As millions of people remain socially isolated and anxious about COVID-19, several U.S. governors are at least making plans to relax controls in their states and revive economic activity — against the advice of many public health professionals.
New York Timesscience and health reporter Donald G. McNeil Jr. warns that the push to reopen is premature. "We're nowhere near getting on top of this virus," he says.
McNeil has spent decades at the Timescovering infectious diseases, including AIDS, Ebola, malaria, swine and bird flu, and SARS. He describes the ways that some Americans are approaching social distancing measures as a "giant garden party" compared with what the citizens of China and Italy have faced.
"I hear anecdotally that people [in the U.S.] are holding ... barbecues and people are still going out on Internet dates and having play dates with kids," he says. "Unfortunately, that's the reason that we have about 30,000 new infections a day in this country. ... China didn't reopen until they had zero new infections a day."
McNeil says even a fairly strict stay-at-home policy is "just the first step" in the battle against the pandemic: "There's a Harvard study that came out recently that said we should have 5 million to 10 million tests per day across [the U.S.] in order to have a clearer idea of where the virus is, where cases are going up. And cumulatively, all the tests we've done now has been 5 million."
McNeil points to China as a model of how to stop a fast-moving pandemic in its tracks, using widespread testing and a strict quarantine. "We're reluctant to follow China, but they did it," he says. "They did it brutally, but brilliantly."
Interview Highlights
On how testing worked in China
The model in China was, when it was time to be tested, you were taken to a fever clinic. You were screened in several ways: Your temperature was taken. You were given a quick flu test and a quick white blood cell count to make sure you didn't have a flu or bacterial pneumonia. And then you'd be given a quick CT scan. They could run as many as 200 CT scans a day on some of these portable machines so that they could check your lungs — because their tests had some time before the results came back too. And only after you cleared all those hurdles and you were definitely still a COVID case, then you got the test, because their tests were imperfect like ours are. And then you didn't go home to wait for the results of your test. You stayed there in the fever clinic, in the center. You were told to sit far apart from other people — 6 feet away from other people. And people sat there sort of scared with their envelopes with their CT scan results in their hands, waiting to hear if they were yes or no.
And then, if you were positive, you went straight into isolation — not back with your family but in one of these gymnasiums or armories, someplace like that, where you were in bed. There might be 100 people in a room.
On the idea that China's lockdown was overly strict
Chinese people love their families just as much as Americans love their families. They were initially reluctant to go into these quarantine shelters too. But when it became clear that it was saving the lives of their families. I mean, yes, some of them were forced in. Some of them were chucked into the back of ambulances by policemen. But that was not the norm. The norm was you were told, "Please come with us to the shelter. You will have food. You will have medical care. We will keep an eye out for you. And in three weeks, if you're good to go back home, we're going to test you, make sure you're OK, and then you can go back home." It's portrayed as brutal. But there are a lot of brutal things that the government in Beijing does. ... In this case, it was not brutal to its own citizens. It saved probably 10 million lives. That's how many I estimated would have died in China if this had just gone unchecked.
On what might happen if the U.S. reopens too quickly
If we all went back into baseball stadiums and churches and piled into grocery stores and got onto the subway, everything would be quiet for about two weeks, and then, whammo! You'd see temperatures go up on the Kinsa app, and then you'd see positive tests go up, and then you'd see hospital admissions go up. And then you'd see people being transferred into ICUs go up — and then you'd see deaths. We'd be on our way back to [previous predictions of] 1.6 to 2.2 million deaths [in the U.S. because of COVID-19] again.
So we have to go out very carefully, in little bits. And if we have enough testing to know how much virus there is around — that's what Tony Fauci [director of the National Institute of Allergy and Infectious Diseases] means when he says, "The virus will tell us." You'll see as the percentage of positive tests goes up — if you have millions of tests being done every day — you'll see, "Uh-oh. We have a problem here in southern Georgia," or "We have a problem here in the upper Michigan peninsula," or wherever we have a problem, and then you go back into hiding. You socially distance yourself as much as possible in that area. That can include anything from closing the schools again to keeping the universities open, because college students can socially distance, but kindergartners can't. You make choices, and you see how far you have to back off.
This is probably going to be a series of steps. We're going to have to do this again and again, dancing in and dancing out until we get to the point where we either have a vaccine or a prophylactic pill or some regimen — some curative regimen that's so good that we're confident that, if I get sick, maybe I get sick, but if I crash, I can count on being saved.
On how we don't yet know if people can become immune to COVID-19 — and how long that immunity would last
We do not know enough, and that's one of the big unsolved things ... because there are these anecdotal reports of people who seem to have been infected a second time. But you never know whether or not they had a false negative test that cleared them before that or whether or not there are some people who have kind of immune systems that are not perfect.
So it's very fuzzy where we are on this thing. But, as Fauci says, normally when you recover from a disease, especially if you've had a bad case of that disease, you have some period of immunity. With things like chickenpox and measles, it's lifelong. Even with flu, it usually lasts a year or two against that brand of flu — that mutation of H1N1 or whatever it is. So we would expect that there's protection, but we don't know what the antibody level is that confirms protection.
On a scenario in which people with immunity could have advantages
They would be the immune elite. There [would] be a whole new class of X-Men in this country. I mean, it's already happening. People who've recovered are very much in demand. We want your blood for the antibodies in it. And they [could], in theory, do the scary jobs, like intubating patients (if they're medical personnel), without fear. As more of them develop, they'll take my job or take yours, because they can go into the office and also they can fly on planes and go out to parties as long as everybody there is immune.
It [would] be a weird dystopian world of two classes: of the immunes and the vulnerables.
On the possibility that people would be tempted to infect themselves, hoping to achieve immunity
I am absolutely sure that will happen. I haven't found it, but I'm sure of that, because lots and lots of young people in this country are cooped up — out of work, frustrated. They're gonna see their friends outside having fun. ... And they're going to say, "What are my chances? One percent I end up dead? Three percent I end up in a hospital needing oxygen? Why don't I just get infected, take my chances and recover?"
On ways in which the pandemic might change our country for the better
This is like going through a war. And if we went through World War I and World War II, and after each of those wars, we tried to create the League of Nations, and we did create the United Nations. People saw that we were all in this together, and the attitudes changed after those wars. Unions were strengthened. Incomes became more level. People had had it with war profiteers, and taxes on the rich went up.
That's one of the reasons I stay relatively optimistic about this, because I can see maybe a better country emerging from this.
It led to the GI Bill and the Veterans Administration mortgages. In Europe, the widows' and orphans' pension funds led to the creation of the famous European social safety net. [They were] a very equalizing kind of events. And I'm hoping that something like that will happen in this country too, that we'll have kind of a rosy outcome from this and that people will value life more.
You heard it in Wuhan. People came out after two months in hiding, and they said, "My God, the flowers are so beautiful. I've never really noticed before." I think people will take more pleasure in the simple things in life and feel lucky that they got through this. So I'm hoping we have a brighter dawn, but we're going to go through some pain first. But then that's one of the reasons I stay relatively optimistic about this, because I can see maybe a better country emerging from this.
Amy Salit and Thea Chaloner produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.
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