For a month, American journalists and public-health experts have praised the coronavirus response of South Korea and Singapore above all others. On Tuesday, Singapore will close its schools and most businesses to guard against an out-of-control outbreak; South Korea just extended its social-distancing policy. In the early months of this pandemic, the most developed parts of Asia have visibly outperformed the rest of the world — a differential that has produced a string of viral charts showing the benefits of mask-wearing and universal testing. But in recent days, Hong Kong and Taiwan, noting a rise of new cases arriving via international visitors, have shut their borders. Cases are spiking in Japan, and a second wave of infections is feared in China, as well. Which means that, all told, many of the nations desperate Americans have spent the last few months praising as exemplary models of public health management do not actually have the virus under control — or at least not to the degree it appeared a few weeks ago, or to the degree you might be hoping for if you expected a (relatively) quick end to quarantine measures and economic shutdown followed by a (relatively) rapid snapback to “normal” life and economic recovery.
If the countries held up as models for how we should proceed can’t figure it out, what does it mean for the U.S., which is saddled with broken institutions and has already bungled and delayed its response at nearly every stage? Here in New York, we are about to enter our third week of sheltering in place; in San Francisco and Seattle, the social-distancing orders have been in effect even longer. Yet there is no clarity to be found from the federal or state or local level for how long these measures will last. And there is no public or concrete plan for, and little visible discussion about, what it would mean to sunset them: how and at what point and in what ways we will try to exit this temporary-but-indefinite wartimelike national bunkering almost all 330 million of us now find ourselves in. What, exactly, is the endgame here?
Some of this ambiguity is inevitable — it may be hard to remember, given the way the coronavirus has distended our sense of time, but this crisis is just a few months old and the scientific and public health wisdom just as preliminary. But while it may not be possible to pinpoint a date, or a month, at which point we can expect to transition out of bunker living, no one seems to have any sense of how we’ll arrive at that determination, how much we will have wanted to contain the outbreak, at what levels, before moving forward, and what steps moving forward would then entail. That there is no coherent federal plan to deal with the outbreak as it currently stands is horrifying enough — an absolute evacuation of presidential leadership that has already cost thousands of lives and will likely cost tens of thousands more. But the fact that there is also no planning to speak of for how we might leave behind the present crisis means all we can see looking forward from the darkness — is more darkness.
Last week, Helen Branswell of Stat news reported that public-health experts in the U.S. are increasingly worried that the public is underestimating how long the coronavirus “disruptions” are going to last — with many Americans assuming a sort of national reopening will begin in early May and most public-health experts expecting at least a month beyond that. Possibly more, even considerably more.
But the bigger question isn’t how long our shutdown will last; it’s what will follow it. In theory, lockdowns of the kind that are now in place in much of the country are designed to contain an outbreak before it gets out of control — this is why China instituted its shutdown in January. But even relatively modest spread of a disease requires more than simple lockdown; it requires an aggressive program to identify those infected, isolate them, and monitor those they may have come into contact with, to be sure those people aren’t themselves spreading the disease. This is the “test and trace” method of pandemic containment; among public-health experts, it is the ideal. But in the U.S., and indeed throughout Europe, as well, the pandemic has progressed much too far for this approach to work. And so — again, in theory — the current lockdowns could provide another opportunity, as well: buying the country time to ramp up a comprehensive testing regimen. We would shelter in place until such a program was ready to go, then reenter “normal” life through that portal of medical surveillance. This program would be a dramatic change to American life — obligatory temperature checks, intrusive testing, and mandatory isolation in quarantine camps for anyone who’d even come into contact with a positive case — but it is the fastest path out of our current predicament. Beyond Twitter, the periodic suggestion from Trump’s executive pals that we should “reopen” the economy, and a few op-ed pages sketching out vague pathways, there is no sign of any real plan to do it at any level of government.
The Nobel Prize–winning economist Paul Romer has suggested that, while imperfect, an aggressive testing regime without “tracing” would also be effective, at the population level, allowing a country like the U.S. to emerge from shutdown without imposing quite as aggressive a medical surveillance state. That is potentially promising, since the latter would be enormously challenging at the logistical, legal, and cultural levels here. But the U.S. is very far from instituting that kind of testing regimen. The only COVID-19 testing being done anywhere in the country is of symptomatic patients coming to doctors and hospitals. Nowhere are we doing the kind of “community” testing Romer envisions, nor are we testing for coronavirus antibodies to confirm how many people have already had otherwise undetected cases of COVID-19. And since we are still so hopelessly short on testing equipment needed to even test all the patients complaining of symptoms, we are very, very far from being able to even imagine a massive nationwide rollout of testing that would allow us to not just swab everyone but continue to swab everyone pretty regularly over the next few months. On top of which, the tests we are using may have a failure rate of about 30%. That means about one in every three people being tested could be getting the wrong result. You can’t build any kind of public-health response on top of information that faulty.
In this context, the complete absence of federal leadership I’ve written about before is especially conspicuous. The White House has offered no meaningful guidance, best-practices advice, or coordinated support to those states and communities around the country living either in fear of the arrival pandemic or in its grip already. Absent a federal policy or public plan, all we have are vague and poorly informed hopes: for a vaccine, which may take a year or more, though tests are already underway (no vaccine for any coronavirus has ever been created, and 18 months would mark the fastest production of any vaccine of any kind in medical history); for treatment (at the moment, we have no drugs proved to help cure the disease, despite the president’s premature endorsement of chloroquinine); for herd immunity (which may take as long to develop as a vaccine); and for seasonality (which could dampen the spread come summer but which most epidemiologists suspect won’t radically alter the trajectory of disease).
So we have no idea how long “this” will last and how it will end. In the meantime, all we have is a daily White House press conference starring a shortsighted, uninformed, and self-contradicting showman of a president, with multiple competing response teams occasionally emerging from the shadows to reveal a basic ignorance about the meaning of federalism. Neither Jared Kushner nor Donald Trump seem to understand what it means for the federal government to act as a backstop, or what the purposes of a federal medical-supply stockpile could be (given the comparatively tiny size of that government), and how few medical supplies could ever be required by its workforce.
“The notion of the federal stockpile was, it’s supposed to be our stockpile,” Kushner said Thursday. “It’s not supposed to be states’ stockpile, which they can then use.”
The more troubling interpretation of that statement is that it isn’t ignorant but strategic and sadistic. The continued messaging from the White House is that at every stage of this pandemic, states and governors will be left to do their own work rather than rely on federal support and — critically — guidance. About a particular untested treatment, the president said on Friday, literally, “What do you have to lose? Take it. I really think they should take it. But it’s their choice … Try it, if you’d like.” Those rolling their eyes this weekend about the fact that both the Republican governor of Georgia and the Democratic mayor of New York seem only to have learned, in the last few days, that asymptomatic people can still spread the disease — a fact familiar to anyone following the story since January — is less an indictment of those two men than the vacuum of guidance from Washington, which requires every state and local leader to piece together their own understanding of the disease.
To the extent Washington is providing help, it is providing it, already, in disproportionate ways: more aid to those states considered friendly to the president, and less to those considered hostile. As the crisis grows, that leverage will become even more brutal, which is to say, for a president like Trump, even more tempting — medical resources used to punish and torture rather than heal. One hopes the White House won’t be that naked, or extreme, in treating desperate states and municipalities as political hostages in the middle of deadly and economically devastating pandemic. But this is, at present, the closest the White House seems to be to an exit strategy or end-game.