Is the United States too far gone to save from COVID-19? Here’s what the experts say
In a country of 331 million people, with 50 state governments employing 50 different approaches to the coronavirus crisis, whoever wins the election in November has a mammoth task ahead to contain the outbreak.
The virus has killed more than 205,000 people in the United States, accounting for one out of five deaths worldwide despite the country’s wealth and world-class medical resources.
Twenty-eight states reported their daily record high of COVID-19 cases in the month of October as experts warned another wave, maybe even bigger than the last two, would hit the US this winter.
So what would public health experts, epidemiologists and economists do if they were in charge?
The ideas are as wild as they are endless, ranging from a multi-billion dollar mass testing plan to implementing another circuit breaking lockdown.
While some solutions appear more in keeping with the models of other nations — including testing, tracing and isolating — others are designed to better fit the American system of governance.
But would any actually prove useful to the US President after the election?
The first problem is a fragmented system
As with other countries, the states take the lead in managing their own coronavirus outbreaks in the United States.
A possible nationwide response could be adopted in conjunction with state measures, but the president would still need every state to be on board with his plan.
“The biggest problem is that most of the actions that can be taken, the authority to take them is at the state level, not at the presidential level,” senior lecturer in American politics and foreign policy at the United States Studies Centre David Smith said.
“So things like lockdowns, mask mandates, closing schools — all of those things happen at the state or local level.
“And there’s not a huge amount that the president can do directly with those kinds of public health measures.”
Dr Smith said the president can certainly encourage states and local governments to take those kinds of measures and can issue guidelines through agencies like the Centres for Disease Control, but at the most, “their guidelines are recommendations”.
“If Joe Biden got elected president and … if he wants a nationwide mask mandate, for example, he would face a lot of resistance from Republican governors if he suggested or recommended something like that,” he said.
“So the big political problem is with how fragmented everything is in America.”
Despite this, there have been some interesting ideas put forward to tackle the pandemic.
We’ve highlighted five of them and asked the experts for their views on whether any are likely to be considered in the United States.
Test, Trace, Isolate
It’s regarded as public health strategy 101 for a reason.
According to the Centre for Disease Control in the US, case investigation and contact tracing is a key strategy for preventing further spread of COVID-19.
But so far the strategy has failed to be adopted at a nationwide scale across the US. There are a couple of reasons for that, according to Dr Smith.
“Other strategies were tried earlier in the year on Trump’s government issued guidelines, [for example] for a period in March specifying sort of semi lockdowns and social distancing and things like that.
“But it’s clear that Trump doesn’t like those measures, he doesn’t even like mask-wearing.”
Even if it was on the table — say, if Biden became leader — it would be difficult to get a nationwide test, trace and isolation policy up and running.
“Even if Biden wanted to introduce a much bigger range of testing, tracing and isolation, it would be up to the states to do it,” Dr Smith said.
“Some have shown a willingness to do it, but a lot of others haven’t. And that’s the problem that Biden would face.”
Epidemiologist Dr Mary-Louise McLaws said that “what goes with the testing is cooperation to isolate”.
“While it’s good in theory … we found in Australia that testing was related to anxiety about how to meet the financial requirements to pay the rent [if you were to test positive].”
Dr McLaws said that you would need an appropriate economic response alongside a public health response.
It came amid a stand-off between Democrats and Republicans on the size of the package, with Mr Trump offering $US250 billion while House Speaker Nancy Pelosi was holding out for more than $US400 billion.
The delay prompted US Federal Reserve chair Jerome Powell to warn of an increased risk to households and businesses, especially with the country suffering an unemployment crisis and lacking the welfare safety net of other developed countries.
It has already left some families in a very vulnerable position.
A circuit-breaking lockdown
When Singapore faced a second wave of coronavirus in April, it ordered a “circuit-breaker” — an eight-week lockdown for all citizens.
Of course, that’s easier to order in a city-state where the Government has significant power, and its five million residents are known for complying with authorities.
It’s a different scenario in a country the size of the US, with the population of some states similar to that of countries.
While some experts say forcing Americans back into their homes is the only option, others say it is legally challenging and culturally impossible.
“It would be really a morale breaker,” Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told STAT, an American health website.
“The stress and strain that people were under during prolonged lockdown is the genesis of why, when they were given the opportunity to try and open up, they rebounded so abruptly.”
Dr Smith also suggests that one of the biggest problems with this plan is that it’s actually up to the states, not the US government, to decide.
“It’s up to governors who have the executive power to make those decisions at the state level and there have been some fairly successful examples of [lockdowns] in the US,” he said.
“But a lot of governors see it as more important to keep the state open economically than to engage in lockdown and there isn’t really anything that the president can do about that other than, you know, making public pleas for them to do it.”
The idea is to test everyone. Test repeatedly. Test again and again. Test your way out of disaster.
But the theory goes that it would be a bargain since it would also allow the country to operate almost normally.
It suggests people get a COVID-19 test once a fortnight. If you test positive, you are quarantined while contact tracers try to lock down the cluster. If you’re negative, you go to work and school and bars and restaurants.
Another option would be a cheap, daily test Americans could take at home — similar to a pregnancy test.
Harvard University epidemiologist Michael Mina says the regime would be nearly as effective as a vaccine in stopping the spread of the virus.
However, the testing scheme only works if people willingly submit to regular swabs and if the US Government (or a philanthropic billionaire) is willing to pay for it all.
It would also require some legislative changes so that batch testing could be legal in the US, or the cheap, at home kits could be recognised.
According to Dr Smith, rapid testing is already happening but on a much smaller scale.
“You look at the US, you see NBA players can be tested rapidly, White House staff can be tested rapidly,” he said.
“And as long as Republicans are controlling one House of Congress, even if they lose control of the Senate but have a large enough minority, it’s not going to happen.”
Bring America’s best and brightest together
America is filled with smart people. And according to Stanford Health Policy researcher Jason Wang, the US should be getting them all brainstorming on a solution to the coronavirus crisis.
“We’ve got the smartest people here in the US because they come from everywhere. But right now those are untapped resources,” he told VOX in March.
“We ought to get the big companies together. Get the governors together, get the federal government agencies to work with each other, and try to find innovative ways to think about how to best do this.”
Mr Wang said these “untapped resources” could be used to predict the next hot spots, pulling data from all the states in conjunction with the federal government agencies, which could be used by big tech companies.
Dr McLaws said there was some merit in this proposal, but it also came down to the collective psyche in America.
“As long as the Americans can cope with having their privacy invaded electronically, [it might work],” she said.
“[It may be] very well and good to find the hot spot [using this technology] but if you don’t get the public on the side [they] are not going to cooperate.”
Some US resources have also already been put to use, with a number of companies currently working on vaccine trials for the coronavirus.
According to public health policy experts, an elimination strategy requires a high-performing surveillance system to be in place to allow quick tracing of any new cases.
It’s worth clarifying here that we’re talking about elimination, which is defined as the absence of a disease at a national or regional level and not eradication, which refers to its global extinction.
An example of how this strategy could be adopted is in New Zealand’s approach.
However, two public health experts wrote in the Conversation that there were five key risk management approaches the country needed to adopt to achieve lasting protection from the pandemic:
- 1.Establish public use of fabric face masks in specific settings
- 2.Improve contact tracing effectiveness with suitable digital tools
- 3.Apply a science-based approach to border management
- 4.Establish a dedicated national public health agency
- 5.Commit to transformational change to avoid major global threats
Already, it’s clear there are some potential roadblocks to this strategy being adopted in the US.
One in particular, is that there is less of an ability for the president to implement full scale lockdowns or quarantine measures in the event of more outbreaks.
“There could well be a third wave and a lot of governors are going to be reluctant to deal with that with lockdowns,” Dr Smith said.
“And [it’s] basically the states who have responsibility for all of the public health measures, everything from testing and tracing to quarantine to lockdowns.”
Dr Smith says in comparison with the US, there had been a level of cooperation in Australia, which is possible because “it’s a much smaller country with far fewer federal units”.
“It [must also] be said, the Federal Government was a lot more on the ball from the beginning about what would potentially be required in terms of making cooperation happen,” he said.
So what strategy is the US using currently?
Mr Trump appears to be preoccupied with the development of a vaccine or other treatments.
In February, he said that one day soon the virus would just “go away. It’ll disappear”. But while many experts publicly disagreed at the time, Mr Trump has since gone on to make the claim repeatedly.
“That’s Trump’s only strategy and the problem with that strategy is it could take a very long time to develop the vaccine,” Dr Smith said.
“Trump, for the most part, if he gets re-elected, he’s probably not even going to try the kinds of public health measures that have worked around the rest of the world.”
Just this week, a report by Columbia University estimated that between 130,000 and 210,000 COVID-19 deaths could have been avoided in the US.
It called the US Government’s response to the pandemic an “enormous failure” and said the “weight of this enormous failure ultimately falls to the leadership at the White House — and among a number of state governments — which consistently undercut the efforts of top officials at the CDC and [Department of Health and Human Services]”.
“A pandemic is not a time for a decentralised and combative national response. It requires strong leadership and coordination across states towards a common purpose of defeating the threat with the might of the whole nation,” it said.
While other countries consider tougher restrictions in light of a second wave, US media has reported how individual mobility is increasing on a week-to-week basis in all 50 states.
Mr Biden, who often wears a mask and has said he would require masks nationwide, has warned against a rushed release of a vaccine.
“I’m saying trust the scientists,” he said last month.
According to Dr Smith, Mr Trump has basically put “all of the eggs in the vaccine development basket”.
“Maybe that’ll pay off, maybe there will be a vaccine, not probably this year, but early next year,” he said.
“But there’s a lot of risk involved with that. It could take a lot longer than anyone expects.”