Skip to Main Content

There’s no point in sugar-coating this. The U.S. response to the Covid-19 pandemic is a raging dumpster fire.

Where a number of countries in Asia and Europe have managed to dampen spread of the SARS-CoV-2 virus to the point where they can consider returning to a semblance of normalcy — friends from Paris just emailed me pictures from their Sicilian vacation — many international borders remain closed to Americans.

On Sunday, Florida reported more than 15,000 cases — in a single day. South Korea hasn’t registered 15,000 cases in the entire pandemic to date. One day last week the U.S. recorded more than 68,000 cases.

advertisement

The website Covidexitstrategy.org has updated its previously tri-colored U.S. map, which showed states as either green, signifying they are trending better; yellow, making progress; or red, trending poorly. A fourth designation, called “bruised red,” signals states with uncontrolled spread; criteria for this category includes hospitals nearing capacity both in terms of overall beds and ICU space. Already 17 states are wearing bruised red.

The virus suppression gains earned through the painful societal shutdowns of March, April, and May — the flattened epidemiological curves — have been squandered in many parts of the country, dejected public health experts agree. A vaccine for the masses is still months away. What can be done?

advertisement

One thing is clear, according to public health experts: Widespread returns to lockdown must be a last resort — and may not be doable.

“It would be really a morale breaker,” Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told STAT. “The stress and strain that people were under during prolonged lockdown is the genesis of why, when they were given the opportunity to try and open up, they rebounded so abruptly. Because what I think happened is, they overshot.”

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

But this is not a binary choice between societal lockdowns and the “party like it’s 2019” approach that put the country in the bind it’s in now. With that in mind, STAT asked a number of public health experts for a single suggestion of how we get ourselves out of this mess. We got lots.

None is a magic bullet. This is going to be a painful and slow process. But there are things individuals, public health departments, state and local governments, and the Trump administration can do.

The fire brigade needs us all.

Turn the clock back

Pent-up people embraced newfound freedoms over-exuberantly, Fauci said. He suggests going back to Phase 1 of the reopening process and then working forward with more caution. “Do it the way they should have done it in the beginning,” he said.

“If we do that, particularly closing the bars, avoiding anything that has a congregation of a large number of people, wearing masks outside essentially all the time, keep distancing … I would almost guarantee that we would see a turnaround of the resurgence that we’re seeing now.”

Embrace al fresco living …

Ashish Jha, director of Harvard’s Global Health Institute, favors banning all indoor public activities that bring together groups of people, for now — including church services.

“My best read of the data is that a large chunk of the transmission is happening when people gather indoors. So, cut out the indoors. No restaurants, no bars, no nightclubs, obviously no schools right now,” Jha said.

He’d close stores, except pharmacies and grocery stores, and require those to limit the number of people they admit at any one time. Staff and customers would have to wear face coverings.

… but tailor tools to local settings

Saskia Popescu, an infection prevention epidemiologist at the University of Arizona, thinks advice like this needs to be pragmatic and take into account that conditions vary across the country. Like where she lives, in sweltering Phoenix.

“Everyone likes to say ‘eat outside!’ she notes. “You can’t do that in 115 F heat, so let’s give people the tools to apply infection prevention strategies for these environments.”

“Social responsibility is huge, but if we don’t do effective risk communication and education, you’re failing people,” Popescu said.

Get creative with risk communications

Marm Kilpatrick listens to a lot of NPR. On NPR, he hears a lot of public service announcements from the Centers for Disease Control and Prevention urging people to cover their coughs, wash their hands, practice social distancing. Kilpatrick, an infectious diseases dynamics researcher at the University of California, Santa Cruz, thinks most of that advice is, by now, not useful.

People should be wearing masks, so by definition coughs are covered. (Plus, people who are coughing should be staying home.) Fomites — viruses coughed onto surfaces — are no longer thought to be a major mode of transmission. And people don’t really get how to social distance except “avoid strangers,” he said.

They need better, more useful messages telling them how to do the things they want to do, but safely. Kilpatrick gives it a go: “Wear a mask. Meet outside. Give space.”

Teach people to think in terms of harm reduction

“One thing I notice is that when people ask me a question, they say ‘yet.’ ‘Can I do this yet?’’’ said Amesh Adalja, an expert on emerging infectious disease and pandemic preparedness at Johns Hopkins. “And I say, ‘There is no ‘yet.’”

He suggests borrowing a page from the harm reduction work that has been done to address sexually transmitted diseases and the opioid epidemic — helping people figure out the risks they face and how to navigate them.

“We have to get better at individual risk calculus,” Adalja said. “It’s not something that people are very good at. And I think that’s why when bars opened in certain places it was like the whole town turned 21.”

Accept that for now the virus has the upper hand

We need to learn to live with SARS-CoV-2, said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy.

Pretending the virus is not a threat or trying to will it away is a recipe for disaster. “You have less chance of winning a policy debate against this virus than you do of … winning a debate against 2,000 angry 2-year-olds,” Osterholm said.

“People have to understand that. It’s like trying to defy gravity. Just because you want to doesn’t mean you can.”

Mine the data more efficiently

Public health is amassing lots of information about who is getting sick and where they’re getting infected. That data should be put to better use, said Caitlin Rivers, an assistant professor of epidemiology at the Johns Hopkins Center for Health Security.

“We can use that information to better direct resources and interventions, for example by closing high-risk activities rather than broad shutdowns,” Rivers said. These kinds of analyses will need to be ongoing, because conditions will change, and should be made public to help people assess their personal risks and guide their decision-making.

Cloudy with a chance of Covid

Data mining could be used to develop local forecasting services, said William Hanage, an epidemiologist at Harvard’s T.H. Chan School of Public Health.

He envisages something like: “Covid activity in your area is currently low. While the risk is not zero, all you need to do is wear a mask while indoors in a public space,” or “Covid activity is expected to be very high and you are advised to shelter in place. Please avoid contact with at-risk persons.”

Consistent consistency

Enough with the “but the flu” and “it’s getting better” and “it’s going to go away on its own” talk. There needs to be consistent communications from all levels of government about the risk the virus poses, said Alessandro Vespignani, director of the Network Science Institute at Northeastern University.

“I know it sounds trivial,” Vespignani said, “but I have the feeling that is impossible to win the fight if a large fraction of the population is not believing there is something to fight.”

Cut out the politics

With more than six months’ worth of experience with Covid-19, the world has good evidence about what works to suppress spread of the virus. All levels of government should be urging people to take those steps, said Tom Inglesby, director of the Center for Health Security at Johns Hopkins.

“If leaders from this point forward spoke with the same messages, consistently, clearly, without division, they likely have the power to change the views of many who have been less convinced of the right things to do because of conflicting, confusing messages they have been hearing,” he said.

Leaders should also practice what they preach — masks in public, avoiding large gatherings — and be guided by science, Inglesby said.

Provide more help for the hardest hit

Black, Latinx, and Native American communities have been disproportionately hard hit by this pandemic, said Richard Besser, president and CEO of the Robert Wood Johnson Foundation. And too little has been done to ensure that essential workers, many in low-paying jobs, have the tools to protect their health and the health of their families and communities.

Fixing this means providing income support so people who are sick or exposed can stay home, and ensuring they have sick leave and family medical leave. It also means funding unemployment insurance for the millions of people who have lost their jobs in the pandemic, and extending rent forgiveness and moratoriums on evictions and foreclosures, Besser said, as well as providing safe places for people who need to isolate or quarantine but don’t have the space to do it at home.

Pop-up testing sites

Natalie Dean said more geographically focused testing would turn up cases that are being missed. And bringing the tests to where the people are would result in a lot more people being tested. Dean, an assistant professor of biostatistics at the University of Florida, said more mobile testing vans could help identify where transmission is happening. That’s a different approach than the efforts to find and quarantine people who have been contacts of confirmed cases.

“So, it is less about using tracing to reconstruct a chain, and more about identifying a hot spot and trying to flood the area with tests,” she said.

Daily home testing, on Uncle Sam

Low-cost — $1 a day or less — home testing for Covid-19 is doable, said Michael Mina, a Harvard epidemiologist and associate medical director of clinical microbiology at Boston’s Brigham and Women’s Hospital.

“The tests exist. The technology exists. They could be manufactured tomorrow and they would detect people on the days that they are most likely to be transmitting,” Mina said.

These tests aren’t as sensitive as laboratory tests — they miss some cases — but they have the advantage of giving an instant answer. The turnaround for lab testing can be a week. If everyone in a high transmission zone could test themselves daily and stay home while they test positive, it would dramatically lower transmission, he said, arguing the government should pay for these tests.

Contact tracing, with national support

Too few states have the capacity to do effective contact tracing, says Crystal Watson, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

“We need this capacity now and we will need it in the fall,” said Watson, alluding to the fact that Covid-19 and influenza will be co-circulating as we get into the autumn and winter. “The White House should embrace a national initiative for contact tracing, and Congress should provide additional funding for state and local public health authorities to expand contact tracing capacity.”

  • Good article, but in addition, a couple of other strategies might help.
    1. Emphasize more of the probable long term effects of infection (lung function, kidney problems, heart, probable life shortening etc.). Maybe this would convince the young to be afraid of it.
    2. Embrace UV-C treatment for closed spaces on a constant basis after research has shown it to be safe if done properly. Would help health providers, restaurants, schools, even homes.

  • The Dumpster Fire analogy perfectly suits the US Covid picture. Far too many Americans are ridiculously selfish and careless, putting the short-term fix of “My Freedom” above any longer term notion of care for their relatives, friends and other co-citizens. A Covid virus thrives in such a careless environment. Masses refusing to wear a mask, to keep distance, and to refrain from dumb partying is full-blown anarchy in the US (at the top and all the way down). It is stupefying that far too few make these really small adaptations – that already support huge returns-to-more-normal in pretty much every other country. If Americans do not chose to shape up and dowse that dumpster fire, then it will be Americans that will see REAL freedom dead-last.

    • It’s colonialism, full stop. This country was originally built on genocide and slavery, which right-wing libertarians like to fantasize was the good old days. Not shockingly, they are typically the same people crowing about their “liberty” when their behavior could literally kill other people. 20 years ago there was a lot of talk about American Exceptionalism, the way Americans view themselves, and it most certainly has roots in the way other nations of people have been compromised to serve the selfish wants (note: wants, not actual needs) of American people. Many of these individuals somehow imagine that the Declaration of Independence and Constitution are guarantees of fun trips to Disneyworld, shopping sprees, and all sorts of nonsensical things that did not even exist until the 20th century and corporate capitalism. It’s also why they deny climate change. It might ruin their fun to consume less or alter their habits in a minor way.

    • Oh it’s Christi… Always the smartest person in the room. Full Stop!
      Let us bow and take note of every breathe that she speaks upon.
      Full of rich advise and true arrogance. “Let them eat cake” says Christi!
      Her manure occurs yet does not smell… She is Truly Amazing.
      “The fact that you don’t understand this leads me to doubt your credibility”
      Her exact words… oh you common people.

  • Sorry but this article is just that. Politics. Our response is fine. You seem to forget that Europe is months ahead of in the phases of the pandemic. These articles are all about the election in the November. Anyone who doesn’t realize that kidding themselves. The Public Health system is made of mainly democrats. The blame if any should fall squarely where it belongs. The APHL is the CDC political arm and hates Trumps

    • Imagine thousands of your fellow country men dying around you, and you thinking your number one priority is to rush to the defense of a half-senile despot who brought multiple life-long mental health issues along with him into the White House.

    • Amy – Europe is not simply months ahead with Covid by date/time. With the general commitment and discipline Europe is likely a year ahead of the US. It’s all in attitude and willingness to co-operate.
      Christi – love your true reality check !

  • Overplayed initial response by Fauci’s ego and estimates of millions dying. People will not believe him and have lost trust in what is said and here we are.
    How to recover from allowing the politicizing of COVID and cancel culture.
    You get back to what matters for all of society and how to help everyone in a straight forward manner “unbiased and non-political way” or you are throwing fuel into the ‘dumpster fire’ and then acting surprised by the results.

    • See, this is what I am talking about. It’s not about humans being bad at social distancing or not being able to calculate individual risk. It’s about wide spread cultural conditioning that common people somehow “know better” than doctors or scientists, along with a big heaping helping of paranoia about “liberty” which is really just code word for believing that personal freedom is equal to be able to do whatever you please and take whatever you want no matter who it hurts if it doesn’t affect you directly.

    • Christi in response to your spin, twist or whatever you comprehend it as…
      Just for clarity I have been in Pharma for over 20 years daily in a quality and scientific data environment that dictates following best practices to achieve success. My points stand clear even without your spin.

    • Since when is big pharma an ethical environment that operates on science and human well being alone? It’s a well known fact that the pharmaceutical industry in the US runs on greed. People with science degrees are also human beings, and some of those human beings are unethical, arrogant, narcissistic, and you appear to be one of them. How comical for you to project your own overblown ego on Dr. Fauci.

    • If any ego has overplayed itself, it is not Fauci’s. Apparently our “leader’s” ego is so damaged and fragile that he can only see the world as he wants to see it, not as science experts recommend. So that ego refused advice from Fauci and other experts that would have delivered better results and saved lives. That ego was and is responsible for the dumpster fire, not those trying to guide him and being rebuffed and undercut at every step. Anyone asking this not be political – ask the president to stop making it political. Until he stops, it is both very political and very personal.

    • Christi exposed for her arrogance looking down on the “common people” as they just don’t get it. Also for her arrogance in that it’s just for “anyone who is honest knows that it’s only a large percentage of Americans” are the problems. Well after watching Dr. Fauci’s responses for 2 months and wondering where is his leadership…. until realizing at best he is a side-kick (like Robin to Batman) and is truly unable to lead the pandemic with his non-actionable responses, besides stopping the entire US cold. He may be a good doctor that knows how to line his own pockets and get grants better than he is any kind of leader to the US in this pandemic. We needed leadership from a scientific approach that resolves the pandemic by guiding the entire population of the US. Sorry I did not fit your twist and appease you…. oh Christi the obvious master of our society. You might want to use the term “you people” next time… ask Perot how that worked out.

  • This is all very reasonable and rational, but it also makes it sound like these behaviors or beliefs are intrinsic to all people world wide, and anyone who is honest know that it’s only a large percentage of Americans “don’t know how to social distance” or “aren’t very good at individual risk calculations.” Please. Please stop insulting humanity because we have a bunch of narcissists with the emotional intelligence of teenagers well into adulthood running around this country. I’ve seen similar excuses applied to climate change denial. “Oh people just aren’t good at big picture thinking, as a general rule.” No, Americans are culturally a huge problem.

    • Yes and no-agree that it is largely American culture problem – but there will always those who need to be spoon fed, and depending on your news source the messaging was quite different.
      Consistent clear messaging on how to asses the risk per categories would definitely help even now.
      Example-crowded bar, no masks-high risk for exposure.
      -walking on a trail without a mask-low risk for exposure.
      -hair cut with masks for all and limited clients in building -low to moderate risk. hair cut no masks/no limit on clients-high risk
      Stuff like that.
      And the press IMMEDIATELY calling out lies of “tests available every where any time”.
      CDC giving VERY clear and precise guidelines on how to count Covid cases, how to report covid cases and deaths DUE to Covid (NOT deaths from other causes and just happened to do a test and positive).
      Stopping the frequent misleading press reports on “89% of ICU BEDS FULL OMG!” failing to put into context NO COVID patients in ICU and only 45 in entire 500 bed facility (yes really)-drama fatigue I think is playing a large part in some of this 🙂

    • Yes, I agree that there is a systemic issue with ignorance and misinformation, particularly in some states more than others depending on their leaders, school systems, etc.

      However, people who feel inherently entitled to “fun” or rampant consumerism above all else will be the individuals easiest to manipulate with false facts or rhetoric.

      I also don’t know if I agree with you on “drama fatigue” either. If ICU beds are 89% full and only a percentage of those beds are taken by COVID patients, it still poses a serious problem to patients who need an ICU bed for other reasons (heart attacks, accidents, etc). The fact that you don’t understand this leads me to doubt your credibility.

  • I know you’re trying, but these “insights” into what coulda, shoulda are way more frustrating than helpful at this point, nearly 6 months into the pandemic. It does us no good to hear experts quoted as to what political leaders should be doing. Almost all of this information has been available for at least several months now.

    What would be helpful is advice, insight into what individuals, families, and communities can do for themselves. What data should we be looking at each day, week, or month, and where will we find it, to help us make informed decisions about our work, recreation, school, shopping, travel (during what’s left of the summer), etc.

    The mixed messaging and political backdrop is not going to change, until January 2021 at the earliest. Until then, we’re on our own. Some lessons on how to put out a dumpster fire when the fire department is not responding would be very welcome.

  • 1) The needless “dumpster fire” reference is unfortunate.
    2) The daily cheap testing should be at the top of the list IMHO because it is:
    – Now doable with current technology (see BD Veritor™ Plus Analyzer etc.)
    – Happening now in healthcare facilities
    – Powerful to wit: if the day started with ‘am I infected’ the hidden virus would be out in the open

    • It’s not approved by the FDA, but this BD test for COVID-19 is in-use! The unit cost $300 and a test is $20. Results in 15 minutes! Current MD testing is taking 4-5 WEEKS! You might as well dump the swabs in the trash unless results can be obtained in 1-2 days.

    • Joe: Jul 6, 2020 – FDA issued an EUA for a COVID-19 antigen diagnostic test, the BD (Becton Dickinson) Veritor System for Rapid Detection of … Coronavirus (COVID-19)

      Christi: Deep breath

  • I was speaking with a colleague regarding what are next steps could be. Many of the above were mentioned. thanks to whoever put this together. I believe this will be helpful to health care planners as they decide their next move.
    this offering is very nonpolitical

  • I’m very curious about daily home testing. I found $100-per-test tests available, but nothing close to $1. Is this something actually available?

    The reason I’m asking is that our school is planning to open with this fantasy that all families are careful (and they are not). I suggested testing all students before returning and they brushed me off. How much would it cost to test a few hundred students?

    I really and truly do not understand why the USA is dragging it’s feet on testing.

Comments are closed.