The Economist USA - 21.03.2020

24 United States

~substantially spread the load,· warns Ash-

.ish Jha, director of the Global Health Insti-

tute at HatVard. 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

m.ckers using a Google sheet-to an esti-

mated u,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 recovecy rooms

into added beds and building tents to

house some patients. The Cleveland Oinic,

a prominent hospital, says it has plans in

pla.ce to add i,ooo 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 respimtory 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

forthe inevitable surge in cases.

Testing?tating?

Whether it will come to all this is still un-

clear. Testing capacity remains con-

stiained, limiting the information epide-

miologists have to feed both their models

and their willingness to speculate. nteir

policy recommendations-social distanc-

ing. closure of schools and large gather-

ings-are nevertheless clear. one team of

researchers bas concluded that an epidem-

ic resembling that of wuhan, where the

novel corona.virus filst 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 C.Ollege London,

who have been advising the British govem-

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 sodety-

American hospital and 1cu capacity would

be exceeded eight times over, and the coun-

tty would be on track for at least um

deaths. Averting this through ·supp~

sion" -isolation of sick, closing of schools

and universities, social distancing for

evecyone-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 7lD to remain in their homes un-

less necessary. New York City is expected to

do the same for its Im residents. In 22

states, bars and restauJa.Dts 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 fedel31 troops to build emergency, tem-

pomy hospital facilities. New Rochelle's

mayor says he is surviving the lockdown

there on ·adrenalin, coffee and .M&MSN.

The goal is to increase genel31 hospital

capacity by a factor of two and 1cu capacity

by a factor of ten within two months. Elec-

tions have been postponed in a few states

for the Demoaatic primaJy, 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

fedel31 government completely fails, as it

has so far, then you can get states and cities

to step up,u says Mr Jha.

The question is bow 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,

whoa fewweeksagowas 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 forthe disease free, in-

crease the flow of safety-net benefits and

giant paid sick leave to more workers

(though this provision appears to be hol-

lowing out with evecy iteration). Even be-

fore that bill was finalised, wash.ington's

attention had already turned to the even

bigger economic stimulus paclcage that

must come next. senaton, both Democrats

and Republicans, are tripping over them-

The Economist March 21st 2020

selves issuing plans to send cash directly to

American families.

The total package, which could beworth

$tttn or more, dwarfs the $toobn-or-so bill

recently signed into law and evecy other

stimulus package in history. TheTrumpad-

ministJation has proposed sending

$5oobn in direct cash to taxpayers, $3oobn

to keep firms afloat, and $20obn to bail out

critical industries like airlines. The typical

partlsan bickering from Congress and even

fromMrTrumphas been muted. Everypol-

itician seems to now realise that the coun-

tty faces an unprecedented eris.is, filst 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

withseemioglyeveryaspectofthecovid-ig

pandemic, deeply uncertain. •

The 2020 population count

Census and

sensibility

eomnavhus threatens America's

biggest and most important suney

W

HEN THE 2020 United States census,

scheduled for April ist, 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 rwal re-

gion," says Lonnie Hunt, the director of the

Deep East 'Iexas C.Ouncil of Govemments

(DETCOG), an intergovemmental agency.

"We have economically distressed people,

rum people, senior citizens, minor-

ities-we check box after box after box.u In

largepartsoftheregionmostpeopledonot ..