Coronavirus is no longer just a threat abroad. It is a global pandemic that has reached the United States where, as of noon, March 8th, there have been 464 confirmed cases and 19 deaths. Italy, South Korea and Japan are the three developed countries with the most cases, and China, where this all started, has had the majority of infections and deaths. This is without doubt the most serious public health situation in recent times and has major economic implications. While anxiety remains high, it is important to focus on a swift and effective policy response that requires the concerted efforts of the federal, state, and local governments.
Our primary objective at this time should be to minimize “peak impact” in terms of infections, cases and fatalities. The first fatality in United States was reported in Washington state on February 29th – one week later that number is 19. The spread of coronavirus is exponential over the first few weeks. “Peak impact” is when the largest number of new infections and fatalities are reported. The minimization of the level of peak impact is critical to ensuring that the epidemic does not overwhelm our healthcare system, like what happened in the province of Wuhan in China or is happening now in Italy. The economic impact can also be mitigated by reducing the level of peak impact. Once the cycle of rapid increase has been halted, a stabilization and tail off can happen. We can learn from the current experiences of South Korea, Japan and Italy. The learnings from China are limited because it is hard to decipher and trust their information.
In South Korea, a country with 50 MM. people the first case was confirmed on January 20th , the same day as United States. Today they have tested 158,000 people (0.3% of their population) , have 7,134 confirmed cases and 50 (0.7% of confirmed cases) deaths. Their outbreak happened not in the largest city Seoul but in Deegu City, which is the fourth largest city. In Japan, a country with 127 MM. people, the first case was confirmed on January 16th . As of March 8th, they have tested 8,176 (0.006%) people, and have confirmed 455 cases with 6 (1.3%) deaths. The Japanese have taken aggressive steps recently. In Italy, which has a population of 60 MM. , the first case was reported on 30 January, as of 8TH March they have tested 42,000 (0.07%) people and have 7175 confirmed cases and 366 (5.1%) deaths. Northern Italy is in lockdown as of this morning. The difference between these countries underline the importance of a swift and effective response.
A swift and effective policy response implies a few elements.
First, we need to have a clear policy regarding testing and then managing confirmed cases. We need to leverage academic and private labs – it is necessary that in all parts of the country people can quickly test and confirm if they have coronavirus. In South Korea, they have developed drive ins with results in 10 minutes. Once diagnosed positively, we need a clear isolation protocol across the state.
Second, we have to figure out standards and processes for quarantine, isolation and control of spread. We need to have a systematic criteria for local jurisdictions to implement a set of emergency measures. For example, the criteria can be number of cases per 10,000 people or some other criteria which is objective. The measures can be a clearly defined list including closing down schools, restaurants, events, businesses and travel restrictions. It is important to restrict travel FROM certain places but not all places. These criteria and measures should be developed by experts at state level with Federal guidance and all towns and jurisdictions should be asked to implement them. Individual jurisdictions and entities will neither have the information or big picture perspective to make these decisions. Moreover, these decisions need to be consistent to be effective. By having quarantines in smaller areas quickly, it may be possible to avoid blanket quarantines in large jurisdictions (as was just announced in Italy).
Third, communication and transparency regarding the spread of the virus and more information about the nature of the disease itself should be done on a consistent basis by state and Federal officials.
People need transparency and effective communication from government to be able to make decisions. That is where the Chinese blundered. Our system is setup both legally and culturally to do better. While the press can and will do its job, it is the government which should lead. People don’t just need reassurance but more importantly they need reliable information and facts about the disease, as those facts develop. Confirmed cases, fatalities and number of tests done are the minimum which should be published on a daily basis by state and Federal government. Additionally, further factual information about the disease itself will be help to the public. It is a fact that no one under the age of 50 has died in South Korean outbreak where 158,000 people have been tested and 7,134 cases have been reported. The fatality rate in children and young adults across all countries is small. This is valuable information, especially when confirmed by authorities.
The trajectory in other countries is pointing to the fact that if well managed this epidemic can be overcome in a matter of eight to ten weeks from when the community spread began. It is also expected that the transmission will slow down once weather gets warmer. So excessive pessimism is not warranted. As of end February, the economy has been firing on all cylinders and is at a high point. With swift and effective response from policy makers and our public, and with some luck, we could put this behind us in eight weeks.