The natural response to a disaster is to at first believe that it is not happening. The Covid-19 pandemic, we are learning, is a disaster playing out in slow motion — when every moment is a little bit worse than one would expect.
In the United States, the result is a grim sense of déjà vu.
Researchers have learned a lot about SARS-CoV-2, the novel coronavirus that causes Covid-19, since it emerged in China at the end of 2019. They have learned more about how it spreads, and how to test for it. They have learned that two drugs, remdesivir and dexamethasone, show some benefit in the sickest patients.
But they have also learned that the virus takes advantage of human instinct. Its long course means that it is possible to believe that things aren’t going to get that bad — long after they are actually becoming catastrophic. And many experts fear — though they may not be able to say for certain — that the U.S. is nearing the point of catastrophe again.
The virus “defies intuition,” said Caitlin Rivers, an assistant professor at the Johns Hopkins Bloomberg School of Public Health. “People like to see the impact of changes in the data much sooner than we actually observe.” In reality, it takes three weeks, sometimes even a month, for surges in the number of case counts to show up as increases in deaths, Rivers said.
There are reasons to believe that things could be different in the states that currently are seeing surges, which include Texas, Florida, South Carolina, and Utah, than they were in New York. The people getting sick now seem younger, on average, which may mean that fewer get serious illness. Still, Rivers said, using the cold language of epidemiology: “It’s hard to imagine that this increase in incidence will not be reflected in any way in the number of deaths.”
Remember, after all, how things played out in New York. The first confirmed case was announced on March 1. A little more than a week later, the National Guard was being called into the city of New Rochelle. At the end of the month, 76,000 New Yorkers had been diagnosed with Covid and more than 17,000 had died. Cases swelled to 390,000, and deaths 25,000 before the epidemic there came under control.
“Even though I am a lifelong, serious optimist, I think Covid calls for realism,” said Susan Desmond-Hellmann, the former CEO of the Bill and Melinda Gates Foundation. “And so for me, this is a moment of realism and humans, including this human, love denial. We love denial.”
The facts are the facts, Desmond-Hellmann said. An estimated 2.4 million Americans have been diagnosed, and more than 120,000 people have died of this novel coronavirus in the U.S. “The virus is still here,” she said.
Rivers said what frustrates her is the sense of resignation about the current state of affairs — to “explain why it can’t be helped and that this is just the way that things are destined to unfold, when the fact is there’s a lot that we could do.”
“There are many other countries that have gained control of their outbreak and they are in a much better place than we are,” she noted.
New Zealand and Iceland, the best examples, are islands. But the list includes much of Europe. Italy, Spain, and Germany have controlled their outbreaks, even after being hit hard. The solutions are the same simple ones public health experts have recommended from the beginning: further ramping up the availability and speed of testing, so patients know when they are infected. Isolating people when they are sick so they don’t infect others. Avoiding crowds and close contact with other people. Washing hands frequently. And, most experts now agree that face masks reduce transmission, helping to keep the virus in check.
“Opening up doesn’t mean stop wearing a mask,” said Desmond-Hellmann. “Opening up means the opposite.”
And returning to some parts of normal life, she said, would just not be sensible. “I’m very pro-religion,” Desmond-Hellmann said. “I think religion is very important for people. But do you really want to put people together and sing hymns right now?”
Both Desmond-Hellmann and Rivers said they were frustrated that the simple message of public health has been politicized: Until there is an effective vaccine, we need to use the measures we have — masks, some distancing, and reasonable steps to reduce infection — to try to keep the virus in check.
“I would love for everyone from President Trump to the governor of every state, to the mayors to people in leadership roles to make it a cultural norm, to make it popular, fun, fashionable to wear a face mask,” Desmond-Hellmann said. “Because it’s all we’ve got right now.”