This week, the other shoe dropped for people living in the U.S. worried about the spread of the new coronavirus. Officials have reported the first local cases of the respiratory illness, COVID-19, in California. The virus is here—and has probably been here for some time—and the U.S. is almost certain to face the sort of larger outbreaks that have already hit China, South Korea, and Italy. But how will the country respond at the federal, state, and city levels, and how should ordinary citizens prepare for a pandemic?
To start with the bad news, the U.S. is not in good shape to handle COVID-19, the disease caused by the coronavirus known as SAR-CoV-2. The Trump administration has for years gutted programs within the Centres for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) that help prevent and manage outbreaks of infectious disease. In 2018, Trump also fired and did not replace the pandemic response team of his National Security Council.
During his first dedicated press conference on the outbreak yesterday, Trump didn’t exactly inspire confidence. He repeatedly disputed the messaging of his own public health agencies, playing down the possibility of a crisis. He appointed Vice President Mike Pence as the head of the White House response team, a man who as recently as the year 2000 argued that smoking doesn’t cause cancer and whose actions as governor of Indiana directly sparked a still-lingering outbreak of HIV in the state. More troublingly, on Thursday the White House announced that any communication between federal health officials and the public would have to be cleared by Pence, someone who doesn’t respect scientific consensus on things like evolution and climate change.
“We have conflicting information from the president and from the CDC. And it’s the scientists who should be speaking,” Holden Thorp, editor-in-chief of the journal Science, told Gizmodo. “And anything that is stopping the scientists from sharing information with the public is of great concern.” On Thursday, Thorp penned an editorial in Science criticising the Chinese government for censoring its scientists and the U.S. for contradicting public health agencies.
One factor that will influence how COVID-19 plays out in the U.S. is the country’s fragmented and exorbitantly expensive healthcare system, which will discourage sick people from seeking care, lest they rack up thousands in medical bills. Our lack of paid sick leave will keep people working, and thus infecting others, when they should be staying home.
States and cities will try to track every possible case at first, isolating them away from the public completely. If we’re lucky, these containment measures will stop the virus before it goes out of control. But that probably won’t work. And while Trump has nodded to the possibility of city-wide quarantines, as was seen in China, the legal mess that would create makes them unlikely. Past a certain point of the virus spreading, quarantines wouldn’t really do any good anyway. During the 2009 swine flu pandemic, for instance, the virus had already spread widely across the country by the time health agencies were able to respond to it in full force.
Instead of strict containment, you’ll see authorities try to reduce the epidemic by offering as few opportunities as possible for it to keep spreading. Health officials will tell you and businesses to practice “social distancing,” and you will be repeatedly reminded to wash your hands and stop touching your face. Some employers will tell workers to work from home if they can; schools and large public events may be shut down; and some of us will have to postpone vacations and cancel social gatherings.
If you take regular medications, you should try to stock up on them now. If you want to wear a face mask, sure, but just know that they don’t do much to prevent disease and only help a bit to keep you from spreading it to others. People with fewer resources and wealth will be left more vulnerable. If you haven’t already gotten the flu shot, do it as soon as you can—fewer influenza patients will ease the burden on doctors and hospitals.
As for COVID-19 itself, WHO experts have now said that it does appear to have a 2 per cent fatality rate, while around 10 to 20 per cent of infected people will have serious bouts of disease that take weeks to fully recover from. We also know that it’s much more dangerous for older people and those with weaker immune systems. For most people, it will probably feel like a bad cold that lasts a week or two. People with milder cases will probably be told to stay home, so as not to overwhelm the hospitals that have to take on serious cases.
At some point, we may have experimental treatments available for these life-threatening cases, but a vaccine will probably not arrive in time, nor will everyone necessarily have access to it. On Tuesday, Human and Health Services Secretary Alex Azar refused to promise that any eventual vaccine would be made available to the public for free or at low cost, citing the need to protect profits for drugmakers.
The CDC’s response to the coronavirus has apparently already been botched. For weeks, state and local health agencies across the country haven’t had the tests needed to even diagnose the disease, thanks in part to a faulty batch of test kits sent out by the CDC. As a result, people at high risk of COVID-19 may have already slipped under the radar.
The first locally caught case, a patient in Northern California, was in intensive care for four days before testing from the CDC confirmed she had the disease. Testing was in part delayed because the patient didn’t fit the initial criteria set out by the agency, as she hadn’t recently travelled to China. It’s certainly worth asking whether the CDC’s limited resources made it unable or unwilling to expand its diagnostic criteria before then, given that other countries had already reported local outbreaks within their borders.
But while the CDC does have its hands tied in some ways, the actual messaging from CDC officials isn’t too off point, according to Peter Sandman, a retired risk communication consultant and former researcher who has written about how countries should talk to the public about the coronavirus outbreak.
“Nancy Messonnier [director of the CDC’s National Centre for Immunization and Respiratory Diseases] did extremely good risk communication in warning that community spread seems inevitable,” Sandman told Gizmodo via email. He was referring to Messonnier’s warning earlier this week, in which she said, “We really want to prepare the American public for the possibility that their lives will be disrupted because of this pandemic.”
Sandman said public health experts and journalists shouldn’t be so worried about panicking the public that they soften the reality of what’s happening during a crisis. People aren’t as inclined to panic as we might assume from seeing the news, he argued. But if people don’t know what’s going on, even if the situation is somewhat unclear or really scary, then they’re less likely to do what needs to be done to get through the worst of it.
“People have to get through their adjustment reaction before they can get down to the hard work of preparedness,” he said.
This isn’t an apocalyptic scenario, but it will be tragic and painful nonetheless. And we’ll need to ignore the bad faith actors who try to take advantage of the situation or whitewash it. Don’t drink silver to kill off the coronavirus, for example, and be sceptical of anything that comes from the mouth of Donald Trump or his political appointees. Do believe the scientists and public health experts who are working around the clock to beat this.
We should be afraid of what’s to come. Things will get worse. But we’re not alone, nor are we helpless. Pandemics are as old as human civilisation, but so too is compassion and cooperation.