No Testing, No Treatment, No Herd Immunity, No Easy Way Out

We need to start preparing for a darker reality.

The past few months have been bleak. Every day has brought word of new casualties from the coronavirus. The world economy entered free fall. And even for those who do not have a sick relative or a mortgage that can’t be paid, the isolation imposed by social distancing has begun to take a heavy psychological toll.

In these circumstances, I—and, I imagine, many others—couldn’t resist latching onto any piece of news that promised quick deliverance from the pandemic. I scoured the papers for positive stories. And I found at least three reasons to hope that the suffering the virus imposed might end sooner than the most pessimistic experts warned.

First, because some people who have COVID-19 don’t seem to show any symptoms, I wondered whether the disease might be far more widespread than the initial data suggested, raising the prospect of the United States’ reaching herd immunity without mass casualties. Second, reports that some existing drugs might prove effective against the disease led me to hope that doctors could soon be in a much better position to heal patients who contract the virus. And third, because some foreign governments have seemed successful in containing the virus through ambitious test-and-trace programs, I thought the United States might find a way to open up its economy without inducing a large resurgence of cases.

There was real reason to indulge in each of these hopes. But in the past several days, a series of developments have undermined the factual basis for all of them. So I am, finally, starting to reconcile myself to a darker reality: The miracle of deliverance is not in sight.

On Thursday, New York Governor Andrew Cuomo released preliminary results from a coronavirus-antibody study to determine the true caseload in his state. (Antibodies remain in a patient’s body even after the disease has cleared.)

According to official statistics, a quarter of a million people, or about one in 100 residents of the state, have contracted the coronavirus, and more than 21,000 have died from it. This would put the fatality rate for the coronavirus at a staggering 8 percent.

The new study suggests that the real caseload is much higher. About one in seven New Yorkers who were administered the test were found to have antibodies to the virus. This is good news. If that rate holds for the general population, and a lot more people than previously known have already had COVID-19, then the true fatality rate could be a little less than 1 percent.

Some researchers have cast doubt on that one-in-seven figure. Existing antibody tests are far from accurate, and may include a lot of false positives. And because the New York study recruited many participants in public spaces such as supermarkets, those selected might have taken social distancing less seriously than the average resident of the state—which would make them more likely to have been exposed to the disease.

But even if the New York antibody study didn’t overestimate the infected population, its findings suggest that there’s no easy way out of social distancing. Experts estimate that for a population to reach herd immunity, up to 80 percent of it would have to be exposed to the coronavirus. Even if the virus has a fatality rate of a little less than 1 percent, this means that letting it spread through the population of the United States would cause about 2 million deaths.

Although the New York study gives us a lot of valuable information, we still don’t know how deadly the coronavirus really is. Some antibody tests, including one in Miami-Dade, suggest a lower fatality rate than the New York study. Others, including one in the Netherlands, come to a similarly pessimistic conclusion. But so long as we can’t rule out that millions would die in the United States alone, plans to brave the virus by going back to normal remain in the realm of the stupid or the sociopathic.

A vaccine is likely at least a year away, according to most experts, making finding an effective treatment against COVID-19 all the more important.

President Donald Trump, for his part, has been touting hydroxychloroquine as a potential miracle drug. But two studies—one by scientists in France, another by doctors working for the U.S. Department of Veterans Affairs—have dashed such hopes. As the VA found, patients who took hydroxychloroquine were actually more likely to die than those who did not.

Most scientists have, from the very beginning, been highly skeptical that an antimalarial drug such as hydroxychloroquine could prove effective against COVID-19. But many did have real hopes for a drug that had proved effective in battling other coronaviruses in lab studies: remdesivir.

Now results from the first randomized clinical trial of remdesivir in patients with COVID-19 have become publicly available. Depressingly, the study concludes that remdesivir “was not associated with clinical or virological benefits.”

This is not the final word on either of these treatments. Different trials could bring better news. We have good reason to hope that effective drugs will, eventually, be discovered. And it’s not inconceivable that a vaccine could become available faster than most experts expect. But the chances of finding a transformative treatment against COVID-19 that could be deployed very soon have dwindled considerably.

We won’t get to herd immunity in the near future. A miracle drug is not in sight. The only way to restart the economy, then, is to put a highly effective system in place to test millions of people, trace their movements, and quickly quarantine those who might have been infected.

But even as the past few days have brought bad news about the science of the pandemic, they have brought terrifying news about its politics: It now seems less likely than ever that the United States will do what is necessary to reopen the economy without causing a second wave of deadly infections.

America is still behind on testing for COVID-19. Although Trump promised almost two months ago that anyone who wanted a test could get one, the U.S. has still conducted only about 5.4 million. The country needs to increase its testing rate at least threefold to reopen safely.

America is also behind on test and trace. Some countries, such as South Korea, now have robust systems in place to inform people that they have been exposed to the coronavirus, and need to self-isolate. But implementing such a system requires two things the United States sorely lacks: widespread trust in the government and a coordinated response from the White House.

In the absence of a federal strategy, some states, such as New York and Massachusetts, are trying to develop their own test-and-trace systems. But without help from Washington, they will likely lack both the resources to build a comprehensive system and the ability to persuade a large majority of their residents to sign up for an app that tracks their movements. Even if, against the odds, they should succeed in both these tasks, they face another obvious obstacle: Viruses don’t respect state lines.

If he were truly interested in limiting the damage to America’s economy, and opening up the country, Trump would be laser-focused on remedying these problems. Instead, the president has doubled down on culture wars and quack cures.

Early last week, Trump fanned the flames of the irresponsible protests against stay-at-home orders that are now being staged in cities across the country. A few days later, he vowed to “suspend immigration” to the United States. Then he suggested that scientists look into the possibility of injecting patients with bleach.

For all his blustering demands to get the country back to normal, the president is failing to take the steps that are required to reopen the economy without a horrific death toll. And for all the ingenuity shown by individual governors, the absence of a coordinated federal strategy may prove impossible to overcome.

I haven’t written much about the pandemic recently. The reason is, quite simply, that I didn’t feel there was much to say. Though every day brought a ton of news, a lot of it was contradictory; for long, painful weeks, I felt as though my overall understanding of the situation was barely improving.

Now I finally feel on firmer ground. Some of what we have learned over the past few weeks has been positive. The fatality rate from COVID-19 is likely to be significantly lower than early estimates suggested. Americans have followed social-distancing guidelines to an impressive degree. So far, we have succeeded in flattening the curve, and have not had to turn thousands of people in desperate need of medical treatment away from the emergency room. Even in New York City, the American epicenter of the pandemic, the number of new infections and new fatalities is ebbing.

We are not in the worst of all possible timelines. And yet, our hopes for the pandemic’s quick resolution should clearly be shelved. Taken together, the three major developments of the past few days paint a bleak picture of the months that lie ahead: COVID-19 is too deadly to let it rip through the population. An effective cure is not in sight. And the federal government is incapable of formulating a coherent pandemic response.

After weeks in which it made sense to hope that something would happen to end this nightmare, the prospects for deliverance are more remote than ever.