read: Grocery stores are the coronavirus tipping point
https://www.theatlantic.com/health/archive/2020/03/can-you-get-coronavirus-grocery-store/608659/

Read: America’s hospitals have never experienced anything like this
https://www.theatlantic.com/science/archive/2020/03/coronavirus-hospitals-need-more-beds/608677/

If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it won’t be quick. “It could be anywhere from four to six weeks to up to three months,” Fauci said, “but I don’t have great confidence in that range.”

II. The Endgame

Even a perfect response won’t end the pandemic. As long as the virus persists somewhere, there’s a chance that one infected traveler will reignite fresh sparks in countries that have already extinguished their fires. This is already happening in China, Singapore, and other Asian countries that briefly seemed to have the virus under control. Under these conditions, there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.

The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.

The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting. But it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems. The United Kingdom initially seemed to consider this herd-immunity strategy, before backtracking when models revealed the dire consequences. The U.S. now seems to be considering it too.

Read: What will you do if you start coughing?
https://www.theatlantic.com/health/archive/2020/03/where-do-you-go-if-you-get-coronavirus/607759/

Read: COVID-19 vaccines are coming, but they’re not what you think
https://www.theatlantic.com/ideas/archive/2020/03/two-extreme-long-shots-could-save-us-coronavirus/608539/

The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.

[...]

III. The Aftermath

The cost of reaching that point, with as few deaths as possible, will be enormous. As my colleague Annie Lowrey wrote, the economy is experiencing a shock “more sudden and severe than anyone alive has ever experienced.” About one in five people in the United States have lost working hours or jobs. Hotels are empty. Airlines are grounding flights. Restaurants and other small businesses are closing. Inequalities will widen: People with low incomes will be hardest-hit by social-distancing measures, and most likely to have the chronic health conditions that increase their risk of severe infections. Diseases have destabilized cities and societies many times over, “but it hasn’t happened in this country in a very long time, or to quite the extent that we’re seeing now,” says Elena Conis, a historian of medicine at UC Berkeley. “We’re far more urban and metropolitan. We have more people traveling great distances and living far from family and work.”

[...]

The Kids Aren’t All Right
https://www.theatlantic.com/health/archive/2020/03/what-coronavirus-will-do-kids/608608/

Graeme Wood: The ‘Chinese virus’ is a test. Don’t fail it.
https://www.theatlantic.com/ideas/archive/2020/03/trumps-chinese-virus-tweet/608263/

[...]

One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trump’s approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero. During the second term of his presidency, the U.S. turns further inward and pulls out of NATO and other international alliances, builds actual and figurative walls, and disinvests in other nations. As Gen C grows up, foreign plagues replace communists and terrorists as the new generational threat.

One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of “America first” politics. The nation pivots, as it did after World War II, from isolationism to international cooperation. Buoyed by steady investments and an influx of the brightest minds, the health-care workforce surges. Gen C kids write school essays about growing up to be epidemiologists. Public health becomes the centerpiece of foreign policy. The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.

In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.

https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/