A Pandemic Comes to the U.S.—An Analysis (21 March 2020) by Lawrence Davidson
Part I—Uncomprehending and Unprepared
On 10 March 2020 U.S. President Donald Trump told reporters in reference to the novel Coronavirus (Covid-19), “It will go away, just stay calm.” He added, “It’s really working out. And a lot of good things are going to happen.” (This is also the president’s attitude toward global warming.) When soon it became clear that things were not “working out” and “good things” were definitely not happening, he denied any responsibility. “I don’t take any responsibility at all” and proceeded to blame the previous administration of Barack Obama. Actually, all of this was in character for President Trump. He has never shown any ability to think ahead and respond to events in a well thought out fashion. His ability to own up to his own mistakes is like that of a 16 year old teenager.
He is also ignorant of what he is dealing with. But here at least he is not alone. Most people, including the vast majority of Americans, don’t know much about Covid-19 or where it comes from. That is one reason why it is so easy to misidentify it is a “Chinese disease.” Alas, diseases don’t carry a nationality. Also, people are only vaguely aware of the exponential growth potential of this disease and why that factor justifies the kind of social distancing policies that many governments are now adopting. So below, I will give some details on these factors.
I confess I am not an expert in any of this, but if my anecdotal experience is at all accurate, I know more than my neighbors. I will strive for accuracy and, If I make some notable mistake, I am sure someone out there will let me know. If an error is confirmed, I will send out a correction or elaboration.
Part II—What is Covid-19?
Covid-19 has the label of a Pandemic disease—one that is spreading through large areas of the globe. “Mere” epidemics are more localized. Covid-19 is also a novel or new disease which in this case means that it is a mutation of a virus that already existed in nature. Such terms as pandemic and epidemic do not say anything about the severity of the disease, and so they can run the range from relatively mild to deadly. Flu epidemics and pandemics are good examples of this—thus the annual flu season can vary in its intensity. On the other hand, the infamous Spanish Flu of 1918 (which wasn’t Spanish in origin) was a pandemic that is estimated to have killed between 20 and 50 million people worldwide. Coming toward the end of World War I, the victims included hundreds of U.S. and Allied soldiers and sailors confined to transports and other ships heading to and from France. Those vessels, like today’s cruise ships, served as incubators for the disease.
As noted above, Covid-19 and its kin are viruses. Viruses are different than the bacteria that cause many infections. Antibiotics take care of most bacteria-caused diseases, though the overuse of such drugs can, and have, produced “superbug” bacteria that are resistant to most antibiotics. In fact, in the realm of warfare against bacteria causing illness, it is a constant struggle between the bacteria’s ability to mutate and production of more effective antibiotics.
Viruses cannot be treated with antibiotics. The best way to fight them is through vaccines. Most vaccines work by taking an inert sample of the disease agent and using it to safely stimulate the body’s immune system, thus creating a ready ability to produce the proper antibodies to the illness if it is contracted. Unfortunately, a vaccine cannot be developed overnight, if one can be developed at all for a particular microbe. So, often their is an interim period between the appearance of a truly novel virus—such as Covid-19—and the production and distribution of an adequate vaccine. Even when available, vaccines are not 100 percent effective as can be seen with the annual flu vaccines. This is because, like bacteria, viruses mutate.
In the case of most viruses and bacteria, you catch the disease in the following ways: 1) close contact with an infected person or animal, whose microbe-laden body fluids are spread through sneezing, coughing, sweating, excreting, and so forth; 2) Touch surfaces that has the virus or bacteria on it due to previous contact with an infected person or animal: the survival time outside the body of any particular disease agent varies. Covid-19. seems to be able to survive between 3 and 72 hours depending on the nature of the surface, such as a door knob, computer keyboard, box of cookies, etc.
These facts speak to the usual list of dos and don’ts: hand washing, not touching your face (but covering your mouth and nose with the inside of your elbow if you have to cough or sneeze), and keeping your social distance (a sneeze can shoot out the bad bugs some ten feet). These are familiar recommendations (if often ignored) because they also apply to the common cold. Community lockdowns enforcing social distancing, on the other hand, are really new and can be life-altering requirements. Where does the need for such extreme measures come from?
Part III—The Threat of Exponential Spread
New infectious viruses are often mutations of existing ones and/or animal-based viruses that somehow manage to jump from their animal hosts to humans—the latter kind being referred to as zoonosis diseases. Ebola and HIV (Aids) are diseases that made this jump. Bats are one ready source of coronaviruses that do occasionally jump to humans. Bats are hosts to multiple strains of such viruses which often get spread via intermediate hosts (civits, pangolins, and camels) which in turn can pass them on to humans. Conversely, as in the case of Ebola, some viruses have made the bat-to-human jump directly.
No one really knows where Covid-19 originated. We do know that there was an initial outbreak in Wuhan, China, amongst people who worked in a market that sold wild animals, but some of these animals were imported into China, so the Covid-19 strain that is causing all this trouble could well have originated further afield.
Because Covid-19 is new, humans have no inherent immunity to it, and that creates the prospect of exponential spread. This means that when left to itself, the disease will increase at a very rapid rate. How fast depends on circumstances, and this factor allows for human intervention. That rate of increase of an infectious disease is mathematically represented by a “basic [rate of] reproduction number,” the symbol for which is R0 (R naught or R zero). We will abbreviate it and just use R.
Say you have a disease with an R number of 2. That means the first person with the disease, patient 0, will on average give it to two others, who will each give it to two more and on it goes. Think of it this way: 1×2=2, 2×2=4, 4×2=8, 8×2=16, etc. On a graph, this rate of increase is known as a J curve, because it shoots up rapidly.
The Covid-19 virus has an R number of 2.5 (1×2.5= 2.5, 2.5×2.5= 6.25, 6.25×2.5=15.62,15.62×2.5=39.05, etc.). By the way, the R number for the measles can range between 12 and 18, which is why taking the vaccine for this disease is so important.
Given the explosive spread potential of such a novel infectious disease as Covid-19, the aim is to flatten out the J curve by creating environmental circumstances that force the R number to 1 or less. Do that and the pandemic begins to slow down (see addendum below). So how do you do that? The Washington Post has set up computer simulations of four different approaches: doing nothing, enforcing a quarantine (such as the Chinese one), setting up a scenario of moderate social distancing, and finally establishing a scenario of extensive social distancing.
Obviously, doing nothing is unacceptable to a vast majority of people (though, as we will see, there are exceptions). In the case of the Covid-19 in the U.S., a country of 330 million, a hands-off approach would most likely find millions of Americans infected, and thousands dying, by summer. A strict quarantine for so large a population is difficult to do without the use of near-totalitarian methods and is probably politically and culturally unacceptable within the Western milieu. That leaves “reasonable enforcement” of social distancing. According to the computer modeling referred to above, the most effective scenario is that of “extensive social distancing.” It is no surprise that this approach is exactly the one now being tried in much of the United States and Europe.
There is the corresponding question of how long such social distancing has to go on. Given that in the U.S. the authorities have come up short on the issue of testing, the answer to that question is complicated by the uncertainty of how many Americans are infected. As a rule, the earlier the intervention, the shorter the time necessary for flattening the J curve. The U.S. is, if you will, behind the curve in this regard. Given the population size, it will take longer than the two-week window associated with the appearance of Covid-19 symptoms.
Part IV—President Trump’s Irresponsibility
We began this analysis by noting that President Donald Trump was, for far too long, dismissive of Covid-19 and in favor of doing nothing. On 28 February, a month after cases of Covid-19 showed up in the U.S., “Trump lashed out at Democrats for raising alarm about the virus, calling it their [the Democrats’] “new hoax.” Indeed there is evidence that Trump thought of the idea of a pandemic as a fantasy, and as a consequence in 2018, his administration shut down the government’s “global health security team” and later cut the budget of the Centers for Disease Control’s department for animal-to-human transmitted infectious diseases by 20 percent. Presently the Centers for Disease Control and Prevention has a budget of about $11 billion to defend the nation against a very real pandemic. In the meantime, Trump engineered a defense budget of some $738 billion, with which the Pentagon, at least in immediate terms, it defends the country from nothing.
Soon enough the spread of Covid-19 became something Trump could not just dismiss with throw away lines like, “just stay calm, it will go away.” Even so, the president could not get beyond that naive and blasé attitude. Again acting in character, he told his Cabinet in early March 2020 that he wanted to see “low numbers” when it came to the spread of Covid-19. He thought that low numbers now would boost his “potential reelection” in November.This despite the fact that he had done nothing to actually realize low numbers. This was a sure sign of a deluded mind that insists there can be no difference between his own desires and reality. The result was a period of blatant lying on the part of Trump and his staff and the failure to create a testing infrastructure to help ascertain the real numbers of the pandemic as it spread through the country. It also confirmed Donald Trump as a criminal accomplice to that spread.
Now, of course, with reality having become undeniable, the president is in the process of rewriting his own history. On 17 March 2020 he told reporters “I’ve always known this is real—this is a pandemic. I felt it was a pandemic long before it was called a pandemic.” That is again the delusional Trump—Trump the congenital liar.
Part V—Conclusion
This failure of our present leadership should be a warning to us all. Don’t judge prospective leaders on airy platform promises or after-the-fact rationalizations, but rather on a demonstrated ability to think straight and with foresight, along with an ability to rationally adjust as conditions change. Of course, folks have to be able to recognize those qualities in others. Avoid leaders who are bound by an ideology that confines their interests to one class, and biases that display misogynistic, racist, and/or fundamentalist leanings. Of course, to choose such leaders, folks have to themselves be free of such biases. Finally, always go for the leaders who believe in science. One might note that Donald Trump fails on all points. How many others fail as well?
So will we be prepared the next time? The United States and the rest of the world will eventually overcome Covid-19. But, as it is not the first pandemic we have faced, it will not be the last.
ADDENDUM:
From the New York Times Covid-19 Briefing of April 23, 2020
“Does an R naught below one mean the virus is defeated? No. An R naught of 0.8 means that 100 people would infect 80 more, and those people would go on to infect 64 more, and so on. While the spread of the virus is slowed, people can still get sick and die.”
