Stay calm. The last seven days have been a demoralizing time for those of us closely following the global spread of the new coronavirus, which causes the disease known as COVID-19. First, reports came out suggesting the incubation period of the virus could be far greater than the originally reported 14 days, and that the incubation period may be as long as 27 days. Around the same time we also learned from China that the virus can be transmitted by healthy people who exhibit zero symptoms. We also received some initial reports that up to 20% of patients may develop severe symptoms, such as pneumonia, often weeks after their initial exposure. We also recently learned that people can potentially become re-infected with the virus after first recovering from it; which could mean—among a long list of possible things—that the human immune system either has a terrible memory with regard to COVID-19, or that this new coronavirus behaves in other unique ways that could allow for re-infection or the appearance of re-infection. We still don’t know enough, including the accuracy of COVID-19 diagnostic tests.
While panicking is not the appropriate response to this situation—or any situation—reasonable and targeted action in the United States could help to contain the spread of the virus. At minimum, targeted containment could slow the spread of the disease to a rate where patients with severe symptoms can be treated at a rate that will not overwhelm the U.S. healthcare system. The alternative is a rapidly moving pandemic that potentially floods U.S. hospitals with millions of severe COVID-19 cases around the same time, resulting in thousands if not hundreds of thousands of preventable deaths. In order to contain the spread effectively though we need to know where the virus is and where it is spreading.
There are reasons to be concerned that the spread of the disease in the United States could be more severe than in other developed countries, due to some unique risks resulting from low-quality or inaccurate COVID-19 reporting data. Here are some specific reasons for my concern:
1. The CDC has already made it difficult for doctors to get early detection tests for COVID-19
One of the most important aspects of managing an emerging epidemic is to understand where cases are occurring, and taking appropriate steps to contain the infection in those areas. The New York Times reported on Thursday morning however that doctors who requested tests in California for COVID-19 had to wait days and get special permission before they received appropriate test kids, and that this delay may have been needlessly exposed some hospital workers to the virus.
The lack of wide-scale public surveying and widespread testing of cases that resemble COVID-19 may allow the coronavirus to spread uncontrolled and undetected throughout the United States. The first known community-spread case in northern California may have been the canary in the coalmine, because this person appeared to have no connection to any individual who had traveled abroad.
Could the virus currently be circulating in public spaces? Could the mail spread it? The Financial Times plausibly suggested a few weeks ago that paper money may be a possible transmission medium. Could credit cards spread this coronavirus? How long does the virus survive on open surfaces? Could your barista give it to you? We have no idea.
We don’t know enough about COVID-19 yet to fully understand the full range of possible transmission routes, which is why early detection is critical. Yet, as of today widespread testing does not appear to be happening, and the public does not know what it should be doing to slow the outbreak. As of mid-day Saturday the CDC did not appear to know where new cases were originating, or even how the virus may be spreading, and neither does the public.
(3/2/2020 Update: COVID-19 appears to have been circulating in Washington State for weeks, and the government appears to have been refusing to test patients with COVID-19 symptoms in Washington DC and New York. The Washington Post broke the story this morning.)
2. The current Government may have incentives to under-report the virus
Whether it is justified or not, COVID-19 is currently sparking talk of another 2008-style economic recession. While no one can accurately predict market movements, and stock market downturns in of themselves tell you nothing, if the current Administration believes its own political survival is tied to the stock market, believes that the current market downturn is being driven by coronavirus news, and believes that claiming the virus is “under control” may help the markets, the administration could try to deliberately under-report the number of cases in a dubious attempt to restore confidence to the markets.
Furthermore, if the economic problems in the U.S. are far greater than meets they eye—due to mountains of low-quality debt taken on by U.S. businesses in prior years—it’s possible that reductions in national consumption by even a few percentage points could ruin businesses across the nation. The risk of such a downturn may create further incentives for the government to encourage businesses to behave as if nothing bad (i.e. a possible global pandemic) is happening.
Days after it was widely reported that millions of Chinese businesses are facing insolvency due to COVID-19 quarantines, the country’s new coronavirus deaths abruptly leveled-off, and new cases in China have reported slowed. What did China do to make this miracle happen, as the virus continued to spread around the world unabated? I could not discern the secret from publicly available information. But an even greater “miracle” could happened in the United States, even without requiring that entire cities go on lockdown.
The strategy of willful ignorance probably will not work, even if it is being actively attempted. The public can not be fooled forever, and they will not believe in a reported slowdown if their neighbors or friends become sick. The only thing that would be accomplished by limiting public knowledge would be to put the public health at risk.
3. The President may try to prevent vital information from being released to the public
While under the U.S. system the Vice President does not report to the President, and the VP has full autonomy, the effect of putting Vice President Pence in charge of all Federal COVID-19 messaging could be that the public will not receive vital information in a timely manner.
While constitutionally the VP is not accountable to the President in any way, and this could mean that Pence may chose to act as an independent agent, the President could easily strip Mike Pence of any role he is given, or even take him off the party ballot in 2020 if he fails to follow orders or disappoints.
As Pence clearly has presidential ambitions himself, there is no reason for him to do anything which may irritate his self-appointed boss. And if the Presidents demands that the people around him disseminate a false narrative around COVID-19—that the President can, though mere force of will, stop, control, or mitigate a force of nature—few may be willing to challenge him in the current surreal and political environment.
4. The U.S. healthcare system is not prepared to handle the complex economics of an epidemic
Unlike most industrial nations, the United States does not have universal healthcare, mandatory sick pay, or effective systems to support working parents. This collectively could mean that, in the event of an epidemic, people who feel unwell may postpone care or even deliberately avoid COVID-19 testing. This may be especially true for people who fear they will be put out of work and financially ruined due to a mandatory quarantine. This raises the risk that the public at large my avoid medical care potentially fostering the rapid spread of COVID-19.
If the American population is already so strained that workers often suffer with medical issues for months without treatment, would they risk a hospital visit that could cost them tens of thousands of dollars, even when their the odds of getting seriously sick may be only one in seven? If 40% American can not afford an unexpected $400 expense, what is the likelihood they are going to be able to afford a $5,000 hospital co-pay or deductible? If there is a risk that COVID-19 patients will have to pay for their own quarantine, could this cause ill people to avoid testing unless they are near death?
While there are many unknowns here, we may soon discover that the weak United States safety net exacerbates the data collection problems surrounding COVID-19 and fosters the coronavirus’s spread.
5. The U.S. has a history of downplaying epidemics
The United States Government does not have a perfect record on handling major infectious diseases. The original 1918 flu pandemic was minimized by the U.S. government and—as Smithsonian Magazine reported back in 2018—the United States government did not make major effort to raise awareness about the disease, seeking, “to preserve public order and avoid panic.”
The history of more recent epidemics such as the HIV/ADIS outbreak is another reason for concern, as it took years to elicit a strong reaction from the U.S., and politicians at the time conveniently (and wrongly) believed that the disease only impacted minority groups. And while “blame the minorities” rationalization is less likely to be effective with COVID-19 than it was with AIDS, the fact that people are were avoiding Chinatown in San Francisco last week for seemingly no other reason than it has the word “China” in its name is not encouraging.
Will people stop buying pizza next because Italy was the first European country to report the community spread of COVID-19?
Conclusion
Stay calm. The situation may not be good, and it appears the conditions may be right for our public officials and institutions to disappoint us. As the virus runs its course over the comings months—hopefully not years—it’s not unreasonable to think that the United States may be one of the countries hardest hit by COVID-19. It may also, in the end, turn out to be one of the countries that did the least to track, control, and manage its transmission. This is not a forgone conclusion, however.
I think it will be a shame if the U.S. fails to act appropriately in the face this historic challenge. While incentives for deceit and willful ignorance may exist, along with structural problems that may make a coordinated national response challenging, the mere presence of incentives does not close the door on the possibility of an effective response.
Still, the fact that two high level Federal positions related to national pandemic response were dissolved within in the last three years—reportedly due to the handiwork of John Bolton—means that there may be no one in the Federal government positioned to handle a complex response to COVID-19. If key positions and roles were eliminated across the government in recent years it may be difficult to recreate these complex roles in the midst of what could quickly become a national crisis.
Despite all this, there remains reasons to be optimistic. Eventually the current administration may realize that a full and truthful reporting on COVID-19 is in its own self-interest, and by extension it’s possible the national interest will take precedence. The U.S. government also still has the ability to set up a national reporting network on COVID-19, and can use all appropriate government powers to control the spread of the disease, including discouraging crowded public events, asking for mandatory public school shutdowns, and distributing advisories on COVID-19 prevention via the national media, emergency cellphone messages, and—yes—even the President’s Twitter feed.
Another reason to be comforted is the realization that we are all descendants of humans who survived the 1918 flu pandemic, smallpox, and even—back in the day—the Black Death. All of us come from hearty stock; if we didn’t we wouldn’t currently be alive.
While these may be difficult times, the odds are still very good we will survive this. And as long as we stay sane and keep our wits about us, our civilization and our Democracy should survive as well.
Additional Reading
Gunderman, Richard. “Ten Myths About the 1918 Flu Pandemic.” Smithsonian Magazine. https://www.smithsonianmag.com/history/ten-myths-about-1918-flu-pandemic-180967810/ Accessed on 2/28/2020.
Ho, Vivian. “‘Please visit Chinatown’: coronavirus fears empty San Francisco district.” The Guardian. https://www.theguardian.com/world/2020/feb/27/chinatown-san-francisco-coronavirus-fears-empty-district Accessed on 2/28/2020
Sullivan, Andrew. The AIDS Fight: Andrew Sullivan on a History of the Movement. The New York times. https://www.nytimes.com/2016/11/21/books/review/how-to-survive-a-plague-david-france.html Accessed on 2/29/2020.