24 United States The EconomistMarch 21st 2020
21substantially spread the load,” warns Ash-
ish Jha, director of the Global Health Insti-
tute at Harvard. To head that off, Mr Jha has
called for an Italy-style national quaran-
tine, lasting for at least two weeks, in which
all non-essential businesses are closed and
gatherings of more than five people are
barred to give time for testing to become
widespread. After a dismally slow start to
testing, the numbers are finally heading
up—although the best estimates come not
from public-health agencies, but volunteer
trackers using a Google sheet—to an esti-
mated 12,535 tests conducted on March
17th. Given the expected scope of the dis-
ease, and the reported obstacles to people
with symptoms actually getting tested,
much more will be needed.
Most hospitals are making contingency
plans. There are plans to add physical beds
by cancelling elective surgeries that can be
postponed, converting recovery rooms
into added beds and building tents to
house some patients. The Cleveland Clinic,
a prominent hospital, says it has plans in
place to add 1,000 beds of capacity within
72 hours if needed. Teams of doctors and
nurses with other specialities could be
conscripted into critical-care work, super-
vised by critical-care doctors who handle
the trickiest cases—like respiratory dis-
tress coupled with organ failure in the kid-
neys or heart. If this is insufficient, recent-
ly retired doctors could be drafted into
service. Some teaching hospitals are using
simulation centres to prepare medical staff
for the inevitable surge in cases.Testing? Testing?
Whether it will come to all this is still un-
clear. Testing capacity remains con-
strained, limiting the information epide-
miologists have to feed both their models
and their willingness to speculate. Their
policy recommendations—social distanc-
ing, closure of schools and large gather-
ings—are nevertheless clear. One team of
researchers has concluded that an epidem-
ic resembling that of Wuhan, where the
novel coronavirus first broke out, would
overwhelm hospitals many times over,
while one resembling Guangzhou, a city
that locked down in the early days of the vi-
rus, could be dealt with.
On March 16th, however, a team of sci-
entists based at Imperial College London,
who have been advising the British govern-
ment, also published forecasts of the epi-
demic’s trajectory in America. As with Brit-
ain, the figures look grim. Without any
mitigation, America would experience
2.2m deaths, they predict (see Briefing).
Even in the case of some mitigation—isola-
tion of the sick, social distancing for the el-
derly, but an otherwise normal society—
American hospital and icucapacity would
be exceeded eight times over, and the coun-
try would be on track for at least 1.1mdeaths. Averting this through “suppres-
sion”—isolation of sick, closing of schools
and universities, social distancing for
everyone—would require months until
therapeutics or vaccines can be developed.
America is therefore turning towards
suppression of the virus. Millions of pupils
and university students have been sent
home and left to take classes online. Mr
Trump has advised that people not congre-
gate in gatherings of more than ten people.
San Francisco and surrounding counties
have issued a “shelter-in-place” order that
requires 7m to remain in their homes un-
less necessary. New York City is expected to
do the same for its 8m residents. In 22
states, bars and restaurants have been or-
dered to close their seating and only serve
takeaway. The state of New York is setting
up drive-through testing centres, starting
in New Rochelle, a commuter town in
Westchester County that was one of the
early sites of a covid-19 cluster, and is urg-
ing federal troops to build emergency, tem-
porary hospital facilities. New Rochelle’s
mayor says he is surviving the lockdown
there on “adrenalin, coffee and m&ms”.
The goal is to increase general hospital
capacity by a factor of two and icucapacity
by a factor of ten within two months. Elec-
tions have been postponed in a few states
for the Democratic primary, which now
seems a dull, distant affair. America’s de-
volved system means that the shuttering
will happen at different rates in different
places, but the trajectory is clear. “You want
a single national response. But when the
federal government completely fails, as it
has so far, then you can get states and cities
to step up,” says Mr Jha.
The question is how long this can go on
for. Unmitigated, the epidemic would not
peak for at least another three months.
Suppression can reduce the spread of the
disease, as China’s experiment with lock-
ing down most of its population showed,
but relaxing these measures will inevitably
bring another surge in cases. Mr Trump,
who a few weeks ago was suggesting the vi-
rus was the latest hoax invented to damage
him, is now warning that this could be the
start of a months-long reorientation in
American life. And while these extraordi-
nary actions should smother the disease,
they will also smother the economy.
The dismal economic forecasts will re-
quire further action from Congress. It
spent the last week haggling over a bill that
would make testing for the disease free, in-
crease the flow of safety-net benefits and
grant paid sick leave to more workers
(though this provision appears to be hol-
lowing out with every iteration). Even be-
fore that bill was finalised, Washington’s
attention had already turned to the even
bigger economic stimulus package that
must come next. Senators, both Democrats
and Republicans, are tripping over them-selves issuing plans to send cash directly to
American families.
The total package, which could be worth
$1trn or more, dwarfs the $100bn-or-so bill
recently signed into law and every other
stimulus package in history. The Trump ad-
ministration has proposed sending
$500bn in direct cash to taxpayers, $300bn
to keep firms afloat, and $200bn to bail out
critical industries like airlines. The typical
partisan bickering from Congress and even
from Mr Trump has been muted. Every pol-
itician seems to now realise that the coun-
try faces an unprecedented crisis, first of
public health and then of the economy,
that will last for months. Whether this ac-
tion will look sufficient 28 days later is, as
with seemingly every aspect of the covid-19
pandemic, deeply uncertain. 7W
hen the 2020United States census,
scheduled for April 1st, was planned,
the areas of most concern were mapped.
They include places like Deep East Texas,
an area of 10,000 square miles north-east
of Houston with a population of roughly
385,000 people. “We are a totally rural re-
gion,” says Lonnie Hunt, the director of the
Deep East Texas Council of Governments
(detcog), an intergovernmental agency.
“We have economically distressed people,
rural people, senior citizens, minor-
ities—we check box after box after box.” In
large parts of the region most people do notCoronavirus threatens America’s
biggest and most important surveyThe 2020 population countCensus and
sensibility