| The rise in the US and Europe doesn't mean this was all inevitable. As Jha told me, "The truth is there's lots of countries that have controlled it." Among the countries that have performed much better than the US: Australia, Canada, Germany, Japan, New Zealand, South Korea, and Vietnam. "What this outbreak gives you is the same problem for every country around the world," Clare Wenham, a global health policy expert at the London School of Economics and Political Science, said. "So you can really see the impact of different policies that were launched." The US's performance "is a testament to failures of the Trump administration." The evidence backs several approaches to dealing with Covid-19: social distancing, aggressive testing and tracing, and widespread masking. But Trump has rejected all these approaches — demanding that states open up early and quickly, punting testing and tracing programs down to local and state governments, as well as mocking and questioning masks. Meanwhile, the public, along with local and state leaders, has collectively become more complacent and fatigued with the pandemic. That's led to more and more people going out, with each interaction carrying a chance of spreading the coronavirus. This has continued despite relatively widespread inaction and apathy already leading to outbreak after outbreak in the US. As Jha has told me, "I, at this point, feel like I clearly no longer understand why our country can't learn its lessons and why we keep repeating the same mistakes." As temperatures have gotten colder, particularly in northern parts of the US, people have flocked more to risky indoor spaces like bars and restaurants. In these places, people are close together for long periods; they can't wear masks as they eat or drink; the air can't dilute the virus like it can outdoors; and alcohol could lead people to drop their guards further. Each of these factors helps the virus spread further. Schools have also reopened since the late summer — with colleges and universities in particular seeing big outbreaks, not only as students go back to class but also as they hit bars and restaurants, party in dorms, and hang out with their peers, friends, fraternities, and sororities. With winter coming, all of this could get even worse. More schools will reopen. It'll get colder in more parts of the US. Thanksgiving, Christmas, and New Year's will bring friends and families together, including from hot spots at colleges and universities. Hospitals and other parts of the health care system may have trouble treating a bigger surge of Covid-19 patients if a flu season appears, too, potentially leading to worse outcomes across the board. What's particularly problematic for the US, though, is that the country is starting from such a high baseline of cases. As RTI International epidemiologist Pia MacDonald has repeatedly emphasized to me, "We never got to low enough levels [of Covid-19] to start with in most places." The threat of exponential growth from such a point could lead to a level of spread that no country has ever seen before — not even in the spring, when the coronavirus first hit the US and Europe. "The next number in the fall is likely going to shoot way up," Michael Osterholm, director of the Center for Infectious Disease Research and Policy, previously told me. "Likely well beyond 65,000, 70,000," the summer's previous peak. "I think this fall is going to be the biggest spike of all." Trump's response to the coronavirus could get even worse
Trump could, in theory, at any moment shift course and try to take the threat of Covid-19 more seriously. Eight months into the pandemic, though, that seems very unlikely. Even after he got sick with Covid-19, Trump continued to downplay the threat of the virus: As he left the hospital, he tweeted, "Don't be afraid of Covid. Don't let it dominate your life." He continued to push a false sense of normalcy in the weeks leading up to the election. One possibility that experts worry about: As bad as Trump has been, maybe he was partially restrained by the election. If he really believes what he was preaching, he could now do even more to discourage social distancing, masking, testing, and tracing. "What is the Trump team, once they have lost, going to do over the next two, three months? Because they're going to have the reins of federal power," Jha said. "It's going to be a very tough two, three months." Citing his conversations with White House staff, he added, "There are a lot of people in the White House task force who are already very worried about this." Consider what Trump and his people were already doing behind the scenes. One of Atlas's first actions when he joined Trump's team was, reportedly, to push for less testing, out of fear that exposing more asymptomatic cases could lead more people to quarantine and more businesses to close down. With Atlas's support, the Centers for Disease Control and Prevention also briefly recommended less testing, especially for asymptomatic people. Trump, who has a tendency to say the quiet part out loud, has repeatedly suggested this is what he always wanted. He said he told his people to "slow the testing down please," since more tests revealed more cases and, in his view, could make the US look bad. Testing is perhaps the least controversial part of this pandemic, with both Democrats and Republicans supporting it at varying levels across the country. After all, who could object to more data showing the disease's spread? That Trump managed to make this into an issue speaks to his never-ending drive to "always play [the coronavirus] down," as he told journalist Bob Woodward. But unchaining Trump and Atlas from politics could go much further than testing. Both have at different points spoken favorably of a "herd immunity" strategy — one that would aim to get younger, healthier people infected and, hopefully, immune to Covid-19. The idea is this would build up enough immunity that the vast majority of the country could go back to life as normal. Experts have widely panned this idea, pointing that it could lead to hundreds of thousands or even millions of Covid-19 deaths as massive segments of the population are infected with the virus and get seriously sick. Sweden, which appeared to try a "herd immunity" strategy while denying it was doing so, suffered one of the highest Covid-19 death rates in the world — even as its neighbors were spared significant outbreaks — before its leaders admitted to a mistake. If the US followed such an approach, and the Trump administration worked even more against widespread social distancing, masking, testing, and tracing, it could make the country's Covid-19 disaster even worse. And even if Trump's approach doesn't get worse, the status quo clearly hasn't been working. One potential for optimism: Maybe Trump will shift course now that the election is behind him. Maybe he only downplayed the virus as part of his reelection bid, out of a desire to make it seem like things were fine and normal, hoping that would boost voters' approval of his presidency. So the lack of political incentives could make Trump act more wisely. But that assumes a level of competence and responsibility that Trump, who got his start in politics by falsely suggesting then-President Barack Obama wasn't born in the US, has yet to display. And if Trump genuinely believes what he's been saying for months, things could get much worse. Biden has to be ready to strike on day one
It will be too late for Biden to do anything about a fall and winter Covid-19 surge in late January. But a Biden administration could take significant steps to put the country on a better path once he takes office. And Biden, as the president-elect, can start putting together a plan and team to accomplish this on day one. When I previously asked experts about what Biden should do, they pointed to several ideas: - Implement policies that are proven to work: A Biden administration could encourage more social distancing, simultaneously offering financial support to affected people and businesses so they don't suffer as much and don't have another incentive to try to go back to normal. It could push, with the bully pulpit and potential funds, states to mandate masks and really enforce those mandates. It could build up a national testing-and-tracing system, fixing supply bottlenecks for widespread tests and putting money into hiring contact tracers. All of these efforts could help suppress the virus.
- Rebuild trust in scientists: Under Trump, trust in scientific institutions has dwindled. Federal agencies like the Food and Drug Administration and the CDC were previously considered the gold standard in their fields, but now Americans and experts are increasingly questioning just how effective these once-respected institutions are, in large part because they've been politically polarized under Trump. By taking steps to ensure Americans that the experts are leading the response and the best science is the guide, Biden could help rebuild some faith in these institutions.
- Prepare the country for a vaccine: If all goes well, a vaccine will be proven to be safe and effective in clinical trials before Biden takes office. But that's just the beginning. After that, the vaccine will have to be distributed to every corner of the country so hundreds of millions of Americans can actually get it. It will be a massive operation — one that experts often compare to nationwide wartime efforts — and the federal government will need to lead that operation to ensure it all goes well.
Crucially, much of this, particularly elements that require more money, will require support from Congress. How quickly Congress acts could dictate how quickly Biden does. And with more than 800 Americans dying of Covid-19 a day now and potentially more dying once we're in the middle of winter, every single day, week, and month will matter. But if done correctly, this could get the US closer to normal more quickly. "If you do things the right way, you can do them," Cedric Dark, an emergency medicine physician at the Baylor College of Medicine, previously told me. "If you do them the wrong way, then you're going to get cases." Before that, however, the US will need to get through the fall and much of winter under the same leadership that's made America's Covid-19 outbreak one of the worst in the world. |
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