How Will the Coronavirus End? - The Atlantic

In 2018, I wrote ... that America was not ready for the pandemic that would eventually come... a new cohort who are born into a society profoundly altered by COVID-19... call them Generation C... shaped by the choices made in the coming weeks...

More transmissible and fatal than seasonal influenza... stealthier... nations must ... identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not... In a crucial month when the American caseload shot into the tens of thousands, only hundreds of people were tested... The testing fiasco ... undermined every other countermeasure...

[in] America’s health-care system ... unaffected states can help beleaguered ones in an emergency... works for localized disasters ... not for a pandemic ... in all 50 states...

the White House is a ghost town of scientific expertise... pandemic-preparedness office ... dissolved in 2018... On January 28 part of that team, urged the government to “act now ...develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear...

Rudderless, blindsided, lethargic, and uncoordinated... “The U.S. may end up with the worst outbreak in the industrialized world”... The U.S. has fewer hospital beds per capita than Italy... Imperial College London concluded that if pandemic unchecked, those beds ... full by late April... By end of June [one] critical-care bed [for] 15 COVID-19 patients in need of one.  By the end of the summer... killed 2.2 million Americans [plus] those who will indirectly die as hospitals are unable to care ... the worst-case scenario.

To avert it... quickly... rapidly produce ... personal protective equipment... shortages are happening because medical supplies ... depend on byzantine international supply chains ...

massive rollout of COVID-19 tests... shortages are, again, due to strained supply chains... Trump said that “anyone who wants a test can get a test.”... untrue... anxious people still flooded into hospitals, seeking tests that did not exist... doctors still had to use masks to examine them, burning ... dwindling supplies... stressed the health-care system...

the third need... is social distancing... without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps... many citizens continue to crowd into public spaces...

when the good of all hinges on the sacrifices of many, clear coordination matters... importance of social distancing must be impressed upon a public who must also be reassured and informed. Instead, Trump has repeatedly played down the problem... In some cases... deepened the crisis... touted unproven medications... signaled that he is prepared to backtrack on social-distancing policies ... to protect the economy...

Even a perfect response won’t end the pandemic... three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long...

the odds of worldwide synchronous control seem vanishingly small... “herd immunity” scenario would be quick... But ... likely leave behind many millions of corpses and ... devastated health systems.. third scenario ... world plays a protracted game of whack-a-mole... until a vaccine...12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it ...

as the status quo returns, so too will the virus.... we need to be prepared to do multiple periods of social distancing... the frequency, duration, and timing of social upheavals, depends on ... seasonality. Coronaviruses tend to be winter infections ... [and] duration of immunity... need to develop accurate serological tests...

We can keep schools and businesses open ...closing them quickly ... opening them back up again once the infected are identified and isolated... COVID-19 may become like the flu... recurring scourge of winter...

The cost ... will be enormous... Inequalities will widen... a secondary pandemic of mental-health problems... Hugs, handshakes, and other social rituals are now tinged with danger... Elderly people... deepening their loneliness... Asian people are suffering racist insults... domestic violence and child abuse are likely to spike...

there is also the potential for a much better world... washing your hands for 20 seconds... working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements... Perhaps the nation will learn that preparedness... is also about fair labor policies and a stable and equal health-care system... America’s identity may need rethinking after COVID-19...

Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines... losing loved ones... After 9/11, the world focused on counterterrorism. After COVID-19, attention may shift to public health...

One could easily conceive of a world in which most of the nation believes that America defeated COVID-19.... Trump’s approval rating has surged... One could also envisage a future in which America learns a different lesson... a repudiation of “America first” politics.