On Monday, President Donald Trump promised that the White House would ease social distancing restrictions much sooner than epidemiologists say is necessary to prevent millions of Americans from dying.
During a coronavirus task force briefing at the White House on Monday night, Trump addressed a nation anxiously socially distancing and sheltering in place, and told them America will soon be open again for business. “It’s going to be sooner than people think,” he said. “The hardship will end; it will end soon. Our country wasn’t built to be shut down.”
The president’s apparent change of heart on a national Covid-19 containment strategy came exactly one week after he had helped to roll out a 15-day plan from the US Centers for Disease Control and Prevention to help slow further spread of the deadly respiratory disease. The guidelines advise people to stay home if they or someone in their household is sick or if they’re among the most vulnerable groups, including the elderly and those with underlying health conditions.
Trump also made his announcement on the same day that the CDC reported 18,185 new confirmed coronavirus infections, which now total just over 33,400 nationwide, with more than 400 deaths. The explosion of cases makes the US one of the worst-hit countries in the world, behind only China and Italy. But the nation’s faltering testing rollout means that those numbers likely represent just a fraction of the actual cases, and the worst is yet to come. On Monday, the World Health Organization’s director general warned that the global pandemic is, in fact, accelerating. It took 67 days to reach the first 100,000 cases globally, 11 days to get to 200,000, and just four days to get to 300,000.
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Against that dire backdrop, Trump spoke to a nearly empty room of reporters, each separated by three vacant seats—a same-day policy enacted after the White House Correspondents Association announced someone in the press pool was suspected of contracting the coronavirus. The 15-day period is set to end on March 30. At that time, Trump said, he will make a determination about whether to continue the restrictions or extend them further. When asked when he planned to end the stay-at-home orders, Trump declined to give a firm date. What he did say was, “I’m not looking at months, I can tell you right now.”
But many epidemiologists are saying that months of aggressive social distancing and self-isolation are exactly what is required to prevent a catastrophic loss of life. The US government has been recommending such measures on a national scale for only a week—which isn’t even long enough to have the data necessary to know if they’re having the desired effect. While public health experts say that at some point the US will have to figure out how to start relaxing some of these restrictions in a targeted way—to allow economies to come back online in places with low transmission rates—they stress that doing so will require the large-scale deployment of testing, community screening, and contact tracing. None of these are up and running yet in the US. Abandoning the blunter tools of social distancing now, without any of these systems in place, would be not just premature, they say, but disastrous.
“It would be utterly irresponsible to urge people to go back to work and normal social life,” says Larry Gostin, a professor of global health law at Georgetown University. “All the evidence suggests that if governments lift physical distancing too soon, it will cause a major resurgence of cases and deaths.”
To understand why hunkering down now is so important, it’s helpful to look at what happened in China, says William Hanage, an infectious disease epidemiologist at Harvard’s Chan School of Public Health. After cities like Wuhan went into complete lockdown, it took about four weeks to see new infections begin to level off. “That’s consistent with what we know about how long it takes infected people to become really sick,” says Hanage. In other words, there’s a lag between when someone is infected and when their infection is diagnosed and recorded. A similar lag exists between when social distancing measures go into effect and when they begin to pay off.
Think of it like this. If you contracted the disease last Monday—on the first day of Trump’s 15-day stay-at-home challenge—you won’t feel sick for a few days. If you manage to get tested, you won’t get results and show up in official case counts for another few days after that. If you happen to be in the small (unlucky) percentage of people who get life-threateningly ill, you likely won’t turn up in an ICU until mid-April. You’re going to be riding the crest of that steeply rising hospitalization curve that has people freaked out about clinics not having enough ventilators. If you’d headed back to work in the meantime, you could have infected many other people (some of whom might also wind up in the hospital) before you realized you were ill.
On the other hand, if you’d stayed home the entire time, you—and millions of other people also staying at home—would have avoided passing the virus to others. The purpose of such social distancing and self-isolating measures, as explained in a recent study from the Imperial College London Covid-19 Response Team, is to reduce the number of new people each contagious person infects. That will “flatten the curve,” as they say, preventing hospitals from being overwhelmed by a sudden surge of sick patients.
Any effects of pulling this curve downward thanks to the two-week national social distancing strategy won’t start showing up until the end of April or beginning of May at the earliest. Declaring victory now, as Trump seemed ready to do Monday night—telling reporters that in the last week “We’ve learned a lot and we’ve fixed a lot of problems”—would only set the stage for the virus to resurface later this year, when it could interrupt the 2020 census and possibly the next presidential election.
Perhaps the most illustrative example of these sorts of lags is what happened in the Italian cities of Lodi and Bergamo. Both were hit by Covid-19 around February 23, and for weeks their infection rates looked nearly identical. Then, on March 8, Bergamo’s shot up so rapidly that the Italian Army was later sent in to ferry coffins away from overwhelmed morgues to remote cremation sites. What had happened on March 8? Nothing. Both cities were by then both in full lockdown. The difference was Bergamo had imposed its social distancing restrictions the day before, on March 7, while Lodi had done so two weeks before, on February 23. It took that long for Lodi’s successful policies to start becoming apparent.
Will the US be Lodi or will it be Bergamo? The US is just now entering the crucial weeks that will decide its trajectory toward one or the other.
Absent any social distancing measures by the US, the Imperial College researchers project the the nation will hit its peak number of infections sometime in June, with as many as 55,000 deaths per day. (That’s about 2.2 million people by the time the outbreak runs its course.) Reversing runaway infection rates, like Lodi did, will require the US to take disruptive and prolonged actions, according to the researchers’ models. “It is difficult to be definitive about the likely duration of measures which will be required, except that it will be several months,” they wrote.
“It’s an economically and socially and politically difficult decision to take really aggressive steps when there aren’t a lot of cases being reported,” says Andrew Lover, an epidemiologist at the University of Massachusetts Amherst, whose own models project infections in the US will continue to grow at an exponential rate without extensive social distancing interventions. “But all the experiences in China and Western Europe suggest that’s what’s needed.”
Hanage says it’s difficult to know exactly how long such interventions need to be in place. Public health officials can’t just pick a date on a calendar. Instead, they need data: most crucially, data showing how many people have been infected, recovered, and are now immune to the virus. But those kinds of studies require blood tests for antibodies, which are still in development. It could take months before such information becomes available.
In the meantime, if the Trump administration is serious about sending people back to work, they’ll have to first get serious about beefing up testing, screening, and monitoring, says Hanage. Building more capacity is essential for health care workers to be able to effectively identify infectious people and encourage them to self-isolate. Shortages in supplies needed to run those tests are still plaguing efforts to expand testing to everyone who needs it.
The US learned of its first coronavirus case the same day that South Korea did, back in January. By last week, that country of 51 million had conducted more than 300,000 tests; a per-capita rate more than 40 times that of the US, according to a recent report by The New York Times. In contrast, the US, with a population of 330 million, has just this week surpassed 270,000 completed tests, up from 4,000 a week ago, according to the Covid Tracking Project.
By testing early and often—at 600 new screening centers and 50 drive-through swabbing stations—public health officials in South Korea were able to quickly map how the virus spread through the population. This epidemiological detective work allowed health workers to isolate people suspected of being contagious, without having to order the entire nation’s population to stay at home.
On Monday, Trump hinted that he wanted the US to move closer to that model; continuing to restrict people’s movement in coronavirus hot spots while loosening up policies and letting people go back to work in places that have low numbers of infections. “We can do two things at one time,” he said.
Deborah Birx, the White House's coronavirus response coordinator, offered more details on how that might happen in the coming weeks, as increased testing capacity starts to paint a fuller picture of the scope and timing of individual outbreaks in places like New York, the San Francisco Bay Area, and Washington state. “If we get data by specific zip codes and counties, we’ll be able to approach this in a very laser-focused way,” said Birx. “What we will eventually get to as a country is being able to simultaneously do contact tracing and containment at the same time as mitigation. Right now we’re just putting everything into mitigation.”
Throughout the briefing, Trump repeatedly interjected a line he had tweeted out over the weekend. “We cannot let the cure be worse than the problem itself,” he said, referring to a rapidly deteriorating economy, triggered, the president believes, by the nation’s adoption of social distancing policies. Last week the stock market took its biggest-ever single day tumble. On Monday, researchers at Morgan Stanley said they expect the unemployment rate to quadruple by next quarter. The president is worried about how soaring unemployment numbers will play with Republican voters in his 2020 campaign for reelection, according to reports in Bloomberg and The Washington Post.
These fears appear to be part of the motivation for the president’s desire to reboot the economy, even in the face of a public health crisis that is deepening daily. Health officials inside the administration have mostly opposed the idea of sending people back to work, including Anthony Fauci, head of the National Institute of Allergy and Infectious Disease. Fauci, who has contradicted Trump in recent days, openly advocating for tough and prolonged distancing measures, was notably absent from the podium Monday night. When asked where he was, Trump replied, “He’s not here because we really weren’t discussing what he’s best at, but he’ll be back up very soon.”
Fauci seems to be getting through, if not to Trump himself, then at least to some of the president’s closest allies in Congress. On Monday, he was reported to have met with Senator Lindsey Graham of South Carolina. After the press briefing Monday, Graham tweeted that he didn’t agree with the president’s interest in potentially easing some of the White House’s recommended restrictions. “President Trump’s best decision was stopping travel from China early on,” Graham tweeted on Monday. “I hope it will not undercut that decision by suggesting we back off aggressive containment policies within the United States.”
That was after Graham and his GOP colleagues in the Senate failed to pass a $2 trillion coronavirus rescue bill for the second day in a row on Monday. Curse-laden clashes with Democrats over who should get the bulk of the government assistance—big corporations or individuals, small businesses and health care providers—sank the procedural vote needed to advance the legislation. The huge financial stimulus package, which could buoy the economy without trading off on social distancing, is once again under negotiation.
Earlier this month, Congress passed $8.3 billion in emergency spending for a coronavirus public health response, including research toward vaccines and new treatments. Last week the Senate passed another $100-billion package that included paid sick leave, a Medicaid expansion, and free vaccines once they become available. The president signed it into law last week.
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The president is expected to revisit the issue of a national social distancing policy as early as next week. But regardless of what he decides, the ultimate authority over whether certain businesses remain shut down will fall to governors and local officials. As Trump and the rest of America are about to learn, the nation’s public health laws concentrate power over these decisions at the local, not the federal level.
Over the past two weeks, cities, counties, and states have imposed curfews, canceled mass gatherings, closed state parks, and shuttered bars and restaurants in an effort to curb community transmission of the virus. More than a dozen states, including New York, California, and—as of Monday—Washington, Virginia, Michigan, and Oregon have gone a step further, issuing shelter-in-place orders to compel residents to stay in their homes with the exception of conducting essential business, like buying food and medications. More than 100 million Americans will soon be subject to such orders.
Citizens will still be obliged to follow these policies, no matter what Trump says. “The president has no legal power to order people back to work or to dismantle state rules for social distancing,” says Gostin. But Trump could still undermine those local efforts by sending conflicting signals. “It would confuse the public at a time when we need consistent health messaging,” Gostin says.
For now, says Gostin, people should listen to what their local public health officials are telling them. “In the longer term, we could ease back on physical distancing, sending younger, healthier people back into the workforce,” says Gostin. “But we have to wait until we have a better control over the epidemic.”
Gregory Barber contributed additional reporting for this story.
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