What America needs to do before lockdown can end
Most of the world outside the United States has reached the end of the beginning of the novel coronavirus pandemic. New confirmed infections and deaths have plateaued and are beginning to fall in some of the hardest-hit countries like Italy and Spain, and Germany is beginning to draw up plans for re-starting its economy. (It seems that only Brazil, with its crackpot far-right president Jair Bolsonaro, is failing as badly as the U.S., with perhaps the U.K. in a close second.)
We're beginning to see a glimmering of what it will take to be able to restore some semblance of normal life. Countries will need to keep a "test and track" apparatus going, and they will need to be ready to reimpose lockdown measures on a moment's notice. Unfortunately, there is no sign whatsoever that the U.S. government is even thinking about what will be required, much less actually preparing to make it happen.
The German plan will include "mandatory mask-wearing in public, limits on gatherings and the rapid tracing of infection chains," Reuters reports. The idea is to allow people to leave their homes, and use testing and tracking to "make it possible to track more than 80 percent of people with whom an infected person had contact within 24 hours of diagnosis." Anybody with the disease will be quarantined, along with anyone they had contact with. If all goes well, the rate of new infections will be low enough that the pandemic will eventually fizzle out.
Now, this is a dangerous thing to attempt, because relaxing lockdown measures recreates the conditions that allowed the virus to spread in the first place. Even the Asian countries like Singapore, Hong Kong, and South Korea which were able to initially squelch their outbreaks have been forced to reinstate controls when new small outbreaks were seeded by international travelers.
But the German government likely does have the bureaucratic competence necessary to keep track of the virus. Germany has been slammed by the virus, with over 100,000 confirmed cases, but its death rate is far less than similarly-afflicted countries like Italy and Spain. One reason is that, as Katrin Bennhold writes at The New York Times, the German government has coordinated an excellent medical response. It has a robust hospital and insurance system, secured big stockpiles of medical supplies, ramped up testing, tracking, and quarantine systems very quickly (learning from South Korea), and deployed "corona taxis" where medics check in on infected patients at home to see if they were likely to need hospitalization — making it much more likely they will survive.
For countries looking to emulate the German example, it will probably be necessary to keep some measures like universal mask-wearing in place not just for the next month, but for as long as it takes to develop a vaccine, as well as limits on international travel. For instance, the World Health Organization might certify nations as coronavirus free when they have had no diagnosed cases for a month and broad statistical sampling finds no cases in the wild, in which case their citizens could travel to other clean nations mostly normally. Anyone coming from infected countries would have to travel wearing full-body protective gear, be tested before and after arriving, and be quarantined for two weeks when they arrive. (Airline pilots and flight attendants would also have to take special precautions.)
The United States, unfortunately, is not even considering German-style steps. We are not testing at remotely their scale, our hospitals are being overwhelmed, and still the federal government is refusing to coordinate the purchase of medical supplies. Indeed, in a sane world it would be coordinating not just with American states but with other countries as well; instead President Trump is interfering with blue states in their attempts to get masks and ventilators. Massachusetts governor Charlie Baker (a Republican) had to send out a New England Patriots jet to snag 1.2 million N95 masks from China.
More importantly, the test-and-track strategy requires a big, expensive surveillance apparatus to monitor people's movements and contacts. You need to test anyone with symptoms as well as the broader population, quarantine anyone who tests positive, and then quarantine anyone who has been in contact with a positive case. Investigators need to be fast and accurate: If they stay on top of things, then small outbreaks can be nipped in the bud, but a single missed contact can lead to a super-spreader event that creates hundreds of new cases.
In the best of times, the American government would surely struggle to implement anything like this. Today we basically do not have a national government. Under Trump, it "has essentially abdicated its traditional role of spearheading a coordinated response," Matt Yglesias writes at Vox. It has fallen to states and city governments to do what they see fit, but even the ones who are taking the crisis seriously have neither the resources nor the power to set up a testing and contact-tracing system across the whole country.
And it's not just Trump, either. No national leader is even talking about testing and tracking in a serious way — not Mitch McConnell, not Chuck Schumer, and not Nancy Pelosi. With Congress unbelievably still in recess, and neither legislative branch willing to set up a remote voting system, Congress has prevented itself from even suggesting such policies until April 20 — which may not even be possible if too many members get infected. Nor is likely Democratic presidential nominee Joe Biden talking about it; his coronavirus response plan has a lot of good ideas but nothing about a huge nationwide virus-tracking system that would help us transition out of the crisis.
So long as Donald Trump remains in office, the Republican Party remains in his thrall, and Democrats remain utterly feckless, the only way to safely reopen American society will be to wait for a vaccine, or wait until enough people have recovered from the virus that herd immunity causes the pandemic to fizzle out. Either option will probably take more than a year, the latter could have a death toll in the millions.
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