USA Today - 27.03.2020

NEWS USA TODAY ❚ FRIDAY, MARCH 27, 2020 ❚ 7A

OPINION

MIKE THOMPSON/USA TODAY NETWORK

Prominent U.S. voices have been

calling for a stop to social distancing

soon, citing the rationale that the con-

sequences of social distancing are

worse than the impact of COVID-19 it-

self. It’s worth looking very closely at

that claim, where we are in the U.S. epi-

demic and what happens if we stop the

social distancing efforts.

COVID-19 has been spreading with

exponential growth in the United

States, and we’re just beginning to get

an understanding of how extensively

as testing has become more available.

There are more than 82,000 U.S. cases

confirmed as of Thursday evening and

nearly 1,200 deaths. A few weeks ago,

we had recognized 70 cases.

We shouldn’t be considering relax-

ing strong social distancing measures

until we have drastically slowed the

rate of spread, dealt with our dire short-

ages of supplies and diagnostic capac-

ity, and prepared our health care sys-

tem to deal with surges in patients.

Some hospitals in New York City

have said publicly that within one to

two weeks, they will not have ventila-

tors to treat everyone. In terms of diag-

nostics, there are shortages of reagents

and swabs. We still don’t have rapid di-

agnostic testing in place in many hospi-

tals. We don’t have capacity to diag-

nose many COVID-19 cases not sick

enough to be in the hospital, so they

aren’t yet recognized or counted in the

trajectory of the epidemic.

How do we gain time to let hospitals

get more supplies and prepare for high

numbers of patients? How do we slow

the spread of disease in America? How

do we lower odds that intensive care

units will run out of ventilators or

space? The answer, for now, is large

scale social distancing.

Measures take time to work

In Asia, we’ve seen these social dis-

tancing interventions, which in some

places have been in place for two

months, work to slow the pace of the

epidemic. They’ve slowed the disease

by slowing social interaction. Left to its

own, this disease spreads from one

person to about 2.5 people, and then

each of those people spread to an aver-

age of 2.5 more and so on. For this dis-

ease to stop, we need to make it so that

on average, one person spreads it to

less than one other person.

These social distancing measures

take time to work. The impact of big in-

terventions in China took about three

weeks to start to reverse things. In the

USA, we’re only about 10 days into large

scale social distancing.

To drop all these measures soon

would be to accept that COVID-19 pa-

tients will get sick in extraordinary

numbers all over the country, far be-

yond what the U.S. health care system

could bear. Many reputable models

predict that systems will be completely

overwhelmed by the peak of cases if so-

cial distancing is not maintained.

If hospitals become overwhelmed,

they could struggle to provide even ox-

ygen for some or many of the 15% of CO-

VID-19 cases expected to be “severely

ill,” and the case fatality rate for CO-

VID-19 could far exceed 1%. Belea-

guered hospitals also might not be able

to provide care for other serious and

life-threatening conditions.

Anyone advising the end of massive

social distancing now needs to under-

stand what the country would look like:

COVID-19 would spread widely, rapidly,

terribly — and could kill millions in the

year ahead with huge social and eco-

nomic impacts.

Before considering changes, we

should use all our energy to get to the

strongest possible position for CO-

VID-19 response. We are not ready. We

need rapid diagnostics in place. We

need extraordinary quantities of per-

sonal protective equipment. We need

more ventilators, and we need capacity

to provide medical care to many more

than we can now.

Encouraging progress

It’s encouraging that we are begin-

ning to make progress. The Food and

Drug Administration has provided rec-

ommendations for developers who

may wish to develop serological tests,

which can be used to identify who has

been infected and recovered already,

and to know how prevalent the disease

is in the USA. Looking ahead, we will

hopefully have therapies to treat at

least the sickest patients.

Together, these measures will help

reduce the number of cases to such a

low level that we could do contact trac-

ing and isolation of cases.

At that point, it will be a far less risky

to pull back on social distancing. In the

coming weeks, we will learn from the

experience in Asia as leaders there be-

gin to relax social distancing.

For now, we need to keep production

lines for medical equipment running,

doctors’ offices working, and groceries,

pharmacies and banks open. It’s im-

portant to have science-informed dia-

logue about which businesses can stay

open. These measures are painful and

have bad economic consequences, but

there would be no return to a normal

society or economy now even if these

measures were ended, given that CO-

VID-19 is rapidly spreading.

We need to press ahead with closed

schools, mass telecommuting, no gath-

erings and staying home unless you

need to go out. Generous economic pro-

grams can help those suffering.

Through social distancing, we can slow

this epidemic together.

Dr. Tom Inglesby is the director of the

Johns Hopkins Center for Health Security.

Why we can’t stop

social distancing now

Coronavirus pandemic

is still moving too fast

Dr. Tom Inglesby

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In the time of coronavirus, it may be
difficult to find things to be thankful for.
But we know of one: the Affordable
Care Act, aka Obamacare.
Highly controversial, though it
should not be, and the subject of much
emotion, though it should not be, the
law is pretty much solely responsible
for approximately 26 million people, or
about 8% of the population, having
health insurance today. And, oh yes, it
turned 10 years old this week.
The law means fewer people show-
ing up at emergency rooms because
they have nowhere else to go. It means
more people getting medical advice
that could help them avoid contracting
the coronavirus. It provides consider-
able comfort to Americans who have
plenty of other things to worry about.
Millions of workers are losing their
jobs — and often their employer-pro-
vided health coverage — because of the
pandemic. It’s more important than
ever that they be able to find insurance,
regardless of preexisting conditions, on
the Obamacare marketplaces or
through the law’s expansion of Medi-
caid. The ACA gives them a safety net.
While the HealthCare.gov window
for acquiring coverage in 2020 ended in
December, a one-time enrollment peri-
od can, and should, be opened now to
allow individuals to sign up. That
would help stabilize insurance markets
and prevent premiums from spiking.
The 11 states that manage their own
health insurance exchanges have al-
ready done so. The main insurance lob-
bying organization and the Republican
governor of New Hampshire, Chris Su-
nunu, are among those calling for this
to be done nationwide.
Not everyone, however, shares this
rosy view of the ACA. The Trump ad-
ministration and most Republicans
still favor abolishing the law, throwing
millions of people off the ranks of the
insured. They mount this campaign
while blithely referring to replacement
plans that do not exist. Eagerly, they
anticipate that the Supreme Court will
do what they themselves could not do
and terminate the law.
Their effort began even before Don-
ald Trump’s election, with multiple
failed votes to repeal the law in Con-
gress, and two efforts to kill it in court,
one of which fell a vote shy in the Su-
preme Court.
Since Trump became president, Re-
publicans have tried again unsuccess-
fully to repeal the law, but they man-
aged to get rid of one key provision, a
requirement that all Americans pur-
chase health coverage. Now the law’s
opponents are back in court, arguing
that because the individual mandate
was eliminated, the courts must con-
demn the rest of the law.

The mere act of eliminating the indi-

vidual mandate looks pretty stupid in

light of today’s pandemic. U.S. officials

are now telling people to shut down

their businesses, work from home,

even stay inside — and we couldn’t ask

citizens to make our health care system

more robust?

Officials were worried about the

“free rider” financial burden on hospi-

tals when just a couple of years ago

they said, in effect, go ahead and be

public charges if you get sick.

Last year, the Congressional Budget

Office estimated that the repeal of this

one provision would cause the ranks of

the uninsured to rise by 5 million by

2029. Some of this has likely already
      taken place.
      When someone who decides not to
      buy insurance shows up at the emer-
      gency room with the coronavirus or
      some other illness, guess who ends up
      paying the bill? Everyone else, in the
      form of higher premiums and tax dol-
      lars. It’s the opposite of personal re-
      sponsibility.
      The Affordable Care Act is not some
      socialist plot but a sound (though hard-
      ly perfect) way to expand coverage, re-
      duce costs and, yes, deal with public
      health crises. Its basic concept of
      Americans being required to buy cover-
      age from insurers who were required to
      sell it came from the conservative Heri-
      tage Foundation in a 1989 paper called,
      “Assuring Affordable Health Care for All
      Americans.”
      In fact, 17 Republicans (and three
      Democrats) turned the Heritage plan
      into a bill in 1994, known as the HEART
      Act that they offered as an alternative
      to a plan offered by the Clinton admini-
      stration.
      Since President Barack Obama es-
      sentially borrowed the plan, Republi-
      cans have done their best to demonize
      the law and try to destroy it, while de-
      nying their own parentage.
      There’s just one word for this given
      the public health threat: insane.

TODAY'S DEBATE: THE ACA TURNS 10

Our view: With virus raging,

it’d be crazy to kill Obamacare

Treating patients arriving by lifeboats

in Miami Beach, Florida, from a cruise

ship Thursday. DAVID SANTIAGO/AP

Ten years have passed since the pas-
sage of the Patient Protection and Af-
fordable Care Act, better known as
Obamacare, and the law has been more
or less fully deployed for six. In prac-
tice, although it may have made health
care more accessible to some, it did so
at the cost of making it less affordable
and worse quality for many others.
On one hand, Obamacare definitely
did reduce the number of Americans
without health insurance. On the other,
it also massively increased insurance
premiums, deductibles and out-of-
pocket maximums for millions of
Americans. Thanks to insurers narrow-
ing their networks and many fleeing
Obamacare’s exchanges, many of us
who liked our doctors, or our insurance
plans, didn’t get to keep either.
In practice, Obamacare’s main
thrust was a radical centralization of
health care. The core of any market-
place is competition and price signals,
and these have been nearly entirely ob-
scured across much of the health care
system by government mandates that
favor inserting third parties between

health care providers and patients.

Obamacare didn’t invent these prob-

lems, but it did increase them.

Instead of (unconstitutionally) sub-

jecting everyone to a one-size-fits-all

health insurance plan with deductibles

so high that people can’t afford to use

them, health care reform should allow

for a diversity of choices.

Let people compete with the current

model by keeping more of their own

earnings to spend on health care ser-

vices of their choice, tax free. Remove

barriers to competition that promote

hospital monopolies and shortages of

care. Reform government-provided

payments under Medicare to focus on

quality, not quantity, of care. Stop en-

couraging states to overspend on Medi-

caid and incentivize them to find better

ways to care for the poor.

In 10 years, Obamacare has inexora-

bly steered health care toward bu-

reaucracy, stagnation and eventually

total government control. The way for-

ward now, better late than never, is in-

novation, competition and choice.

Adam Brandon is the president of

FreedomWorks.

Opposing view:‘A radical

centralization of health care’

Adam Brandon

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