At least two Americans will die of covid-19 in the time it takes to read this op-ed. The mortality rate is climbing in 13 states as infections rise in more than 30 states.

As the pandemic surges, policymakers are asking how they can stop this explosive spread. I see three scenarios for what happens next:

1. Status quo. Texas, Florida and Arizona are among the states already on the brink of overwhelming their health-care systems. More and more intensive-care units will reach and exceed capacity. Arizona has already implemented “crisis standards of care” to ration its increasingly scarce resources.

Policymakers have instituted some mitigation measures, but most are too little, too late. Arizona bars are closed, but not restaurants. Some counties in Florida are requiring masks, but the governor refuses to issue a statewide mandate. Politicians are pushing for in-person schooling to begin next month even as test positivity approaches 20 percent there and results take up to two weeks. If schools reopen in this hotbed of infections, outbreaks will quickly mushroom and sicken students, teachers and their families.

There will be a breaking point. Perhaps it will come when patients can’t access non-coronavirus health services: when women in labor or heart attack patients are turned away from ERs. In the meantime, the United States is on track to surpass 200,000 deaths by the fall. By then, out-of-control spread is estimated to leave nearly 1 in 4 Americans unemployed.

2. Full shutdown. A full shutdown would mean that everyone in the entire country stays at home for four to six weeks. Those already infected would spread the virus only to their immediate households. If no one has additional contacts, we collectively starve the virus and stop transmission.

I know what you’re thinking: Didn’t we try that already, back in March? Some states did, and it worked: The New York region is a case in point. But only half the states had full stay-at-home orders at the end of March. Many states began loosening restrictions even as infection rates there climbed. At best, the United States “flattened the curve,” with roughly 17,000 daily infections as our lowest point. Contrast that with Germany, Australia, South Korea and many other countries that crushed their curves and brought their case counts essentially to zero. That’s how these other countries have resumed most parts of pre-pandemic life. Their schools opened with few outbreaks; businesses are back; and large-scale events such as concerts are beginning to safely take place.

There is an argument for a do-over — but this time, we all do it and we do it right. “The idea of a hard shutdown should be on the table,” says Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services. “It would be more difficult and disruptive, but the short-term pain could bring the economy back more quickly.” An added benefit: If we were to reduce cases that much, we would have enough testing and contact tracing when reopening.

3. Whack-a-mole. However effective a full shutdown would be, many would say it’s too impractical. Some believe it may not be necessary. As Harvard global health professor Ashish Jha explains, “We can take a more targeted approach than we did in March; we don’t need to shut down the places that are doing well.” States facing the most dire conditions will need some version of stay-at-home orders until they hit specific goals, such as test positivity rates below 5 percent, results returned in less than 48 hours and sustained downward trends in infections for 14 days. Others trending in the wrong direction must reinstitute some restrictions until they can meet these metrics, too.

Would this approach be sufficient? Perhaps, though the rebound that follows reopening would be much more rapid than with “full shutdown” since cases would not be fully suppressed. Problems of inadequate testing and tracing are almost certain to recur. There is also no evidence from other countries that such a piecemeal approach would work. Some states could get their infections under control but experience surges as a result of interstate travel. And even if political will exists to close businesses (and to offer necessary support for small businesses and employees), there will again be tremendous pressure to reopen before doing so is safe.

So which scenario will it be?

“This is America’s third strike,” says professor and epidemiologist Michael Osterholm of the University of Minnesota. First, the country wasn’t prepared for a pandemic. Next, the U.S. response was far from adequate — and we still lack a national strategy.

Decision time has arrived. Is the specter of “status quo” bad enough to force an urgent course correction, or will complacency continue until death hits home for more families? It would take a lot to switch to “whack-a-mole” — and a “full lockdown” would save even more lives. Either way, we need to muster our collective willpower if we are to stop the death toll and destruction of covid-19.

Even as the number of U.S. coronavirus cases passes 3 million, President Trump has repeatedly played down covid-19’s toll on the country. (The Washington Post)

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