Is There A Long-Term Strategy For Overcoming The COVID-19 Pandemic?

Mar 23, 2020
Originally published on March 23, 2020 11:12 am
Copyright 2020 NPR. To see more, visit https://www.npr.org.

STEVE INSKEEP, HOST:

What's the strategy for overcoming the coronavirus pandemic? I don't mean a short-term tactic; I mean a longer-term strategy. We now know some early moves by the United States - an effort to stop flights from China - did not quite stop the virus from arriving. An effort to test for the virus suffered numerous delays. Now millions of Americans are staying home and practicing social isolation. The federal government asked for 15 days of that, but that alone is unlikely to end the crisis. We are very early in a long struggle, which we'll examine over the next 11 minutes.

We start with NPR global health correspondent Nurith Aizenman. Good morning.

NURITH AIZENMAN, BYLINE: Hi. Good morning.

INSKEEP: So if not 15 days, how long is this fight likely to last?

AIZENMAN: Well, the short answer is probably around 18 months. You know, the thing to remember is that human beings have never encountered this virus before; none of us have immunity. And so really, all of the strategies for fighting this add up to one goal, which is slowing down the pandemic, limiting the number of people who get sick - basically buying humanity time until scientists can come up with a vaccine. And there are so many steps to that - testing it to make sure it's safe, make sure it works; manufacturing it, giving it to millions and millions worldwide. And the timeline we're hearing for that is maybe a year, probably more like 18 months.

INSKEEP: OK. So 18 months is the goal - surviving 18 months. And people are naturally going to wonder, so wait a minute - is the government going to ask me to stay home for 18 months? - 'cause I can't do that. That's going to be hard for people.

AIZENMAN: Yeah. I mean, there's wide recognition that that kind of blanket strategy is not sustainable indefinitely. And the way to think of it is really Phase 1 in a larger effort to get us to a situation where we can bring down the number of cases low enough and we can ramp up our testing and treatment capacity high enough so that then we can manage this through some kind of more targeted strategies. And some countries like South Korea were able to move quick enough early on that they are already in that phase. But researchers and modelers are telling us that here in the U.S. right now, the virus has already spread so widely and new cases are rising so fast that we need to take immediate drastic action now to slow it down before we can contemplate those next steps.

INSKEEP: Are we even fully in that first phase, by which I mean are enough people practicing social isolation and staying home?

AIZENMAN: Well, frankly, what I'm hearing from researchers is no. You know, sure, there are a number of very large U.S. states that have issued stay-at-home rules, but that is not the case for people in many parts of the country. And really what you want to do is impose these drastic measures to stop people from interacting face-to-face before the cases start to erupt in a really obvious way. And because we don't have adequate testing in the U.S., we don't yet know where the next hot spot is brewing and we're still mostly flying blind.

INSKEEP: Oh - because of the lack of testing.

OK. So we are in this 18-month fight. We're in an early phase and maybe not even fully into that early phase. So let's talk about what could come next, what tools are available.

We'll bring another voice into the conversation - Juliette Kayyem. She is a former senior Department of Homeland Security official during the Obama administration. She is at Harvard's Kennedy School of Government, and she has been tracking the coronavirus outbreak. Good morning.

JULIETTE KAYYEM: Good morning.

INSKEEP: Let's say you do get enough people to stay home. Does 15 days buy you enough time to get some other technique in place?

KAYYEM: No. I mean, we just have to be realistic about it. No country has done it in 15 days. Social distancing is just buying time towards managing this virus. So you know, we're not going to eradicate it or suppress it for another 18 months, as Nurith said. So we are now in the management phase. Fifteen days won't do it. We're not even beginning the slope upward here in the United States, and our social distancing measures have been, you know, not national. They have been haphazard - one state does this; one city does that.

So we are looking at a much longer period. Dr. Fauci says anywhere from six to eight weeks, where we just try to buy ourselves some time - in the meanwhile, surge resources to stabilize our health networks so that they don't crumble as more patients come into them.

INSKEEP: Oh, things like hospital beds and respirators and masks...

KAYYEM: Exactly.

INSKEEP: ...And that sort of thing. But let me just ask what happens after that six to eight weeks. Let's say...

KAYYEM: Yeah.

INSKEEP: ...That we're all staying home for six to eight weeks, people naturally wonder, once we all start to come back out again, as we have to to resume normal economic activity because we have to, does the disease just explode then?

KAYYEM: No, it won't if we do this right. And that is - what we're trying to do is go from, you know, what we're in right now, which is community spread, to what might best be called is whack-a-mole. Right? We're trying to simply isolate and identify the people who are sick or potentially sick and then isolate anyone who would have been near them. It's called test and trace, so it's dependent on getting tests in.

At that stage, then we'd be able to isolate the sick, test their contacts, care for them in available intensive care beds with available respirators because we've surged resources. It will look and feel different. I mean, there will - it won't feel normal because there will be outbreaks here and there, and the lights don't go on immediately. But we will begin to get, you know, essentially what's a steady-state suppression effort until we get a vaccine distributed.

As someone who thinks about response and homeland security, at that stage, then we can minimize harms but also maintain some social cohesion. We're not close to that yet.

INSKEEP: Nurith Aizenman, you mentioned briefly South Korea. When Juliette Kayyem talks about test and trace, is that what South Korea did that seems to have been quite successful in leveling this off?

AIZENMAN: Yeah. For the most part, they have not done the kind of, you know, countrywide lockdown approach that China had to do because they caught this early enough on that they were able to do this contact-tracing. They do an incredibly elaborate version of this, but they are sort of one of the models that we'd be looking to. And then also, we're going to see in China where they're going to be - you know, they're slowly unfreezing the country. And that will be also a really interesting test case of whether this more targeted approach works and how and what lessons we can learn.

INSKEEP: Juliette Kayyem, are we then looking at a situation where we all resume normal life or what seems like normal life but periodically Chicago has to shut down or someplace where there's a hot spot has to shut down?

KAYYEM: That's exactly what we would envision. I mean, at some stage, you know - and I hate to use this analogy - it might feel a little bit like gun violence or mass shootings. That there's - something happens, and then we have to respond. But we have no language for this in homeland security. This is the struggle. In the military, we have a concept of acceptable losses - right? - that you do something - you invade, you do whatever - and you accept a certain number of losses because the goal of, you know, basically society functioning is worth it. Here, we don't have that language, but it's basically how we're planning it, which is there'll be some losses but we have to open up.

INSKEEP: And Nurith Aizenman, we're here talking about a strategy - possible strategies. We're about to ask what the federal government strategy seems to be. But you've been hearing from health professionals across the country. Do they and do state officials and local officials sense what the long-term strategy is?

AIZENMAN: You know, I think no. And I think one of the things that, you know, one public health official that I talked - public health researcher that I talked to who talks to governors told me is that they need to do a better job of really articulating what that next phase strategy looks like - what's the moment that you get to it and how does it work? - because some of the governors that are thinking about imposing these kinds of measures are hesitant to do so because they don't know how long they have to do it for. They want to know, what's the exit strategy? And that's going to be really important to articulate.

INSKEEP: OK. NPR's Nurith Aizenman and Juliette Kayyem of Harvard University, thanks to both of you.

KAYYEM: Thank you.

AIZENMAN: You're welcome.

INSKEEP: Well, let's ask what the strategy is as best we can determine. And NPR White House correspondent Franco Ordoñez is on the line next. Franco, good morning.

FRANCO ORDOÑEZ, BYLINE: Good morning.

INSKEEP: You've been watching all these briefings - hours and hours of briefings with the president, vice president and many health officials. What's your best understanding of the longer-term, one-year - 18-month strategy?

ORDOÑEZ: Yeah. I mean, it is really, frankly, a bit unclear. You know, the president is saying that there is a long-term strategy. He just delivered a tweet yesterday about - saying that after 15 days, they will have - they will make more decisions. But frankly, the rest of the society is already well past those 15 days. Schools are closed for much later - my kids' schools are closed until mid-April. Conferences are being canceled. There's questions about whether the Olympics will be played.

And the president is more focused, right now at least, on short-term goals, like helping states get masks and ventilators they need, providing additional bed space for hard-hit areas like California and New York. And there's a lot of hope there, too, about wanting the economy to improve, hoping that unproven therapies will surprise, you know, public health officials. There's just so many questions left.

INSKEEP: You alluded to that presidential tweet which gets the strategy without quite saying what the strategy is. And it's quite meaningful here. I want to read this quote - this is from the president - "we cannot let the cure be worse than the problem itself."

That's his first sentence. What is that alluding to there?

ORDOÑEZ: I think what he's alluding to is he does not want the issues that could come out of this, such as the poor economy, the bad economy, the people - the loss of jobs, could hurt America worse than the virus itself. There's already much discussion about unemployment dropping down to 30%. That would be incredible. Numbers of people are already out of jobs. It's a very scary time.

INSKEEP: OK. So he's saying, let's not completely destroy the economy by making everybody stay home too long. But then he says, "at the end of the 15-day period, we will make a decision as to which way we want to go," acknowledging there perhaps that a strategy is not in place - the longer-term strategy.

ORDOÑEZ: Yeah, I think the longer-term strategy is very uncertain. The president says there is a long-term strategy, but it's very light on details. You know, we've spoken and we've heard from the president many, many times about plans for the short term. Vice President Pence was touting how we are on Day 7 of the 15-day guidelines just yesterday. Well, those seven days - you know, the next six days are going to come by extremely quickly - pardon me, the next eight days are going to be - come very quickly. And we need plans. We need more plans to - so society can continue.

INSKEEP: Does the sheer scale of the aid legislation that Congress is debating right now - close to $2 trillion - suggest that lawmakers do see a long-term fight?

ORDOÑEZ: I think so. I mean, the expanding price tag of that package shows the expanding pressure that lawmakers are under. So many people are under - out of work. And they really need to get this going.

INSKEEP: Bottom line here - it could be an 18-month battle according to the experts. We will continue tracking it.

NPR's Franco Ordoñez, thanks so much.

ORDOÑEZ: Thank you.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.