The tiny nation-state of Singapore had done a great job against the virus as has Taiwan and still they are examples to the world that any “win” is more coexistence with an enemy that never really leaves.
What does “winning” against a coronavirus mean? In the case of Covid-19 for now it means catching up, not eradication. When you catch up, then each case of someone who has it can be identified, the past contacts traced and isolated, and even if someone gets seriously ill or dies, it stops there, wherever “there” happens to be.
The US is nowhere near catching up.
Coronaviruses are curious entities, identified only in the 1970s as a family of RNA strands in little capsules of fat that, while rampant in the animal kingdom, only in a relatively few cases, seven to be exact, learns to duplicate itself in humans. Once it makes the jump it becomes a permanent resident, as former FDA Commissioner Scott Gottlieb has said, “In perpetuity.”
Those viruses are so small they can fly through a surgical mask as easily as a hummingbird flies through a redwood forest.
Someday, apparently not anytime soon, it will be neutralised by a vaccine. The vaccine will activate antibodies that keeps the virus from engulfing the body’s defences, but the virus will never disappear. Whether it’s called MERS, or SARS or 229E or NL63 or OC43 or HKU1 it will be here generations from now. There will likely be others as well, each with a separate profile of contagiousness and mortality.
Everyone will get a “flu shot” and it will be tailored for the main viruses and their likely seasonal variations and their presence will no longer be a crisis – until another one shows up that is more dangerous and insidious than the rest.
Vaccine generation will be perfected and their development will be accomplished faster and faster.
For now, however, back to Singapore. There, Covid-19 is still relatively rare, so that the Straits Times newspaper can profile each new victim. Persons who brushed up against the patient can be meticulously traced and they can be isolated. Yet with such a marvellously effective system, Covid-19 is not under control. Singapore is undergoing a “second wave” and just recorded its worst day for infections yet. Since that new record is only 142 cases, they are all being individually attacked and a serious new outbreak will be avoided. Until there is a vaccine, however, the defences will have to be on high alert. Otherwise there will be a third wave, a fourth wave and so on.
Contrast that with the vastly larger United States where the first wave is causing several hundred deaths a day, where the delay in testing, the delay in development antibody assays, have triggered a brute-force engineered shutdown of the economy, of daily life.
Testing is spotty, a total of 1.9 million tests done which is about one in every 172 Americans. As the Coronavirus Task Force’s Deborah Birx said in Wednesday night’s briefing – with some frustration since it was second time she’s brought it up – only 88,000 of those tests have been done using Abbott Lab’s processing system. It produces results in minutes. The processing machines, more than 18,000 of them. are everywhere.
Hospital administrators, laboratory technicians, it seems, are creatures of habit, used to the old slow way. Until testing speeds up there is little hope of catching up, of eventually corralling new cases and tracking down their contacts, hitting the virus case by case. Birx was preparing to issue a more direct appeal to leave those old ingrained practices behind on a conference call later Wednesday night.
With that as context, will those elements of fast testing, antibody assays, contact tracing be in place in the United States in 22 days, when the “30-day” guidance runs out? Of course not, so the myth of any relaxation of the guidelines as soon as April 30, or probably as soon May 30 and perhaps June 30 is just that, a virus myth.
Reopening the economy as soon as May would guarantee a second wave and not a small one. Eventually, when all the elements of control are finally present, the virus will be fenced in to some extent, but there will still be a base level of infections and deaths. Hopefully a whole lot less than this week’s toll.
So far the total US deaths will be passing 15,000 a few hours from writing, soon, perhaps this week, the total will become the worst in the world, having passed both Italy and Spain.
The next myth, of turning the economy back on like it has a big on-off switch, is probably assumed by nearly no one who has been paying attention. When President Trump said Wednesday night, “It would be nice to open with a big bang, or most of the country” he had said, “We have to be on the downslope.”
As Singapore and other places show, the downslope is easily turned back into an upslope. Rigorous mitigation – more rigorous than any of the experts thought was achievable in the United States – is the only thing now standing in the way of the virus and it’s a fragile line of mitigation defence, many weeks and maybe months away from containment.
It will take all the other elements of control to claw back the virus spread to a containment phase that has never been possible in New York, New Jersey, Connecticut, Chicago, Detroit, New Orleans, Los Angeles and then all the other places just beginning their battle, like Philadelphia and Denver.
The American economy is a very complicated mechanism, made up of individuals who have to decide whether it’s safe; of multiple layers of finance and retail and wholesale markets that have to weather the storm of defaults and bankruptcies; of hundreds of thousands of business owners slammed into paralysis by the purposeful and calculated destruction of demand; and of all the wage earners and workers who must get back on the bus and subway, in carpools and truck cabs.
The seniors and everyone with underlying medical conditions will still be seniors and will still be vulnerable after April 30. They will still need protection through the summer and into the fall.
Trillions of dollars of support are being dumped into the hole that used to be this economy. The small-business support program – an untested effort to keep people on payrolls – is already being replenished with another $250 billion.
As a sidenote, Senate Republican Leader Mitch McConnell warned Wednesday it won’t be that easy – maybe impossible – to do that stay-at-home voice vote in his chamber and the House as soon as this week. No matter, the Treasury Department will have to go back to Congress again and again to hold things even partially in place so some part of it is still there when the time comes.
Hopes abound and eventually hope will win out against Covid-19. Historians can say there is on average another pandemic every 25 years and medical science will get more and more competent.
But by April 30? June 30?