Experts fear ‘national naivete’ on COVID optimism

After an unprecedented month of strict social distancing and an economic lockdown that has cost tens of millions of jobs and untold billions in damage, Americans saw the faintest glimmers of hope last week that the worst of the coronavirus crisis may be passing.

Modelers at the University of Washington downgraded their projections of the number of people who would die. Some states closed field hospitals they never had to use. Major professional sports leagues began considering how to play abbreviated seasons. President Trump promised businesses would reopen soon, with his characteristic bravado.

“I think we’re going to open up strong. I think we’re going to open up very successfully, and, I’d like to say, even more successfully than before,” Trump said Thursday.

On Friday, Trump said he would listen to public health experts if they said it was too early to reopen the country — though he added he would also consider the other side of the argument. His comments came hours after U.S. Surgeon General Jerome Adams said on Fox News that “most of the country will not” be able to open for business May 1.

Public health officials and experts say the optimistic projections of an America that gets back to work by the beginning of May, or even later in the summer, are more than misplaced. Rushing back to something approaching normal, they fear, would risk a second wave of the virus, one that would create a new tsunami of cases, deaths and economic damage.

It is not realistic to think that American society will get back to normal, the experts said, until a coronavirus vaccine has been developed, tested and administered to billions of people across the globe.

“There is a disconnect. It’s sort of a national naïveté about what the next 18 months means, maybe a sort of willful refusal to deal with the brutal facts,” said Prabhjot Singh, a physician and health systems expert at the Mount Sinai Health System and the Icahn School of Medicine. “A real leader would help the nation do this. That’s not where we are right now. And so I think the cognitive dissonance will continue, and the shocks will come and go, bearing down hardest on people who have less reservoir.”

Amid the worst week in public health in American history, when more than 10,000 people died from the COVID-19 disease and 150,000 more tested positive, there were some early signs that the strict stay-at-home orders issued in many states in mid-March were beginning to have an effect. The number of new cases confirmed in countries like Italy and Spain, the two European nations hit hardest by the coronavirus pandemic, began to bend down. States like California, Oregon and Washington, where governors implemented some of the nation’s first lockdowns, also showed signs of progress.

But as the virus spreads more widely through the rest of the United States, the data does not show the case curve bending in a meaningful fashion. The U.S. is now reporting more cases daily than Italy or Spain. By the weekend, more Americans will have died from the coronavirus than in any country outside of China or Iran, authoritarian countries without transparency where the true death tolls are unknown.

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“In the past week, we have seen a welcome slowing in some of the hardest hit countries in Europe, like Spain, Italy, Germany and France,” Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, told reporters Friday. “At the same time, we have seen an alarming acceleration in other countries.”

The model the White House coronavirus task force has publicly embraced as the most likely scenario, published by the Institute for Health Metrics and Evaluation at the University of Washington, projects about 60,000 Americans will die of the coronavirus by Aug. 4 — but only if full social distancing measures continue through May. More relaxed measures would mean more cases, more hospitalizations, and a higher death count.

If stay-at-home orders remain in effect for 30 days followed by steady-state mitigation measures, the Department of Homeland Security projects 200,000 deaths from COVID-19, according to documents released Friday by The New York Times.

The disconnect between newly optimistic outlooks and the dire warnings of health officials are in part a function of an outbreak that has hit different communities unevenly, coupled with the exhaustion and stress wrought by a frightening disease and a crippled economy.

While the number of cases in hard-hit areas like New York, New Orleans and Detroit may slump, the virus will find new fuel in other areas. On Thursday, at least a dozen states reported their highest one-day case counts. They included both states like Massachusetts, Minnesota and Colorado, which took early and aggressive steps to enforce social distancing rules, and states like Alabama, Arizona, Iowa and Texas, where governors resisted early calls to order lockdowns.

“This is a four-quarter game. We’re probably now getting to be toward the latter part of the first quarter. New York City is in the middle of the second quarter. Asia is getting past halftime, and Europe may be at halftime,” said Clay Marsh, the vice president and executive dean for health sciences at West Virginia University, who has been tapped to lead his state’s coronavirus response team.

As Trump and his advisers hope to relax restrictions to allow businesses to open, the nation’s governors, who have the authority to maintain stay-at-home orders, are showing few signs they are ready to lift restrictions. 

Stay-at-home orders are in effect until at least May 1 in Massachusetts, Ohio and Washington. Several more states formally canceled school for the rest of the academic year. Multnomah County, Ore., seemed to offer a preview of what much of the rest of the nation will do soon when it extended its state of emergency into the second week of July.

But the lockdowns will not last forever. And when, eventually, some restrictions are relaxed, the number of coronavirus cases is likely to rise again, in what epidemiologists term the second wave. 

The height of that second wave will be determined by the speed and success with which the United States takes advantage of what would be a new window of opportunity to wrestle the virus under control. But to do so will require steps and scale unprecedented in the history of global public health, some of which will intrude on the American way of life.

“The next peak, which could be several months from now, could be several times larger than what they just went through. And you have to prepare for that now. No time for happy talk, you go from one battlefield to the next,” said Michael Osterholm, director of the Center for Infectious Disease Research and Prevention at the University of Minnesota.

On Friday, the WHO’s Tedros urged caution among countries that are considering easing restrictions — comments that seemed implicitly directed at the American administration.

“Lifting restrictions too quickly could lead to a deadly resurgence. The way down could be as deadly as the way up if not managed properly,” Tedros said.

Proposals from a handful of organizations that have begun thinking about how to reopen society and the economy envision a future unlike anything Americans are used to. Some call for disease surveillance on a scale unprecedented in world history, including the use of smartphone apps that raise as many privacy concerns as logistical concerns. 

Others envision months of constant testing to quickly identify those who have been infected; one proposal offered by economist Paul Romer would test every American every two weeks, requiring laboratories to process about 20 times more tests every day than the U.S. has the capacity to process today.

“As we establish control of this for the first wave and when we relax our social distancing interventions, testing and contact tracing will be a very important part to monitor for the second wave,” said David Bangsberg, the founding dean of the Oregon Health Science University-Portland State University School of Public Health. “We need to keep on going until transmission has stopped, and the tough bit is going to be when we relax these interventions.”

If Americans used the worst week of the crisis to find a silver lining, health experts say they are only now beginning to come to grips with what a new normal might look like. An economic catastrophe awaits, and rebuilding will be delayed by a virus that still lurks.

“We know that when we come back out of this, rejoin each other, then we’re going to have to do that with some caution and some thought and we’re going to have to look at physical distancing, and we’re probably going to be wearing masks,” Marsh said.

–This report was updated at 9:58 a.m.