38 United States The EconomistMarch 14th 2020
2 played the chance of big disruption to or-
dinary lives and the economy. His insis-
tence that virus hysteria was being amped
up by his political enemies has distracted
from the crucial message, which is to get
ready. His announcement on March 11th of
a ban on most travel from Europe was con-
fused (he initially appeared to suggest it
would apply to cargo), arbitrary (it excludes
Britain) and accomplishes little now that
the virus is spreading from within.
These mistakes cannot be undone. But
what matters now is giving people the right
information and reinforcing hospitals
ahead of the inevitable deluge of cases. Un-
fortunately, the difficulties in testing and
honest messaging look set to persist.
Even after the error in the test kits was
detected, the increase in testing has been
slow. Andrew Cuomo, the governor of New
York, and Bill de Blasio, the mayor of New
York City, have been begging the fdato
speed up approval for automated testing,
to boost capacity from around 100 tests a
day to the several thousand that are need-
ed. A doctor at a Chicago clinic says that she
has received no kits, nor guidance on when
they will come. When she sees patients
with covid-19-like symptoms she has to
send them to be tested at a nearby hospital.
Now that kits are being delivered, re-
searchers are reporting another pro-
blem—a shortage of the components need-
ed to extract genetic material from
samples. The White House promised ca-
pacity of 1m tests by March 6th. The cdchas
stopped publishing data on the number of
tests performed. But the latest cobbled-to-
gether estimates, as of March 11th, are of
7,000 tests in total, well behind almost ev-
ery developed country with an outbreak.
Mr Trump has minimised the threat all
the same. On March 9th he blamed the
“Fake News Media” and Democrats for con-
spiring “to inflame the Coronavirus situa-
tion” and wrongly suggested that the com-
mon flu was more dangerous. The same
day, Nancy Messonnier, an official at the
cdc, was warning, correctly, that “as the
trajectory of the outbreak continues, many
people in the United States will at some
point in time this year or next be exposed to
this virus.”
Correcting the course of the outbreak is
vital because America’s health infrastruc-
ture, like that of most countries, is not
equipped to deal with an enormous surge
in serious cases. A recent study of covid-19
in China found that 5% of patients needed
to be admitted to an intensive care unit
(icu), with many needing intensive venti-
lation or use of a more sophisticated mach-
ine that oxygenates blood externally.
America has 95,000 icubeds and 62,000
mechanical ventilators, while only 290
hospitals out of 6,000 offer the most inten-
sive treatment. Much of this equipment is
already being used for current patients, in-cluding those with seasonal flu. Human ca-
pacity, such as the number of pulmonolo-
gists and specially trained nurses, is also a
limiting factor—although in Italy, where
the epidemic is raging, specialisms have
begun to matter less. Mortality in over-
whelmed hospitals will certainly be higher.
To reduce the chances of this happen-
ing, rates of transmission must be slowed
by encouraging social distancing and tele-
work, and cancelling large gatherings.
(Sports events are already being called off:
the National Basketball Association season
was suspended on March 11th.) But in
America authority over public health is
largely delegated to the states and some cit-
ies. It is for each locality to declare a state of
emergency; 13 had done so as of March 11th.
The decentralised system means that con-
tainment regimes will differ.
Mr Cuomo has ordered a series of mea-
sures: a one-mile containment area in New
Rochelle, site of a cluster, serviced by the
National Guard; and a state-produced line
of hand-sanitiser made by prisoners to
ameliorate a shortage. At the same time,
New York City and Chicago have so far re-
sisted closing their public schools, notingthat many poor households rely on them
for meals and child care. Many private uni-
versities are cancelling classes and switch-
ing to tele-instruction (causing much diffi-
culty for some septuagenarian professors).
Harvard gave its undergraduates five days’
notice to pack their things and leave.
Maintaining a healthy population re-
quires people not to spread the disease, but
also to seek treatment without worrying
about crippling debt. America is one of the
few countries in the developed world that
does not mandate paid sick leave. A mere
20% of low-paid, service-sector workers
can count on it. Those without cannot stay
at home, because a retail worker cannot
just fire up Slack and Zoom as a white-col-
lar office worker might.
Health care is also extraordinarily cost-
ly. People who are uninsured, underin-
sured (ie, liable for a high share of their
treatment costs) or fearful of surcharges
for using out-of-network hospitals and
physicians may keep away—particularly if
their pay has recently fallen or stopped al-
together. “The idea that people should have
skin in the game kind of doesn’t work when
you’re also playing with your neighbour’s
skin,” says Wendy Parmet, a professor of
public-health law at Northeastern Univer-
sity. Some insurers, as in Illinois or in Cali-
fornia, insist that patients will not be made
to pay for testing. But as yet there is no such
policy at national level.
Last week Congress passed an emergen-
cy appropriation of $8.3bn to fight the vi-
rus, which Mr Trump signed into law. Al-
most all that money will be devoted to
front-line measures—such as test-kits,
laboratory equipment and additional staff.
A bigger fiscal stimulus will probably be
needed. Mr Trump and Democratic leaders
have sketched competing visions for what
to do. The president would like to provide
tax credits directly to stricken industries
such as airlines, frackers and cruise-ship
operators, cut payroll taxes (usually paid
every two weeks) and offer paid sick leave
to hourly workers. Democrats have pro-
posed more generous paid-sick-leave
rules, expanded payments for programmes
like unemployment insurance and nutri-
tion assistance, and guaranteed payment
of all testing and out-of-pocket treatment
costs. The need is urgent, but the haggling
could drag on for some time.
Thus far in his presidency, Mr Trump
has faced a few crises. Most he generated
himself, including various trade wars and
bouts of chest-thumping, which could
generally be defused. The virus, however,
will circulate no matter how much the
president may wish it gone. Talking down
the risks is not a winning strategy. To fight
the outbreak, America needs clear, unvar-
nished public information and policies
based on the best science. Is the president
capable of endorsing that? 7The known knowns
United States, confirmed covid-19 cases
To March 11th 2020Source: Johns Hopkins CSSE1,0001,2507505002500
January February MarchIsolation chamber