4 disease experts reveal how they'd address the coronavirus pandemic in the US if they could wave a magic wand
- The US is the new epicenter of the coronavirus pandemic, with more than 101,000 cases and 1,500 deaths.
- Experts told Business Insider that the US has not yet seen the worst of this outbreak - its case total is still rising rapidly.
- The way to stave off hundreds of thousands of deaths is strict social distancing, enforced uniformly across the country.
- Two experts said they would put the entire US on lockdown if they were given a magic wand.
- That would buy doctors time to produce tests, antiviral drugs, and potential vaccines. Otherwise, healthcare systems around the nation will be pushed beyond their limits and many more people could die.
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The US is the new epicenter of the coronavirus pandemic.
A week ago, on March 20, just over 19,000 people in the country had gotten infected and 255 were dead. Now the US has the world's highest number of cases: more than 101,000. At least 1,500 people have died.
The question on many people's minds is: When will we have seen the worst of this?
"We have absolutely not seen the worst," Dr. Mark Roberts, a professor of health policy at the University of Pittsburgh, told Business Insider. "Simulations indicate that there could be possibly hundreds of thousands of cases, and potentially even more."
Recent projections from 18 infectious-disease-modeling researchers suggest that anywhere from 195,000 to 1.2 million people could die by the year's end.
Which begs a second question: How do we save the highest possible number of people?
Business Insider asked four experts what they would do in the US if they could wave a magic wand, given the options we have now.
They all agreed that strict, nationwide social distancing is necessary. Because the virus spreads person to person when in close contact, the best way to stymie it is to keep people apart.
"Pretend that everyone - 100% of people everywhere - would stay at home, not go out, and not get near anyone else," Roberts said. "There would be no new infections. Infections are caused by the actual infectivity of the virus, the number of contacts, and the length of contacts. Social distancing decreases the last two components of that."
An infectious-disease epidemiologist from Washington, DC - whose identity is known to Business Insider but is being kept anonymous because her employer has prohibited her from commenting publicly on the coronavirus - said she would immediately issue "a full, nationwide stay-at-home order for a minimum of two weeks but ideally four weeks."
That's necessary, she said, because the US's response is now "behind the virus' spread." Officials did not mobilize the use of public-health tools like testing and contact tracing quickly enough, she added - if they had, "perhaps strict stay-at-home orders wouldn't be needed."
The US must break the pattern of exponential spread
A person with coronavirus infects two to two-and-a-half other people, on average. Since it's so new, people have not yet developed immunity, which means it can spread easily.
"Exponential growth is actually a very normal pattern for pathogens that a population has never seen before," Meghan May, a professor of infectious disease at the University of New England College of Osteopathic Medicine, told Business Insider. "If no one has any onboard immunity to prevent them from becoming infected, every infected person has the potential to infect many others, who each have the potential to infect many others."
In that sense, she said, the coronavirus is "not necessarily acting in an unusual way - we are just having an unusual experience because so much spread had already occurred in the United States by the time we were able to routinely test for it."
The US has lagged behind other countries when it comes to coronavirus testing. The CDC at first developed its own test, which proved faulty, and the subsequent test-kit shortage has prevented officials from understanding the severity of the epidemic in a timely manner.
More than a month after the US's first coronavirus case was detected, fewer than 500 tests had been done, according to the COVID Tracking Project. As of Friday, 626,000 tests had been completed.
Whether or not the US's rising number of cases is primarily a product of increased testing capacity (May thinks that's a big part of it) or simply shows a spike in people getting infected (as the Washington, DC, epidemiologist believes), the US so far does not appear to be flattening the curve of the virus' spread.
In fact, we're "nowhere close" to that, according to Dr. Scott Braithwaite, a professor of population health and medicine at NYU Langone Health.
"The way I think about it is, the first thing you have to do is get it out of an exponential growth," he told Business Insider. The next goal is to achieve linear growth, followed by a steady decrease in the number of new infections over time, Braithwaite added - "but we're not there yet."
Strict, long-term social distancing
The experts agreed that the most promising way to stop the US outbreak's sharp upward climb is to enforce strict social distancing.
Ensuring that people stay 6 feet away from one another, Braithwaite said, would mean "each person isn't going to transmit the virus to two to three other people anymore, enabling the virus to die out of a population in three to eight weeks."
At the very least, social-distancing rules would delay the outbreak's peak and allow health officials to make progress on a four-pronged response, May said: implementing rapid coronavirus testing and isolating patients, using a repurposed antiviral drug to slow the disease, developing an antibody test to determine who has been exposed and recovered, and producing an effective vaccine.
But right now, the patchwork of restrictions and stay-at-home orders in the US - while helpful - aren't enough, all four experts said.
"People with mild symptoms or no symptoms may still be spreading it around if they are not practicing physical distancing," May said.
Twenty-three states and various metro areas have instituted lockdowns - some stricter than others. But this piecemeal version of social distancing is "not working - and that's because we're not doing it right," Donald McNeil, a New York Times health reporter, said on "The Daily" podcast earlier this week.
Without real social distancing, the experts said, patients will flood hospitals, healthcare workers will face dangerous shortages medical resources like protective gear and ventilators, and local healthcare systems will wind up overwhelmed in a matter of days or weeks.
Braithwaite said that if it were up to him, he would put the entire country on lockdown for three to eight weeks.
"If people think, 'Well, if I change my life in this unpleasant way for three to eight weeks and just weather through it, then maybe in order to get things back to normal,' [they] could do it," he said.
Whenever the restrictions lift, Roberts said, people should also get released from containment measures slowly.
"Strict social distancing for four weeks followed by no social distancing only delays the peak," he said. "It is better to gradually decrease the intensity of distancing."
These recommendations contradict President Trump's approach
President Donald Trump is pushing for the US to return to normal by Easter.
"We have to open up our country, I'm sorry," Trump said on a phone call with governors this week, according to the Associated Press.
On March 22, he vowed on Twitter to reconsider social-distancing measures in 15 days so that the coronavirus cure does not become "worse than the problem itself."
But Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN on Wednesday: "You've got to understand that you don't make the timeline; the virus makes the timeline."
May said the US has two options: Either leaders institute "greater uniformity and continuity across state lines with regard to testing capacity and physical-distancing enforcement," she said, "or we will get to the other side of this the hard way."
If we go hard way, she added, that would mean "the majority of the population will contract the disease and either become immune - after illness or by asymptomatic infection - or they will contract the disease and have a poor outcome."
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