TheEconomistMarch 14th 2020 171W
hen a newdisease first took hold in
Wuhan, the Chinese authorities did
not have the luxury of advanced notice.
Their initial strategy, in the crucial early
weeks of what would become the global
pandemic covid-19, was obfuscation and
censorship, which did nothing to halt the
spread of the virus that causes the disease.
Only now, months after the first cases were
reported, have new transmissions slowed
to close to zero—and only after an unprece-
dented, draconian lockdown for hundreds
of millions of citizens.
America, by contrast, had the luxury of
several weeks’ notice. Yet the crucial early
weeks when it could have prepared for the
spread of the disease were squandered, in a
country with some of the world’s best epi-
demiologists and physicians. As of March
11th, almost 1,300 Americans had been diag-
nosed with covid-19. Several times more
probably have the disease undetected and
are transmitting it within communities.
And still the country looks behind in its
preparations for what now threatens to be abruising pandemic.
America’s decentralised authority, ex-
pensive health care and skimpy safety-net
will all make the pandemic response hard-
er to deal with. The uncertainty is high, but
a plausible scenario—one-fifth of the pop-
ulation falling ill, and a 0.5% fatality rate—
would lead to 327,000 deaths, or nine times
that of a typical flu season.
How America got here was the result of
two significant failures—one technical,
the other of messaging. A country of Amer-
ica’s size could probably not have avoided a
serious outbreak of covid-19. But with
enough information, the early spread of
the disease could have been slowed. That
lowers the peak of the outbreak, lightening
the load on hospitals when they are most
overstretched, thereby saving lives. It also
gives the health service and the govern-
ment time to prepare, and the population a
chance to learn how to respond.
However, in America the testing regime
has worked badly, because of faulty test-
kits manufactured by the Centres for Dis-ease Control and Prevention (cdc) and tan-
gles in administrative red tape between the
cdcand the Food and Drug Administration
(fda), another government agency. “The
debacle with the tests probably reflects un-
derlying budget cuts. You can’t have surge
capacity if you’ve already been cut to the
bone,” says Scott Burris, director of the
Centre of Public Health Law Research at
Temple University. In 2010 the cdc budget
was $12.7bn in current dollars; today it is
$8bn. Whether skimpy budgeting, bureau-
cratic blockages or both were to blame is as
yet unclear and sure to be the subject of a
future investigation.
When there are just a few infections, the
health system has enough epidemiologists
to track down and quarantine patients and
their recent contacts. Without surveil-
lance, however, small clusters rapidly be-
come full-blown epidemics. This is where
America finds itself today. The estimated
doubling time of the virus is six days. If that
remains constant, as is likely, the close-
to-1,300 current cases are the bottom of a
sickening ride up an exponential curve of
infections. “In literal terms, we have no
idea about the number of cases because no-
body has tested to any meaningful extent,”
says Marc Lipsitch, a professor of epidemi-
ology at Harvard. “Tens of thousands of
cases in the usseems plausible,” he adds.
A successful testing regime also buys
time for the right messaging. But from the
start, President Donald Trump has down-Public healthDropping the ball
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