On Tuesday, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, testified before Congress that the U.S. is seeing a “disturbing surge” in coronavirus cases. He added, “The next couple of weeks are going to be critical in our ability to address those surges we are seeing in Florida, Texas, Arizona, and other states.” There have now been more than a hundred and twenty thousand deaths from the virus in the U.S., and the American caseload, after being relatively even with Europe’s, has soared ahead of it. Despite these indicators, most states are in the process of reopening their economies.
欧洲杯买彩票To discuss the status of the pandemic and how Americans should think about conducting their lives in response to it, I spoke by phone with Marc Lipsitch, a professor of epidemiology at Harvard’s T. H. Chan School of Public Health. During our conversation, which has been edited for length and clarity, we discussed why contract tracing may be less effective than some had hoped, what states should be doing to contain the virus, and how much outdoor activity is now safe for most people.
What is your big-picture takeaway about the state of the virus in terms of where we are today, on June 23rd?
欧洲杯买彩票In a few places, it’s very much under control and then in other places, like certain parts of the United States and Brazil, it’s not at all under control. Because a small minority of the population has been infected to date, and because of the level of contagiousness that it has, we’re a long way from the point where natural immunity, even if it’s strong, will provide a significant block to further transmission of the infection and, therefore, we’re just in this rather awful position. As at the beginning of the pandemic, most of the population is still susceptible. We’ve learned something about how to control it and what works and especially what doesn’t, and we’re just at a position where further spread is inevitable in most parts of the world. The only question is how we limit that and how we mitigate the consequences of having it, and also the consequences of limiting it, which are also really terrible.
What are your biggest lessons about what has and has not worked?
欧洲杯买彩票I think there’s emerging evidence—not proof yet, but emerging evidence—of some seasonality to transmission. I think we’ve learned that a very intense shutdown of society, as in either the European version or the East Asian version, can reverse transmission even in the season of the year when transmission is probably close to its most intense. A big ingredient in that was the locking down of populations, and another ingredient was the contact tracing and testing and case-based interventions. I think New York and some other places that didn’t have testing in place at the time when the epidemic was most intense, and certainly didn’t have contact tracing in place, have shown that lockdowns alone can control transmission and bring the reproduction number below one.
What we don’t know yet is which parts of that we can relax while still maintaining transmission at an acceptable level. Probably that’s because different people have different ideas about what’s acceptable, and partly that’s because we haven’t done the relaxation in places that really had it under control—and we especially haven’t done that in the winter.
欧洲杯买彩票I think the question is, How much can we restore society to a minimal level of functioning while still controlling the virus? Is there an overlap between acceptable viral control and acceptable social functioning? I think that depends a lot on the location, because both concepts of acceptability are social constructs, but I think it’s going to be particularly challenging in a place like the U.S., which seems to have some of the least tolerance of any place in the world for the pain brought by the lockdowns.
How much of America’s problem is its size, and how much of it is luck, and how much of it is poor policy choices?
欧洲杯买彩票I think size is an important piece of it. I think not just poor policy choices but deliberate minimization of the threat by our national government, and a deliberate sidelining of public-health authorities in the response. And if you take the President’s words seriously, there are deliberate efforts to continue misunderstanding the epidemic by keeping testing limited. It all amounts to a really clear explanation for why we have the size of problem we have.
I think we had time at the beginning of this epidemic—really, almost a couple of months, January and February—to make preparations, to treat this as a preventable possible crisis, and that it was worth investing money, time, and political will to avert, and that’s what a number of other countries did. They built up their health-care systems, they figured out ways to get out testing, and made many other preparations—and our national government actively blocked doing that.
Did those missteps cause the divergence, or is it that we’re not taking steps now that other countries are taking?
欧洲杯买彩票I think we’re missing a second opportunity. In those places where it’s not a crisis right now, which is most of the United States, we should be, again, using the time to actively prepare for the eventuality of having our health-care system overwhelmed and also trying to prevent it. Even this morning, there was news from Florida that the governor is trying to change the reporting of intensive-care beds, and that in a state that’s been one of the worst states for reporting clearly what the data show throughout the epidemic. You know, this is a crisis where good data is essential, and playing around with the way that you report data to try to make things look better is exactly the opposite of what we need. I think that, at some state levels, there are a lot of missed opportunities to be gearing up rather than gearing down. We’re missing the second opportunity. It’s not just the history.
In some places, we’re doing much better. Massachusetts is an example of a place that I think is being about as effective as it could possibly be.
What are they doing that’s so effective?
欧洲杯买彩票New York is another one. The governors are soliciting advice and listening to advice from epidemiologists and scientists. The data being produced are of relatively high quality. It’s challenging to get good data right now, because public health has been not well funded for so long, and the systems are not great, but the quality of data is relatively high in some of these states, like New York and Massachusetts.
In New York City, for example, they’ve been the first that I’m aware of to publish their data on contact tracing, and they got panned in the press for doing it, but they responded to that by publishing more and trying to get more people to look at the data. My understanding is that there’s a clear awareness within state governments like Massachusetts and New York that things could get really bad again, and that plans are being made for how to deal with that and try to avoid some of the difficulties from the first round. It’s treating this as an ongoing threat where, like with insurance, you hope you don’t use it, but you put some money and some time into it because you want to be in a better position should things get bad. Also, the reopening is being targeted to specific metrics of improvements in the COVID欧洲杯买彩票-19 burden, and is being done fairly gradually. That’s really different from a lot of other states.