By many measures (like the most cases and the most deaths), the United States has the biggest and worst coronavirus outbreak in the world. Our numbers are the worst, and I suppose you could dispute such a strong statement, but no one who cared about honesty based on factual accuracy could dispute that, although we are on the opposite side of the planet from where the virus originated, and although we are a rich, scientifically advanced country, we are the hardest hit or among the hardest hit.
I can think of lots of possible contributing factors. But after listening to the most recent episode of the Al Franken Podcast, in which he interviewed a brilliant epidemiologist (who happens to be named Brilliant), I’m going to pass along his view of the why, which is fundamentally about the passage of time, specifically the month or more that the United States government, led by its president, spent denying that we had a very serious potential problem, during which the virus spread, almost certainly carried by people who were infected but didn’t know it and moved around the country.
During that month or six weeks, the epidemic spread far, deep and wide. After that period, although you could argue about other things that may have been done right or wrong, it become exponentially (remember that word) harder to defeat or contain the spread.
And, yes, that was the month or more, from late January to early March, that Donald Trump spent downplaying the seriousness of the threat, promising that it would go away by itself when the weather warmed up.
The numbers for doing such comparisons are complicated and problematic. And my negative attitude toward President Trump is a challenge, to which I confess. But it appears that Trump’s unwillingness to acknowledge the seriousness of the COVID menace for six weeks or so after it reached our shores is a big, and perhaps the biggest, reason it got so much bigger here than in many, many other places.
Dr. Larry Brilliant, the epidemiologist whom Franken interviewed last week, is known, among other things, for his work with the World Health Organization in the 1970s, helping to successfully eradicate smallpox in India, which might be a pretty relevant credential for speaking about how to defeat a pandemic. Brilliant currently serves as the chairman of the board of an organization called (amazingly enough) Ending Pandemics. The full interview with Franken is accessible here.
But in case you don’t listen to the whole thing, I’ll just highlight the portion where Franken asked Brilliant about how smallpox was eradicated in India by, as Franken put it, having “lots and lots of people going from village to village, door to door, finding every case of smallpox, [until] you found the last case of smallpox.”
While that is surely an oversimplification, it does seem to get to the essence of what worked in India with smallpox. But the key to its success, and the key to why it’s now too late to do the same thing for COVID in the United States, is that it’s too late to contain the disease once it has spread so far and wide. I’m not suggesting the pandemic will never end; rather that it is too late to contain its spread.
Brilliant seemed less interested than Franken in making the contrast about what worked in India and the failure under Trump to contain or eradicate COVID. For example, Brilliant acknowledged to Franken that the approach that worked with smallpox in India in the ’70s was easier in some ways “because you can see the disease [smallpox] right on their face when you see someone who has contracted it.” Also, unlike COVID, a vaccine existed for treating smallpox. Those are big differences, and I appreciate that kind of intellectual honesty.
But the contrast that Brilliant drew, which at least implied a devastating critique of the Trump administration’s efforts on COVID, was to emphasize the importance, in fighting a highly communicable disease, of acting early, while the number of carriers is small and in a limited area, and then focusing laser-like on locating everyone with whom those infected have had contact, making them likely to develop and/or spread the disease.
That piece of controlling an epidemic is much easier in the age of cellphones, compared to the situation his team faced in India in the mid-1970s where, he said: “It’s harder because it’s India. It was harder because we didn’t even have mimeograph machines, let alone iPhones.”
The sharpest direct criticism Brilliant had with Trump’s excuses on COVID was about Trump’s insistence on minimizing the problem when it was small, which prevented much of America from taking it seriously until it had already spread so far and wide across the United States that it could not be surrounded or contained by isolating those who had been infected or had had contact with carriers.
The best strategy, in both instances, smallpox in India or COVID in America, would be basically the same, he said.
You find every single case, then you do epidemiology. You do backward tracing to find out where they’d been and whom they’ve been in contact with. You do forward tracing, to find who has been in contact with them, who might have caught the disease and have gone to some other place.
You find them and [use the tools that] you have. We had a vaccine then; now we have quarantines. And it works. It was Plan A. It’s what we should have done when the first cases came to the United States in January, which they did, even though the only case that’s been reported that early was February 5 — but that was a death, which means the cases began in January.
That’s what we should have done. But the federal government failed us. We had no testing. They dismissed the threat, constantly saying it would disappear in April. … And the CDC failed us, my beloved CDC. …
(He’s referring to the test, developed by the Centers for Disease Control, which turned out not to work.)
It’s not just, Al, that they failed in that first test. It’s that they then failed to do Plan B, which would have been to bring in the test that the Germans did, that the South Koreans used and China used. … If you’re trying to get rid of a disease and you need to test everybody, and you’ve geared up to make a test and it’s contaminated and it doesn’t work, you get a test from some other place — if you really believe that it’s a serious enough problem, you kind of swallow your pride and you take what you can get.
OK, you’ve heard some of that before. But perhaps we haven’t emphasized enough the consequences of the screw-up in the U.S.-made test and the failure to bring in one that worked.
But the key is what that screw-up cost. It cost time, time that the virus used to spread, as highly contagious viruses do.
This is the key point he made, in explaining why the United States turned into the hottest COVID spot in the world: It was the long delay that enabled the virus to spread beyond the point the contact-tracing epidemiological approach could solve:
When you’re dealing with a virus that … spreads exponentially and the exponent is two or five, you don’t want to give that virus a seven-week, six-week head start. … You can have a billion cases before you know it. It’s really hundreds of millions. …
(This is why I suggested you keep in mind the word “exponential” above. If everyone who catches the virus infects four or five others, the numbers explode pretty fast and far.)
And you can’t have that time back. You can’t historically revision it. You can’t pretend that it didn’t happen.
But what we’ve done is we’ve gone from Plan A, which would have been you find every case, you put a ring of quarantine around it, to Plan Z, which is you close everything.
And we’ve done that because of desperation. We had no choice. Once that virus was out of the bag and it was in every single county, every state, you can’t go back. You then have to change your plan.
The only plan that was available to the United States then was a plan that has totally knocked out our economy, … and there is a linear direct relationship between [everything that was done then] and what we’ve had to endure, what is it, six weeks.
As I mentioned above, Franken was more interested in emphasizing Trump’s role in these errors, but Brilliant cut him off:
Let’s leave aside the president. We do not have a plan in place today. We should have a two-year or three-year or four-year or six year plan….