How bad could the Coronavirus get in the US? I asked an expert.

“We’re beyond containment now.”

As the Covid-19 coronavirus spreads across the US, the government’s response has officially shifted from containment to mitigation.

In short, that means our hope of stopping the disease in its tracks has ended. Our main goal now is to prevent a huge spike in cases, or “flatten the curve.” There was, perhaps, a window of time in which a sweeping, coordinated response — at the national and local level — might have dramatically limited the scope of this crisis. That did not happen, and now we must deal with the reality of a serious epidemic.

If that wasn’t bad enough, the US is also lurching into this crisis with an administration that is totally ill-prepared for the moment. It’s extremely worrisome that the president has glibly tweeted misinformation about the coronavirus — and dismissed news of it as a “hoax” — in the midst of an outbreak. (He did, however, finally strike a sober tone in his Oval Office address on March 11.)

To get some clarity on the situation, I reached out to Amesh Adalja, an infectious disease specialist at Johns Hopkins University. I wanted to know how dire the situation is right now, how bad we can expect things to get, what we’ve done right and wrong so far in our response, and if we’re prepared for what comes next.

A lightly edited transcript of our conversation follows.

Sean Illing

How dire is the situation right now from your vantage point?

Amesh Adalja

Right now, we’re at a critical inflection point. We’re in a pandemic, but we don’t yet have our hospital inundated with patients. We have a lot of recommendations going out there in an attempt to “flatten the curve” through aggressive social distancing measures.

I think this is the time where we absolutely have to get our hospitals ready; it’s past time, really, but we’ve got to move as quickly as possible. As the number of cases explodes, we’re going to increasingly reckon with the reality that this virus is not going to spare the US.

I don’t think that things are dire right now, but there’s going to be immense disruption and suffering and we’ve got to be ready for that.

Sean Illing

Can our hospital system handle the inevitable explosion of cases that’s coming?

Amesh Adalja

There are some hospitals that are more or less prepared, and there are others, like smaller rural hospitals without sufficient ICU beds, that are really going to be strained. But even the bigger hospitals in major metropolitan areas are going to be taxed and will have to be creative in terms of how they deal with bed space. They’ll need to expand their capacities by converting other parts of the hospitals into makeshift ICUs.

Everyone needs to prepare for the worst-case scenario right now.

Sean Illing

What is the worst-case scenario?

Amesh Adalja

I think the worst-case scenario is probably a 1 percent case fatality ratio with a lot of critically ill patients that need to be admitted to the ICU, and the majority of our ICU beds are already occupied. [Vox’s Julia Belluz explained why it’s so hard to pin down the death rate for Covid-19.] So the worst-case scenario is that we start running out of ICU beds and we start running short on mechanical ventilators and then we have to make hard decisions about how to optimize the scarce resources that we have.

I hope that we don’t get to that point, but we have to prepare for it.

Sean Illing

To be clear, a 1 percent case fatality ratio sounds like a low number, but we’re talking about a staggering number of casualties here.

Amesh Adalja

Yes, it will be substantially higher than a really severe flu season, perhaps as much as 10 times worse.

Sean Illing

And what does that mean exactly?

Amesh Adalja

In our worst flu season without a pandemic, in 2017, we had about 80,000 American deaths. We’re talking about 10 times more than that.

Sean Illing

That’s 800,000 deaths.

Amesh Adalja

Yes. Again, this is what I’d consider the most realistic worst-case scenario. Let’s hope this doesn’t happen, but we have to prepare for it.

Sean Illing

Scott Gottlieb, the former commissioner of the FDA, tweeted that we face two paths forward: the path of South Korea or the path of Italy. South Korea appears to have reversed the outbreak, while the situation in Italy has deteriorated rapidly.

Have we lost our chance to replicate South Korea’s success?

Amesh Adalja

One thing that gives me hope is that we don’t hear reports right now of ICUs being overwhelmed with patients. We know that this has been spreading here since at least January, so that’s a somewhat encouraging sign. But the situation is highly fluid and can turn quickly. For now, though, I wouldn’t quite go that far.

Sean Illing

My understanding is that South Korea has tested nearly 140,000 people for coronavirus so far. The US, by contrast, has tested less than 9,000 people. Can we make up the ground we’ve lost?

Amesh Adalja

I do think that we have the capacity to make up that loss as soon as we get more test kits out there.

Sean Illing

What went wrong here? Why has our testing capacity been so limited compared to other countries?

Amesh Adalja

In general, what happens in public health emergencies is that early testing is done by government health labs. From the beginning, we knew this was going to be more than a travel-related illness. But the initial guidance from the government was to just test people from China — that was a mistake.

This was always going be a much bigger problem, and that should have been anticipated from the start. But because of the way this virus was narrowly classified, that made it harder for big labs and state health departments to make their own tests; they had to use the CDC kit, which required a regulatory fix and involved a ton of red tape.

All of this cost us badly needed time.

Sean Illing

Based on what I’m hearing from you, it does not seem like the federal government is prioritizing the right things. For instance, President Trump just suspended all travel from Europe (excepting the UK) for 30 days. Is that a good idea? Will it help to reduce the risk in any meaningful way?

Amesh Adalja

No, I don’t think the travel ban will have any substantial impact on the spread of this virus. We have undiagnosed cases here already. We have undiagnosed, unrecognized chains of transmission already in the US. This is what’s fueling the virus, not travel from Europe or anywhere else.

Sean Illing

What should the federal government be doing now that it isn’t currently doing?

Amesh Adalja

We need to move away from this idea that this is a travel-related illness. We need to move away from these containment measures. All of this is taking vital resources away from efforts to find new cases and isolate them, and doing more diagnostic testing and implementing more social distancing measures.

We’re beyond containment now. This is about slowing the inevitable advance of the virus.

Sean Illing

Do you believe that we’re prepared for what’s coming?

Amesh Adalja

I don’t think the country, as a whole, is prepared. I think the diagnostic testing deficiencies is a good example of that. We’re behind the eight-ball on this already.

Sean Illing

Is there a message you think isn’t getting to vulnerable populations that they need to hear?

Amesh Adalja

I think it’s very important for vulnerable populations to be cognizant of the risks that they face, to try and evaluate their lives, and cut out as much nonessential social contact as possible until we get this thing under control. This is how we will save lives.

Reference Link:
https://www.vox.com/2020/3/12/21171505/coronavirus-covid-19-outbreak-containment