Contribute Try STAT+ Today

President Donald Trump’s televised address on Wednesday was clearly aimed at calming the U.S. public, as well as the stock market, about the novel coronavirus and the disease it causes, Covid-19.

It had the opposite effect, as the impact from Covid-19 only seemed to get bigger. There are now more than 1,300 known cases in the U.S. (more on that in a minute) and 130,000 globally.  Following the speech, the NBA and MLB suspended their seasons. Movie star Tom Hanks announced via social media that he and his wife, actress Rita Wilson, had tested positive for Covid-19 while in Australia. The S&P 500 and the Dow Jones Industrial Average both fell nearly 10% Thursday.

Why wasn’t Trump’s speech calming, as he hoped? It did not address the fundamental ways that Covid-19 threatens the U.S. or provide information about how the country will effectively respond to the crisis.

advertisement

A travel ban may not work

The dramatic centerpiece of Trump’s speech was a ban on travelers from Europe entering the U.S. for 30 days. In theory, this might at least prevent new cases from coming to the U.S. and seeding outbreaks. But many experts think it is far too late for that.

Such a ban only works if we don’t have a “tremendous number” of infected people in the U.S., wrote Michael Mina, an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health, via Twitter message. “But we do — we just aren’t testing. Preventing one or two every so often at the airports is going to be eclipsed by exponential growth of cases occurring right now in the U.S. This is the problem. We waited too long for all of this.”

advertisement

Support STAT: If you value our coronavirus coverage, please consider making a one-time contribution to support our journalism.

Carlos del Rio, chair of the Hubert Department of Global Health at the Rollins School of Public Health of Emory University, tweeted: “Containment is basically futile. Containment efforts won’t reduce the number who get infected in the US.  Now we’re just trying to slow the spread, help healthcare providers deal with the demand peak.”

The big problem is the number of Covid-19 cases in the U.S.

Trump said that after “taking early intense action” by banning travelers from China and other countries that had Covid-19 outbreaks, “we have seen dramatically fewer cases of the virus in the United States than are now present in Europe.”

But while experts do credit Trump’s earlier travel bans with slowing the emergence of Covid-19 in this country, they currently believe that there are many more people infected than the government has found because of a series of problems instituting widespread diagnostic testing, something other nations have done.

Just after Trump’s speech, New York Gov. Andrew Cuomo said on CNN that he expects cases to “skyrocket” as new diagnostic tests come online.

“It is much more prevalent than we know,” Cuomo said. “The testing does not reflect what it is. These are not random sample tests. It is because we have no testing capacity. That is why the numbers are low. If you actually had testing capacity, you would see how high the numbers are already.”

Trump is still understating the seriousness of Covid-19

In earlier comments, Trump had referred to the new coronavirus as being like influenza, and even at one point said that people who were infected might go to work. (They shouldn’t.) This time he was much more serious, telling older Americans to avoid unnecessary travel and crowded areas and saying nursing homes should stop all medically unnecessary visits.

But Trump continued to call the risk “very, very low” for the vast majority of Americans.  “Young and healthy people can expect to recover fully and quickly if they should get the virus.”

That’s true, but Covid-19 is far less mild than many experts make it sound. It’s true, 80% of patients have “mild” cases, but half of those include pneumonia. About 15% develop severe illness, and 5% need critical care.

In testimony to Congress Wednesday, Anthony Fauci, the director of the National Institute for Allergy and Infectious Diseases, stated that although mortality in China was stated to be about 3%, he believes that milder cases were missed and it is closer to 1%. Still, he pointed out, that “means it is 10 times more lethal than the seasonal flu.” If a third of Americans caught a virus with 1% mortality, a million people would die.

Trump barely mentioned the best weapon against the disease

The best way to stop a virus from spreading, barring the existence of powerful treatments or effective vaccines, is something called social distancing. This is what has worked to control the outbreak in China, where 80,932 people have been infected.

Viruses spread when people interact. Social distancing means that we keep people from interacting with one another entirely. The NBA and MLB shut down. So do movie theaters, Broadway shows, and even schools. People work from home. Travel crawls to a stop.

Compare the warnings about what the world could look like in Trump’s speech to those of his former Food and Drug Administration commissioner, Scott Gottlieb. He tweeted that, due to the slow rollout of diagnostic tests, the U.S. probably lost its chance to have an outcome like South Korea, where testing and quarantine of the sick slowed the spread of the Covid-19. But, he wrote, the country needs to “do everything” to avert the “tragic suffering” that occurred in Italy, where the health care system has been overwhelmed by the disease.

“Business is leading the way on mitigation and social distancing, filling a void left by policy makers,” Gottlieb wrote. “But shutting down NBA games is not enough. This must be practiced in places large and small. Small gatherings, parties, all should be postponed for the next month or two.”

Trump said little about preparing hospitals

Gottlieb also warned that the U.S. needs to create “surge capacity” in hospitals. Elective procedures should be canceled, and hospitals should try to have as few patients being treated as they can. That way, if thousands of patients with Covid-19 pneumonia hit them all at once, they can be treated.

Peter Bach, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes, said in an interview that this kind of stop could free up beds and save supplies for when they are needed later. “If we can lower our staffing now, we will reserve health care resources for when we really need them,” he said. But he said he didn’t think that would happen without federal action, and promises to hospitals that they would be bailed out for lost revenue.

Generally, the response has shaken faith in U.S. institutions such as the Centers for Disease Control and Prevention because, in the face of a battle that requires clear thinking about supply chains and logistics, there have been too many lapses. This has been most visible with the failure to bring diagnostic tests online, something other nations have done.

It was even evident in Trump’s speech. He misstated the nature of his own travel ban, saying it applied to cargo as well as people. If this had been true, it might have applied to chemical kits that diagnostic testing labs say they need to get tests online. Their manufacture, Qiagen, has said its workers in the Netherlands and Germany are working seven days a week to get the kits ready. An hour after the speech, Trump said in a tweet that the ban only applies to passengers.

Your daily dose of news in health and medicine

Privacy Policy