march 16–29, 2020 | new york 29
s CNN
y
ve to be majornursing
ed by
t over
tict politics had” he said, while an aide brought him a
t
ynew infections are declining, not trending to-
ward half the population.
But there are good questions about whether
this success can be replicated in other parts of
the world and even whether it can be main-
tained in China itself. China’s measures to slow
the spread of the virus have been draconian,
and the country is seeking to ease up on them
and return to normal. But since most of the
population has never been infected, most peo-
ple remain “naïve” to the virus—they don’t have
antibodies and are vulnerable to a resurgence of
the epidemic, at least until there are effective
antiviral treatments or a vaccine available. And
over time, practices that shut down large frac-
tions of the economy and society are likely to
prove less sustainable.
It is possible, as countries ramp up their test-
ing and surveillance capacity, we will increase
our capability at managing the outbreak by
identifying and isolating individuals with the
infection, allowing us to reduce our reliance on
population-level containment measures—this
has been key to South Korea’s success at slowing
the growth of new infections with less-severe
restrictions on social activity than we are seeing
in China or Italy. On Friday, the president held
a press conference to tout expanded testing but
dodged a question about when those tests
would actually become available. And even at
South Korean levels of social disruption, epi-
demic containment would require a more
intense and prolonged change to the American
way of life than a lot of people and even policy-
makers have yet to recognize.
The even less palatable option is to try to let
it run its course in the most orderly manner
possible. After a large fraction of the population
is infected—40 to 70 percent are the numbers
I tend to hear thrown around—many people
will have developed antibodies, making it
increasingly difficult for the virus to find vulner-
able hosts to infect and causing the epidemic to
ebb naturally. The big problem with this out-
come is that it would entail a very large number
of deaths even if the infection fatality rate proves
to be on the low end of the estimates.
And then there is the Italy problem. There, as
in the U.S. and everywhere else, hospitals have
limited capacity to treat patients with severe
lung illnesses. If the health-care system gets
overwhelmed with an enormous number of
covid-19 cases requiring intensive care, the
quality of care will deteriorate and a larger frac-
tion of patients will die than would die in a well-
functioning health-care system. This is why
people keep talking about the need to “flatten
the curve”: Merely slowing the growth of the
epidemic, even if it doesn’t reduce the ultimate
number of cases, would lessen the pressure on
the medical system is considerably. But as IMARCH 10 WAS JUST a few days ago, but it already feels very far away—
before the NBA season was suspended, Tom Hanks tested positive, and
a national state of emergency was declared. On that date, Think Global
Health, which is a project of the Council on Foreign Relations, produced
a report that includes a data table that tells us how many people
in the United States might ultimately die from covid-19 under a
variety of different assumptions. In the
top-left corner, the table shows a scenario
where 0.1 percent of people in the U.S.
contract the virus and 0.1 percent of those
die from it, leading to a bit more than 300
deaths. That’s the best corner of the table.
We like that corner. What we don’t like is
the bottom-right corner of the table, which
contemplates 50 percent of the American
population contracting the virus and one
percent of those dying. If we end up in that
corner, about 1.6 million of us will die.
We could land anywhere in the table.
Beyond that, unfortunately, I can’t offer
much more specific guidance—in fact,
depending on which experts you ask, we
could land outside the table, too. But our
knowledge about our lack of knowledge is
a kind of knowledge. The coronavirus end-
game depends on a series of unknowns.
We keep getting more data, but we still
don’t know how inherently infectious or
deadly this virus is. We don’t know how
well we as Americans will respond and are
responding to those risks of infection and
death: how effectively we will reduce its
spread, ensure that our hospitals are capa-
ble of handling a flood of sick patients, and
heal those who are in the hospital. Theearly public response was abysmal, but we
don’t know how quickly, or dramatically,
that is changing. And, in large part because
of the appalling failure of the Centers for
Disease Control and Prevention to ensure
an adequate supply of usable testing kits,
we don’t know how bad the virus outbreak
in the U.S. is already. However bad it is,
things will get worse.ROUGHLY, THERE ARE two ways to ad-
dress an epidemic that threatens to spiral
out of control and infect much of the
world. Plan A is to stop it by imposing
public-health measures that reduce the
rate of transmission, such that each person
who gets infected ends up infecting less
than one person on average, and the epi-
demic begins to die out. Dr. Cyrus Shah-
par, one of the creators of the table that
tells us so much about what we don’t
know, told me the more benign outcomes
proposed in its leftward columns are based
on the apparent success China has had in
doing that: Outside the Wuhan area, in-
fections so far have made up less than 0.1
percent of the population. In the Wuhan
area, the disease has hit approximately 0.5
percent of the population. In both areas,This WillGet WorseThe grim math ofa coronavirus future.by josh barroY ___ DD ___ AD ___ PD ___ EICTRANSMITTED________ COPY ___ DD ___ AD ___ PD ___ EIC0620FEA_Corona_lay [Print]_36899495.indd 29 3/13/20 9:55 PMmarch16–29, 2020 | newyork 29new infections are declining, not trending to-
ward half the population.
But there are good questions about whether
this success can be replicated in other parts of
the world and even whether it can be main-
tained in China itself. China’s measures to slow
the spread of the virus have been draconian,
and the country is seeking to ease up on them
and return to normal. But since most of the
population has never been infected, most peo-
ple remain “naïve” to the virus—they don’t have
antibodies and are vulnerable to a resurgence of
the epidemic, at least until there are effective
antiviral treatments or a vaccine available. And
over time, practices that shut down large frac-
tions of the economy and society are likely to
prove less sustainable.
It is possible, as countries ramp up their test-
ing and surveillance capacity, we will increase
our capability at managing the outbreak by
identifying and isolating individuals with the
infection, allowing us to reduce our reliance on
population-level containment measures—this
has been key to South Korea’s success at slowing
the growth of new infections with less-severe
restrictions on social activity than we are seeing
in China or Italy. On Friday, the president held
a press conference to tout expanded testing but
dodged a question about when those tests
would actually become available. And even at
South Korean levels of social disruption, epi-
demic containment would require a more
intense and prolonged change to the American
way of life than a lot of people and even policy-
makers have yet to recognize.
The even less palatable option is to try to let
it run its course in the most orderly manner
possible. After a large fraction of the population
is infected—40 to 70 percent are the numbers
I tend to hear thrown around—many people
will have developed antibodies, making it
increasingly difficult for the virus to find vulner-
able hosts to infect and causing the epidemic to
ebb naturally. The big problem with this out-
come is that it would entail a very large number
of deaths even if the infection fatality rate proves
to be on the low end of the estimates.
And then there is the Italy problem. There, as
in the U.S. and everywhere else, hospitals have
limited capacity to treat patients with severe
lung illnesses. If the health-care system gets
overwhelmed with an enormous number of
covid-19 cases requiring intensive care, the
quality of care will deteriorate and a larger frac-
tion of patients will die than would die in a well-
functioning health-care system. This is why
people keep talking about the need to “flatten
the curve”: Merely slowing the growth of the
epidemic, even if it doesn’t reduce the ultimate
number of cases, would lessen the pressure on
the medical system is considerably. But as IMARCH 10 WAS JUST a few days ago, but it already feels very far away—
before the NBA season was suspended, Tom Hanks tested positive, and
a national state of emergency was declared. On that date, Think Global
Health, which is a project of the Council on Foreign Relations, produced
a report that includes a data table that tells us how many people
intheUnited States might ultimately die from covid-19 under a
variety of different assumptions. In the
top-left corner, the table shows a scenario
where 0.1 percent of people in the U.S.
contract the virus and 0.1 percent of those
die from it, leading to a bit more than 300
deaths. That’s the best corner of the table.
We like that corner. What we don’t like is
the bottom-right corner of the table, which
contemplates 50 percent of the American
population contracting the virus and one
percent of those dying. If we end up in that
corner, about 1.6 million of us will die.
We could land anywhere in the table.
Beyond that, unfortunately, I can’t offer
much more specific guidance—in fact,
depending on which experts you ask, we
could land outside the table, too. But our
knowledge about our lack of knowledge is
a kind of knowledge. The coronavirus end-
game depends on a series of unknowns.
We keep getting more data, but we still
don’t know how inherently infectious or
deadly this virus is. We don’t know how
well we as Americans will respond and are
responding to those risks of infection and
death: how effectively we will reduce its
spread, ensure that our hospitals are capa-
ble of handling a flood of sick patients, and
heal those who are in the hospital. The
early public response was abysmal, but we
don’t know how quickly, or dramatically,
that is changing. And, in large part because
of the appalling failure of the Centers for
Disease Control and Prevention to ensure
an adequate supply of usable testing kits,
we don’t know how bad the virus outbreak
in the U.S. is already. However bad it is,
things will get worse.ROUGHLY, THERE ARE two ways to ad-
dress an epidemic that threatens to spiral
out of control and infect much of the
world. Plan A is to stop it by imposing
public-health measures that reduce the
rate of transmission, such that each person
who gets infected ends up infecting less
than one person on average, and the epi-
demic begins to die out. Dr. Cyrus Shah-
par, one of the creators of the table that
tells us so much about what we don’t
know, told me the more benign outcomes
proposed in its leftward columns are based
on the apparent success China has had in
doing that: Outside the Wuhan area, in-
fections so far have made up less than 0.1
percent of the population. In the Wuhan
area, the disease has hit approximately 0.5
percent of the population. In both areas,This WillGet WorseThe grim math ofa coronavirus future.by josh barro