On Monday, Harvard University epidemiology professor Marc Lipsitch predicted that within a year, 40% to 70% of the world’s population would get the novel coronavirus and COVID-19, the disease that it causes. With a world population of 7.5 billion, that means 3 to 5 billion people globally would get the novel coronavirus, and COVID-19 would kill up to 60 to 100 million. This would make the new coronavirus the worst pandemic in history, surpassing even the Spanish Flu of 1918-19 that killed 50 million people.
More relevant to us, here in the United States, we would have up to 130 to 230 million cases of coronavirus, and up to 2.5 to 3.5 million people would die of COVID-19. These numbers are simply mind-boggling.
We obviously cannot stand by and allow this worst-case scenario to play out in America. For this reason, President Trump held a news conference Wednesday on the federal government’s response efforts, during which he named Vice President Mike Pence to lead the virus fight. But it’s unclear what level of anti-virus effort the Trump administration has in mind. President Trump said he would be happy to work with whatever level of anti-virus funding Congress deems appropriate.
As a global health professional, I have worked in the field for over 30 years, mostly in Africa. For the past 20 years, I have focused on infectious diseases, such as HIV/AIDS, tuberculosis, malaria and Ebola. We have learned the hard way that military-style campaigns are a very effective way to combat these kinds of infectious disease viruses, because the way viruses operate conceptually fits into a military model. These viruses are very aggressive; they threaten to invade and overwhelm our national and physical defense systems (our immune systems). To defend ourselves, we have to develop and deploy weapons with which to defeat the viruses.
With coronavirus, the best weapon would obviously be a vaccine, which is, unfortunately, more than a year away. So in the meantime, we have to fall back on other means of defense, such as border security, quarantines, social isolation, virus testing and treatment in isolation units. The risk of taking a low-key federal government approach, rather than aggressively waging war on the coronavirus at the earliest opportunity, is that it may spread much faster and much farther than we anticipate, overwhelming our health systems and our communities. We need strong and unified national leadership, not partisanship. We need to ensure that we go to war on the coronavirus, working together closely as a nation.
Wartime footing against the coronavirus begins with these steps: At a minimum, Congress should pass the initial proposed $2.5 billion emergency funding measure to help with the response, and the Health and Human Services Department and the Centers for Disease Control and Prevention should continue to work with state health departments and private hospital and health systems to update pandemic plans to cover coronavirus. Within days, Vice President Pence should elaborate his detailed plans for leadership of the unified federal response effort, combining the powers of Congress with the expertise of federal agencies with the relevant scientific expertise, such as the CDC.
Outside of government, our U.S. manufacturing base needs to rapidly begin to produce and distribute protective gear and virus test kits to our health care workforce. The current supply of protective apparel for health care workers depends on factories in China that are shut down due to the virus. Even when those factories re-open, they will have to re-supply China first, before they can respond to demand from the United States.
There are four critical lines of defense that we must establish in going to war on the coronavirus:
1. A national strategy with global containment and initial border security initiatives.
Until Wednesday, we did not have a federal leader, a name and a face for the fight against the coronavirus. Now we have the vice president of the United States. Let’s hope that he steps up and takes charge immediately.
The CDC has had a pandemic preparedness plan in place for over a decade, but we need to update it and tailor it to the coronavirus. State and local health departments and public officials need to participate in this process as time permits, and the public needs to know the process is underway to instill confidence.
In terms of information, infectious disease experts, not pundits and social media, must provide timely updates. We need real-time information on numbers of virus cases and deaths, down to the state and local level and updated weekly. In the absence of such information, rumors will fly and panic may ensue.
Scientific information poses a challenge. Science tends to move more slowly than the public’s desire for quick answers. We need to focus on virus detection, treatment and prevention. It is a core part of our national communication strategy to inform people everywhere in the United States about what we do and don’t know and when we can reasonably expect to have answers and better safeguards (a vaccine).
We do know the coronavirus spreads through respiratory droplets (sneezing, coughing, etc.).
We do know that respiratory droplets can travel up to approximately six feet through the air.
We do know that a quarantine period of 14 days is sufficient for coronavirus to emerge.
We don’t know for sure yet if asymptomatic individuals can transmit the coronavirus.
We don’t have a vaccine, but there are many initiatives underway to find one soon.
We don’t expect to have a vaccine ready in a few weeks or months for coronavirus.
Fighting the coronavirus requires international containment, and initial border measures at home. What will and won’t we do, strategically? Americans are unlikely to allow a Diamond Princess-type cruise ship lockdown, in which large numbers of passengers are placed under effective house arrest but denied access to health care. Administration of virus testing was slow on the cruise ship, and the sick and infected were not promptly separated from the non-infected. Japan tried this, and it was a disaster.
Nor would Americans agree to an indefinite lockdown of 50 million people, as has happened in China.
Yet it is easy to imagine how ignorance, panic, rumors, and a lack of planning and preparation could lead to widespread emergency quarantine and containment in the United States. Alternatively, communities could seek to exclude virus victims out of fear and ignorance. Congressional leaders in Alabama rejected using a federal facility there for quarantine purposes. We can expect more “NIMBY” behavior.
To contend with the threat of coronavirus around the world, the U.S. government should fully empower the CDC and the U.S. Agency for International Development with the resources and expertise to assist other governments in need of our help. The better other countries and continents can contain and control the coronavirus, the fewer cases will arrive at our borders.
Can we keep it out? Country after country has seen that it cannot keep the virus in or out. China could not keep it in. Japan could not keep it out. Nevertheless, we can be sure some Americans will call on our government to close our borders to coronavirus. In late January we suspended entry into the United States for foreign nationals who had traveled to China within the past two weeks. Americans who had been to the Hubei province of China were asked to enter a 14-day quarantine on their return. The U.S. government has invoked a public health emergency, giving it quarantine powers.
We have the option to quickly and cheaply screen international passengers at airports for fever, to test those with fever for the virus, and to communicate that a quarantine of 14 days applies for anyone who tests positive. This would be at least one initial line of defense at our borders. To be realistic, however, not every fever represents coronavirus, and not every coronavirus will present with a fever on arrival. So authorities should advise the public that border security alone cannot keep coronavirus out of the United States.
Our government could also monitor outbreaks around the globe, and suspend flights to and from the worst affected areas, except for special cases, such as infectious disease teams. This too is a stop-gap measure.
CDC has cautiously suggested that we may have to consider closing schools, working from home, and banning public events in communities where coronavirus cases have been identified and confirmed. This would have to be done thoughtfully to avoid mass lockdowns of the kind seen in China this year. Japan announced Thursday that it is closing all schools until May, despite only about 900 cases of coronavirus countrywide. Hopefully, the U.S. government will advocate for targeted closures, and only in those cases in which schools, churches, or other gathering places have had confirmed cases of the coronavirus.
2. We need an army of disease experts and health care providers.
You and what army are going to beat the coronavirus? We need leaders—infectious disease experts, but also enlightened and committed public officials—working together, to beat this virus. They need to mobilize an army consisting of infectious disease doctors and health care providers, equip them with protective apparel, and train them in infection control so that they can treat virus positive patients. If Pence is effective in his new role, he could make a world of difference in the U.S. response to the virus. He made a good start Thursday, by naming Dr. Deborah Birx to be the White House response coordinator. Dr. Birx has very successfully led U.S. government HIV/AIDS efforts globally for years.
3. We need weapons in the form of health care facilities, virus test kits and protective apparel, and then a vaccine.
To win a war, you need weapons that work against your enemy. We don’t have a vaccine yet, and current estimates suggest we won’t have one for months if not a year. So, we can’t count on a vaccine this year. What then are our next best weapons to fight the virus? They include virus tests, treatment, quarantine (and self-quarantine) infection control, and surprisingly, simple hygiene such as good hand-washing.
Quickly, there are multiple virus tests, but they are in short supply, and none of them are foolproof. The quarantine measures appear adequate to detect anyone who has been exposed, if the virus tests work. The federal government needs to establish policies and priorities for whom to test, in what order, when and where. People will begin to clamor for the tests, and we need rational guidelines to make use of them.
Health care facilities and training of medical professionals and staff, including local ambulance services, constitute a crucial link to preparation, mobilization, workforce development and equipping ourselves. We have a small time window to draw up a rational hospital plan, and to map out the costs. The UK National Health System is criticized for lacking the capacity to provide beds for everyone who will need them in a coronavirus outbreak. The same is likely to be true in the United States if we do not take action very soon.
4. Resources, including funds, information, and community leadership and involvement.
We have already discussed the need for the administration and Congress to put aside partisanship, and work together to quickly pass an emergency funding measure, and establish policy guidelines and a sense of national purpose around the coronavirus fight. Federal, state and local officials and agencies will all have to ramp up their existing efforts to achieve extraordinary levels of cooperation and effectiveness.
We have discussed the need for timely and reliable information, in the absence of which communities will invent their own misinformation, leading, predictably, to fear, panic and misguided actions. But we can’t rely on national and state leaders to do everything for us. At the community level, we need to get involved, step up as leaders and take rational, effective actions that prevent and treat the coronavirus.
Community leadership must ensure the education and mobilization of the American public. At the same time, and importantly, we must not isolate, marginalize and stigmatize community members. Throughout history, and most recently with Ebola and AIDS, we have seen time and again how a new virus spreads fear and incites panic in populations everywhere, with blame assigned quickly, wrongly and unfairly.
The good news? We can win this war. We won the fight against Ebola in 2013-2014. We can win again.
Carl Henn, MPH, is an infectious disease specialist who has spent more than 30 years working as a global health expert in Africa and other regions to address AIDS, tuberculosis, malaria, Ebola and other infectious diseases. He has worked for the U.S. Agency for International Development, Peace Corps and other organizations outside the federal government.
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