Scientists warned that the
United States someday would become the country hardest hit by the coronavirus
pandemic. That moment arrived on Thursday.
In the United States, at
least 81,321 people are known to have been infected with the coronavirus,
including more than 1,000 deaths — more cases than China, Italy or any other
country has seen, according to data gathered by The New York Times.
The Times is engaged in a
comprehensive effort to track the details of every confirmed case in the United
States, collecting information from federal, state and local officials.
With 330 million
residents, the United States is the world’s third most populous nation, meaning
it provides a vast pool of people who can potentially get Covid-19, the disease
caused by the virus.
And it is a sprawling,
cacophonous democracy, where states set their own policies and President Trump
has sent mixed messages about the scale of the danger and how to fight it,
ensuring there was no coherent, unified response to a grave public health
threat.
A series of missteps and
lost opportunities dogged the nation’s response.
Among them: a failure to
take the pandemic seriously even as it engulfed China, a deeply flawed effort
to provide broad testing for the virus that left the country blind to the
extent of the crisis, and a dire shortage of masks and protective gear to
protect doctors and nurses on the front lines, as well as ventilators to keep
the critically ill alive.
“This could have been
stopped by implementing testing and surveillance much earlier — for example,
when the first imported cases were identified,” said Angela Rasmussen, a
virologist at Columbia University in New York.
“If these are the cases
we’ve confirmed, how many cases are we still missing?” she added.
China’s leaders, stung by
the SARS epidemic in 2003 and several bird flu scares since then, were slow to
respond to the outbreak that began in the city of Wuhan, as local officials
suppressed news of the outbreak.
But China’s autocratic
government acted with ferocious intensity after the belated start, eventually
shutting down swaths of the country. Singapore, Taiwan, South Korea and Japan
quickly began preparing for the worst.
The United States instead
remained preoccupied with business as usual. Impeachment. Harvey Weinstein. Brexit and the Oscars.
Only a few virologists
recognized the threat for what it was. The virus was not influenza, but it had
the hallmarks of the 1918 Spanish flu: relatively low lethality, but
relentlessly transmissible.
Cellphone videos leaking
out of China showed what was happening as it spread in Wuhan: dead bodies on
hospital floors, doctors crying in frustration, rows of unattended coffins outside
the crematories.
What the cameras missed —
in part because Beijing made Western journalists’ lives difficult by
withholding visas and imposing quarantines — was the slow, relentless way
China’s public health system was hunting down the virus, case by case, cluster
by cluster, city by city.
For now, at least, China
has contained the coronavirus with draconian measures. But the pathogen had
embarked on a Grand Tour of most countries on Earth, with devastating epidemics
in Iran, Italy, France. More videos emerged of prostrate victims, exhausted
nurses and lines of coffins.
The United States, which
should have been ready, was not. This country has an unsurpassed medical system
supported by trillions of dollars from insurers, Medicare and Medicaid. Armies
of doctors transplant hearts and cure cancer.
The public health system,
limping along on local tax receipts, kills mosquitoes and traces the contacts
of people with sexually transmitted diseases. It has been outmatched by the
pandemic.
There was no Pentagon
ready to fight the war on this pandemic, no wartime draft law. There was
eventually a White House Coronavirus Task Force, but it has been led by
politicians, not medical experts.
The Centers for Disease
Control and Prevention is one of the great disease-detective agencies in the
world, and its doctors have contributed mightily in skirmishes against Ebola,
Zika and any number of other health threats.
But the agency retreated
into silence, its director, Dr. Robert Redfield, almost invisible — humbled by
a fiasco in the failure to produce basic diagnostic testing.
Now at least 160 million
Americans have been ordered to stay home in states from California to New York.
Schools are closed, often along with bars, restaurants and many other
businesses. Hospitals are coping with soaring numbers of patients in New York City,
even as supplies of essential protective gear and equipment dwindle.
Other hospitals, other
communities fear what may be coming.
“We are the new global
epicenter of the disease,” said Dr. Sara Keller, an infectious disease
specialist at Johns Hopkins Medicine.“Now, all we can do is to slow the
transmission as much as possible by hunkering down in our houses while, as a
country, we ramp up production of personal protective equipment, materials
needed for testing, and ventilators.”The world will be a different place when
the pandemic is over. India may surpass the United States as the country with
the most deaths. Like the United States, it, too, is a vast democracy with deep
internal divisions.
restarts, and be forced to
do it all again.
In the meantime, with the
virus loose in the streets while millions of Americans huddle indoors, when
will it be safe to come out and go back to work?
“The virus will tell us,”
said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt
University Medical School.
When a baseline of daily
testing is established across the country, a drop in the percentage of positive
tests will signal that the virus has found as many hosts as it can for the
moment, and is beginning to recede.
When hospital admissions
have hit a clear peak and begun to plateau, “we can feel optimistic,” Dr.
Schaffner said. “And when they begin to drop, we can begin to smile.”
That moment may arrive
this summer. But as soon as the first of Americans begin venturing cautiously
out, we will have to start planning for the second wave.