These achievements will be too late.
Our brains are not wired to easily comprehend geometric growth. Epidemic waves grow slowly at first but progress to massive acceleration and momentum. On the present trajectory, before we inaugurate a new president and before we deploy vaccines, the United States will experience unprecedented trauma from the coronavirus. Anthony S. Fauci, the nation’s top infectious disease expert, may understate the problem when he says, “We’re in for a whole lot of hurt.”
In many Midwestern states, covid-19 cases and hospitalizations are doubling every 14 to 21 days — or faster. The probable and tragic reality is that much of the rest of the United States is on the same path. U.S. cases rose by more than 34 percent in the past week, and the United States surged past 120,000 confirmed coronavirus cases per day. On the present course, by Inauguration Day we can expect to see 400,000 Americans infected each day, a rate equal to that recently experienced in Belgium and the Czech Republic. Even with the lower fatality rates witnessed over the summer, such increases could result in deaths on a scale not seen since the 1918 influenza pandemic.
The United States cannot afford to repeat the slow and ill-coordinated response we saw in the spring. Delay will result in unnecessary sickness and death now and financial loss later, when the spread will inevitably trigger panic, hobble the economy and strain hospitals beyond capacity. Without course correction, over the coming months health-care workers, themselves vulnerable, will face stresses beyond any they have experienced since the pandemic began. Our ability to care for covid-19 patients will deteriorate, as will treatments for heart attacks, appendicitis, injuries and the other maladies that compete for limited hospital beds.
The key words in this dire prognosis are “on the present course.” We must disrupt this momentum now. Interventions delayed until 2021 will come too late.
The president-elect and his team must assume a leadership role over the next days. That role entails working with governors, local officials and private businesses to initiate as broad a national strategy as possible for emergency actions. This is, of course, a tall order. It will help if leaders in the executive branch, pressed by public opinion, join the effort. To succeed, the president-elect must use the power of his bully pulpit to outline and advocate for imperative actions.
In the near term, those actions need not be comprehensive. Increased testing, contact tracing, isolation and quarantine, more personal protective equipment, and other interventions are important, but they will not address the immediate challenges of the surge. In addition, they require spending authority and complicated logistical improvements.
What must be urgently targeted are the conditions that are most conducive to super-spreading events — the most important force driving the epidemic wave. Multiple epidemiological studies have shown that gatherings of more than 10 persons, close contact in confined spaces, prolonged contact and contact without face masks pose the highest risk.
As a foundation for emergency response actions, the emphasis should be on three interventions, executed in concert, in any region with case counts over 20 per 100,000 persons per day. These are to temporarily 1) restrict all indoor gatherings of adults to no more than 10 people; 2) close indoor restaurants, bars and clubs; and 3) mandate universal mask-wearing in public.
These steps will not eradicate the coronavirus. But by reducing super-spreading events, they could reverse the present trajectory of community transmission, halving (or better) the growth rate between now and Inauguration Day, and buying time for additional interventions and vaccines.
Such a plan would require sacrifices, but the president-elect and Congress could alleviate the necessary pain by subsidizing affected businesses in a targeted way as part of a coronavirus relief act. Without that assistance, the practical economic needs of affected individuals will compete with the collective needs of the public health.
We should emphasize what is not being asked. This plan would not require a national “lockdown” of workplaces, mass transportation or most economic activities. Schools would be asked to reduce density, require masks, employ hybrid learning models and practice sufficient distancing. Temporary school closures should be reserved for only those communities experiencing the most severe outbreaks.
Leadership cannot await Inauguration Day. Delay will multiply the magnitude of the problem, damage to our economy and our health-care system, suffering, fear and loss of life. Seventy days from now is too late for transition.