TheEconomistMarch 21st 2020 231T
he titularconceit of “28 Days Later”,
as with many contagion-style horror
films, is of a man waking up after a month-
long coma only to find society upended by
a rampaging virus. Many Americans are ex-
periencing something similar. On March
3rd there were just 122 confirmed cases of
covid-19—the disease currently sweeping
the world—and only seven deaths. By
March 17th there were 7,786 confirmed
cases (even these were a sure underesti-
mate given the dearth of testing) and 118
deaths. Twenty-eight days later, on March
31st, what might America look like?
“We don’t know whether we’re going to
look like Italy or the provinces outside Hu-
bei” in China where the spread of covid-19
was fairly effectively contained, says David
Blumenthal, president of the Common-
wealth Fund, a health-policy think-tank.
“But the likelihood is—given the slowness
with which we responded to the epidem-
ic—that we look more like Italy,” he adds.
Jerome Adams, the surgeon-general, has
warned of the same.
Can America’s health system cope? The
structural problems that make pandemic
response more difficult—lack of paid sick
pay, a large uninsured population and a
significant number of insured people
nonetheless worried about out-of-pocket
medical bills—cannot be mended over-
night. Instead, public-health experts and
doctors are increasingly worried about
sheer capacity constraints. In China, 5% of
those diagnosed needed intensive care.
There are roughly 97,000 beds in intensive
care units (icus), of which one-third are
empty. Though America has relatively few
total hospital beds per person compared
with other countries, it ranks among thehighest for icubeds per person, with near-
ly three times as many as Italy.
“The real limiting factors are likely to be
the ventilators or the staff,” says Greg Mar-
tin, a professor of medicine at Emory Uni-
versity and president-elect of the Society of
Critical Care Medicine. There are roughly
50,000 physicians trained in critical care
and 34,000 similarly specialised nurses
and assistants. This could be insufficient
in the face of hundreds of thousands of
cases at peak rates of infection.
Then there is the problem of kit. In Chi-
na, half of those in critical care required the
use of ventilators, machines that help peo-
ple breathe. There are thought to be 62,000
full-featured mechanical ventilators in the
country, many of which are already in use
(see Business). Older stocks of perhaps
100,000 devices—including cpap ma-
chines used for those with sleep apnea—
could be called upon if needed, but would
provide only basic functions. Ramp-ups in
ventilator production are being pondered,
including through emergency powers giv-
en to the president under the Defence Pro-
duction Act of 1950, but there has been little
actual action yet. On a phone call with state
governors, President Donald Trump urged
“respirators, ventilators, all of the equip-
ment—try getting it yourselves”, which
could spark an unhelpful competition be-
tween states for scarce resources.
“Under almost any basic scenario,
things look tough. Hospital beds will be
completely full many times over if we don’tResponding to covid-19
In sickness, not in health
WASHINGTON, DC
American life has been transformed in a few short weeks. The next few will be
even tougher
United States
24 The 2020 populationcount
25 TheDemocraticprimary
26 Gay,ruralfamilies
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28 Lexington: Pandemic polarisationAlso in this section