I’ve been speaking to epidemiologists about their best- and worst-case scenarios to gauge what may lie ahead and see how we can tilt the balance. Let me start with the best case, since we could all use a dose of hope — which may even be therapeutic — before presenting a bleaker prognosis.
“The best case is that the virus mutates and actually dies out,” said Dr. Larry Brilliant, an epidemiologist who as a young doctor was part of the fight to eradicate smallpox. Brilliant was a consultant for the movie “Contagion,” in which a virus evolved to become more deadly, but that’s the exception. “Only in movies do viruses seem to become worse,” he explained.
Two other lethal coronaviruses, SARS and MERS, both petered out, and that is possible here. “My hope is that COVID-19 will not survive,” said Dr. Charles G. Prober, a professor at Stanford Medical School.
Several countries have shown that decisive action can turn the tide on COVID-19, at least for a time. China, astonishingly, on Thursday reported not a single new case of domestic transmission. While China is still vulnerable to a second wave, it has apparently shown that the virus can be squelched.
The West isn’t going to copy the coercive tactics of China, but Singapore, Taiwan, South Korea and Hong Kong have also demonstrated that, at least temporarily, the virus can be controlled.
The weather may also help us. Some respiratory viruses decline in summer from a combination of higher temperatures and people not being huddled together, so it is possible that Northern Hemisphere nations will enjoy a summer break before a second wave in the fall. That’s what happened during the 1918 Spanish flu pandemic: It hit in the spring of 1918, went away but returned worse than ever in the fall.
Of the four coronaviruses that cause the common cold, two diminish in warm weather, while two are more variable. SARS and MERS did not have clear seasonal variations, and even seasonal flu is transmitted in the summer, although less than in winter. So while experts hope that hot weather will shortly bring a reprieve from the coronavirus — the flu is already on the retreat — there’s no solid evidence.
One reason for measured optimism is the prospect that antiviral medicines will beat the coronavirus; some are already in clinical trials. Scientists have hopes for remdesivir, originally developed for Ebola; chloroquine, an old anti-malaria drug; and some anti-HIV and immune-boosting drugs. Many other drugs are also lined up for trials.
Even without proven treatment, the coronavirus may be less lethal than was originally feared, so long as health care systems are not overwhelmed. In South Korea and in China outside Hubei Province, about 0.8% of those known to be infected died, and the rate was 0.6% on a cruise ship.
So that’s the best case, and it’s plausible. If you want to feel upbeat, stop reading here.
The nightmare is a surge that overwhelms the hospital system. A colleague, Stuart A. Thompson, and I worked with two epidemiologists to develop an interactive model of the virus that suggested that up to 366,000 ICU beds might be needed in the United States for coronavirus patients at one time, more than 10 times the number available. A Harvard study reached a similar conclusion.
Severe shortage of supplies
This is an interval of quiet when the United States should be urgently ramping up investment in vaccines and therapies, addressing the severe shortages of medical supplies and equipment, and giving retired physicians and military medics legal authority to practice in a crisis.
During World War II, the Ford Motor Company turned out one B-24 bomber every 63 minutes; today, we should be rushing out ventilators and face masks, but there’s nothing like the same sense of urgency.
The optimal path forward is to hope for the best while preparing for the worst. Outcomes depend in part on us — and my conversations with experts leave me concerned that we still are not doing enough.
“If anything, we’re still underreacting,” said Dr. Chaz Langelier, an expert on respiratory infections at the University of California at San Francisco. “In the last week, in terms of public health response and testing, we’ve maybe gotten to the pace we should have been at a month ago.”
This crisis should be a wake-up call to address long-term vulnerabilities. That means providing universal health coverage and paid sick leave — and if you think that the coronavirus legislation Trump signed on Wednesday achieves that, think again. It guarantees sick leave to only about one-fifth of private-sector workers. It’s a symbol of the inadequacy of America’s preparedness.
Health priorities
More broadly, the United States must remedy its health priorities: We pour resources into clinical medicine but neglect public health. What’s the difference? If you get lung cancer, surgeons operate to save your life, but public health professionals keep you from smoking in the first place.
If you get the coronavirus, a doctor will treat you; public health aims to keep the pandemic from getting near you. The United States has a decentralised and spotty public health system, and it has endured painful budget cuts, yet historically public health has saved more lives than clinical medicine.
We may dodge a bullet this time, but experts have been warning for decades that a killer pandemic will come; typically, they expected an avian flu like the 1918 pandemic rather than a coronavirus.
Singapore and South Korea did well this time partly because they had been frightened by SARS and MERS and were vigilant; if we, too, can be scared enough to invest in public health and fix our health care system, then something good can come from this crisis — and in the long run, that may save lives.
The Big One is approaching, whether now or later, whether we’re prepared or not. Ferguson, the infectious disease modeller who predicted deaths in the United States might reach 2.2 million, came down with a cough and fever a few days ago. He tested positive for the coronavirus.
Nicholas Kristof is an American journalist, author and a winner of two Pulitzer Prizes
—NYT