Of all the resources lacking in the Covid-19 pandemic, the one most desperately needed in the United States is a unified national strategy, as well as the confident, coherent and consistent leadership to see it carried out. The country cannot go from one mixed-message news briefing to the next, and from tweet to tweet, to define policy priorities. It needs a science-based plan that looks to the future rather than merely reacting to latest turn in the crisis.
Let’s get one thing straight: From an epidemiological perspective, the current debate, which pits human life against long-term economics, presents a false choice. Just as a return to even a new normal is unthinkable for the foreseeable future — and well past Easter, Mr. Trump — a complete shutdown and shelter-in-place strategy cannot last for months. There are just too many essential workers in our intertwined lives beyond the health care field — sanitation workers; grocery clerks, and food handlers, preparers and deliverers; elevator mechanics; postal workers — who must be out and about if society is to continue to function.
A middle-ground approach is the only realistic one — and defining what that looks like means doing our best to keep all such workers safe. It also means leadership. Above all, it means being realistic about what is possible and what is not, and communicating that clearly to the American public.
When leaders tell the truth about even near-desperate situations, when they lay out a clear and understandable vision, the public might remain frightened, but it will act rationally and actively participate in the preservation of its safety and security.
Our leaders need to begin by stating a number of hard truths about our situation. The first is that no matter what we do at this stage, numerous hospitals in the United States will be overrun. Many people, including health care workers, will get sick and some will die. And the economy will tank. It’s too late to change any of this now.
In three to four weeks, there will be a major shortage of chemical reagents for coronavirus testing, the result of limited production capacity, compounded by the collapse of global supply chains when the epidemic closed down manufacturing in China for weeks.
The second hard truth is that at this stage, any public health response that counts on widespread testing in the United States is doomed to fail. No one planned on the whole world experiencing a health conflagration of this magnitude at once, with the need to test many millions of people at the same time. Political leaders and talking heads should stop proffering the widespread-testing option; it simply won’t be available.
Much better, instead, to immediately gear up for epidemic intelligence, based on techniques used for many decades. Among those is so-called illness surveillance, in which epidemiologists survey a sample of doctors’ offices in a given geographic region each day to learn how many patients sought care for illnesses with symptoms of fever, cough and muscle aches. The increasing or decreasing occurrence of patients with these symptoms provides a reliable estimate of influenza activity during the winter months — or now, the incidence of Covid-19.
A third hard truth is that shortages of personal protective equipment — particularly N-95 masks — for health care workers will only get worse in the United States as global need continues to rise precipitously. There is no point holding out the false hope that the Defense Production Act will save the residents of the United States. Not enough manufacturing activities can be converted to produce masks in a matter of weeks. You can’t turn engine-making machinery into an N-95 respirator assembly line just because you want to.
For example, even as 3M was producing at 100 percent of its capacity (35 million N-95 masks a month), a single hospital in New York City used up more than two million masks in February, before the surge in Covid-19 cases there. And new production won’t happen for many months.
If you can’t make nearly enough masks to meet the need, then you must conserve the masks you can make. Unfortunately, some hospitals in the United States are not employing science-based methods for conserving these invaluable lifesaving masks.
Making ventilators — machines that breathe for patients who cannot effectively do so on their own — poses an even more formidable challenge. For example, a Medtronic ventilator has about 1,500 parts, supplied by 14 separate countries. More machines might, at best, be manufactured by the hundreds a month — but not by the thousands, as is needed right now.
It is precisely in the face of such hard truths that a national strategy and leadership are crucial. Otherwise, hospitals, governors and politicians will only vie against one another in the reasonable service of their own constituencies.
“Respirators, ventilators, all of the equipment — try getting it yourselves,” Mr. Trump said on a recent conference call with governors. “We will be backing you, but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”
This is exactly the wrong message. The White House must take charge, keeping track of national inventory, purchasing the precious resources and distributing them where they are most needed at the moment. As Andrew Cuomo, the governor of New York, has suggested, ventilators could then be redistributed as outbreak hot spots shift around the country.
More than anything, what the United States needs right now is for the president to undertake an intellectual Manhattan Project: gather the best minds in public health, medicine, medical ethics, catastrophe preparedness and response; political leadership; and private-sector manufacturing and the pharmaceutical industry.
It took nearly three years to develop the atomic bomb. The effort against Covid-19 will need to be bear fruit within days — and come up with a comprehensive but realistic blueprint for getting America through the next 12 to 18 months, or however long it takes for a vaccine to become widely available or herd immunity to take hold in the population. Once a plan has been devised, the president will have to dispense with any happy talk and instead actually convey what the experts are telling him. He will have to define the new normal for a frightened nation that is looking for facts, direction and a common purpose.
Michael T. Osterholm is director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Mark Olshaker is a writer and documentary filmmaker. They are the authors of “Deadliest Enemy: Our War Against Killer Germs.”