By Donald G. McNeil Jr.
On March 16, back when White House news conferences were still deemed safe to attend, President Trump stood before reporters and announced that drastic nationwide restrictions — in schools, work places, our social lives — were needed to halt the coronavirus.
The guidelines, “15 Days to Slow the Spread,” were accompanied by a grim chart. Based on a prominent model by London’s Imperial College, the chart illustrated with a sinuous blue line how many Americans might die if nothing were done to protect the public’s health.
The line rose sharply as the estimated deaths went up, then drifted slowly down until finally, at the far right end of the graph, the number of new cases reached zero. Our national nightmare would end by October 2020 — that is, right about now. Along the way, if no action was taken, about 2.2 million Americans would die. Dr. Deborah Birx, one of Mr. Trump’s science advisers, referred to the graph as “the blue mountain of deaths.”
Clearly, the pandemic has not ended. So far some 215,000 Americans have lost their lives to the coronavirus, and reliable estimates suggest that the number could reach 400,000. Health experts agree that, with stronger leadership, the death toll would have been far lower.
Nonetheless, there is a collective accomplishment here worth acknowledging. In the Imperial College report, the authors underscored that their worst-case estimate would almost certainly not be realized, thanks to human nature: “It is highly likely that there would be significant spontaneous changes in population behavior even in the absence of government-mandated interventions.”
That prediction proved true, as millions of Americans agreed, however reluctantly, to accept the sacrifices involved in shutting down parts of the economy, keeping distance from one other and wearing masks.
In the day-to-day fights over reopening schools or bars, it is easy to forget that there was a time when the idea of canceling large public gatherings — the St. Patrick’s Day Parade, the N.C.A.A.’s March Madness basketball tournament — did not seem remotely necessary. That there was a time when leading health officials said that only sick people and hospital workers needed to wear masks.
Today, and despite the president’s own resistance, masks are widely accepted. Various polls show that the number of Americans who wear them, at least when entering stores, went from near zero in March to about 65 percent in early summer to 85 percent or even 90 percent in October. Seeing the president and many White House staffers stricken by the virus may convince yet more Americans to wear masks.
The slow but relentless acceptance of what epidemiologists call “non-pharmaceutical interventions” has made a huge difference in lives saved. The next step is pharmaceutical interventions.
Some are already modestly successful, such as the antiviral drug remdesivir and steroids like dexamethasone. But in the near distance are what Dr. William Schaffner, a preventive medicine specialist, has called “the cavalry” — vaccines and monoclonal antibodies. They are likely to be far more effective.
Since January, when I began covering the pandemic, I have been a consistently gloomy Cassandra, reporting on the catastrophe that experts saw coming: that the virus would go pandemic, that Americans were likely to die in large numbers, the national lockdown would last well beyond Easter and even past summer. No miracle cure was on the horizon; the record for developing a vaccine was four years.
Events have moved faster than I thought possible. I have become cautiously optimistic. Experts are saying, with genuine confidence, that the pandemic in the United States will be over far sooner than they expected, possibly by the middle of next year.
WHERE IS THE PANDEMIC HEADED?
That is still some time off. Experts warn that this autumn and winter may be grim; indoor dining, in-classroom schooling, contact sports, jet travel and family holiday dinners may all drive up infections, hospitalizations and deaths. Cases are rising in most states, and some hospitals already face being overwhelmed.
The final death toll from Covid-19 will depend both on how we behave going forward and how quickly innovations arrive.
Already the United States is faring much better than it did during the Spanish influenza — the worst pandemic to hit the country to date, and the one to which this one is often compared. It began in early 1918 and did not completely fade away until 1920, when herd immunity arrived, at the cost of 675,000 lives. The country’s population at the time was 103 million, so that toll is equivalent to 2 million dead today.
Pandemics don’t end abruptly; they decelerate gradually, like supertankers. The Centers for Disease Control and Prevention has estimated that about 10 percent of the American population has been infected. As that figure grows, and as people begin to get shots after a vaccine is approved, transmission should slow.
Every Covid survivor and every vaccine recipient will be a broken link in the chains of transmission. There have been rare cases of people becoming infected twice; this happens even with chickenpox. But scientists assume that almost everyone who recovers from Covid cannot get or transmit the virus, at least for many months. Even by spring, we will not be entirely safe, but we probably will be safer.
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In the interim, as the pandemic runs its course, the percentage of infected people who die from the virus has been falling. The reasons are many.
The average age of each new person infected is almost 30 years lower than it was in March. Fraternity brothers may be reckless, but few older Americans are.
Nursing homes have become better at protecting their wards. The death rate per nursing home resident in states that were hit by the virus in late summer is about one-quarter the rate in the northeastern and southern states that were hit first.
Simple interventions like pulse oximeters are detecting pneumonia before it becomes life-threatening. Steroids like dexamethasone have lowered the number of deaths among hospitalized patients by about one-third. Rolling patients onto their stomachs and delaying ventilator use also helps.
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