There Is No Plan D for Fighting the Pandemic

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To say that America’s handling of the coronavirus epidemic is a dumpster fire would be unfair to dumpster fires. Dr. Robert Redfield, director of the Centers for Disease Control,warned on Dec. 2 that the next few months “could be the most difficult time in public health history of the nation.”  He said the death toll from Covid-19 could reach 450,000 before winter is over. 

It’s too late to save lives already lost and too early for a retrospective on a crisis that’s very much ongoing. But it’s the right time to start making sense of where the U.S. is now and what options remain.

Plan A for fighting Covid-19 fell apart almost immediately. It was to identify people with the disease and isolate them while allowing the rest of the public to go on with life as usual. That has worked in the past for diseases with obvious symptoms but failed with Covid-19 because people can spread the disease without knowing they’re infectious.

Once Covid-19 got a foothold in metro New York and a few other spots, the U.S. went to Plan B—stay-at-home orders for most of the nation, even areas that hadn’t been touched by the disease. The thinking was that since you couldn’t tell who had the disease,  the only safe thing to do was shut almost everything down. If Plan B had worked, the virus would have been extinguished within weeks, because it can’t survive if it can’t find new victims.

But Plan B was a worse face-plant than Plan A. It wasn’t followed strictly enough to extinguish Covid-19, but it was strict enough to give the U.S. the deepest recession on record. And because it punished parts of the country that were (then) free of Covid-19, it kindled suspicions about government edicts that complicate the virus-fighting effort to this day.

Plan C is what the U.S. is on now. It’s to keep life as normal as possible, banning only the most dangerous activities, while taking precautions such as social distancing, hand-washing, and mask-wearing. Plan C makes sense, and there’s no reason in theory that it couldn’t work. Except, as the mounting death toll goes to show, it is failing just as surely as Plan A and Plan B failed before it.

Plan C is failing because people aren’t complying with it. Some continue to believe, or at least say they believe, that Covid-19 is a hoax. Others are tired of putting their lives on hold. Whatever the reason, the predominant setting for infection has become homes and other private gathering places that are beyond the reach of government authorities. 

“It’s much harder to design a public health intervention to mitigate this is now that it’s behind closed doors,” says Dr. Amesh Adalja, a senior scholar at the Center for Health Security at Johns Hopkins University’s Bloomberg School of Public Health. “The best thing you can do is plead with people to take common sense solutions.”

In his Dec. 2 press conference, the CDC’s Redfield cited a study in Kansas finding that counties that followed a July 3 state mask mandate saw a 6% reduction in the rate of new cases, while counties that opted out of the mandate saw the rate of new cases rise 100%. Seems convincing, but apparently not convincing enough for the many Americans who continue to scoff at mask-wearing. People who are lax about wearing masks in public are even less likely to wear them when friends come over, even though that’s a perfect environment for SARS-CoV-2 to spread: indoors, with inadequate ventilation, close quarters, and prolonged contact.

“The U.S. is so far gone that to look at Taiwan and South Korea is almost laughable,” Adalja said in an interview last month. “We can’t do in November what Taiwan and South Korea did in March.” Right: Those countries are controlling Covid-19 with testing, tracing, and isolation—an impossibility when the virus has penetrated every crevice of society.

The problem for the U.S. is that there is no Plan D for non-pharmaceutical intervention. The only hope is for vaccines to save the day. Meanwhile, cases are mounting and hospitals are filling up. If hospitals overflow, as they did briefly in New York City last spring, the death toll will skyrocket, because some cases of Covid-19 will go untreated or undertreated. Governors might be forced to go back to Plan B, a lockdown—not because it’s ideal, but because it’s the only tool they have left.

If the case load gets extremely high, concepts for tamping down the virus with minimal disruption “don’t apply anymore, because you’re already acting late. There is really no way around except for this bundle of highly intrusive measures,” says Dr. Peter Klimek of the Section for Science of Complex Systems at the Medical University of Vienna, corresponding author of a paper published on Nov. 16 in Nature Human Behaviour, “Ranking the Effectiveness of Worldwide COVID-19 Government Interventions.”

As the office poster says: When you’re up to your neck in alligators, it’s hard to remember that your initial objective was to drain the swamp. 


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