united States The Economist March 21st 2020
Responding to c:ovid-19In sickness, not in health
WASHINGTON, DC
American life has been tr.msformed in a few short weeks. 11le next few will be
even tougher
T
HE TITULAR. conceit 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
arampagingvirus.Many Americans are ex-
periencing something similar. On Man:h
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 t18
deaths. Twenty-eight days later, on Man:h
JBt, whatmJghtAmerlcalooklike?
"We don't know whether we're going to
look like Italy or the provinces outside Hu-
bei" in China where the spread of co'ricl-ig
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 suqeon-geneRI, has
warned of the same.
can America's health system cope? The
structuRI 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, publlc:-health experts and
doctors are increasingly worried about
sheer capacity constr.tlnts. In China, 5% of
those diagnosed needed intensive care.
There are roughly 97,000 beds in intensive
care units (1cus), of which one-third are
empty. Though America bas relatively few
total hospital beds per person compared
with other countries, it ranks among the~ Also in this section
24 lhe 2D2D population count
25 lhe Democratic primary
26 G~ rural families
'Z1 The Bible museum
.28 Laxlnston: Pandemic polarisationhighest for1cu beds 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 nunes
and assistants. This could be Jnsufftdent
in the face of hundreds of thousands of
cases at peak rates of infection.
Then there is the problem of kit. In Chi-
na, halfofthoseincriticalcarerequired the
use of ventilators, machines that help peo-
ple breathe. There are thought to be 62,ooo
full-featured mechanical ventilatoIS 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 of1950, 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
completelyfullmanytimesoverifwedon't ~