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Once again, U.S. at pandemic crossroads

The United States has a narrow window to force the coronavirus into a partial retreat before the one-two punch of school openings and colder weather brings a widely feared rebound.

It’s blowing it, again.

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Until vaccines and drugs arrive — and top scientists say they aren’t as imminent as President Donald Trump keeps promising — the tools to fight the virus remain the same: testing, masks, all the things Americans have been hearing about but not always doing since March. They are crucial right now. New cases have fallen from the pandemic’s second peak this summer, creating a brief chance to wrestle the caseload lower — not to zero, but low enough to blunt the impact of the new infections expected this fall.

“We could be on our way to much less infection,” said Nicole Lurie, who was HHS assistant secretary for preparedness and response in the Obama administration.

But the Trump White House isn’t doubling down on Public Health 101, even as new hot spots emerge, in both the South and the Upper Midwest. Trump devoted only a few sentences to basic precautions in his pre-Labor Day weekend press briefing, followed by the upbeat assessment that “we’re really rounding the turn.” He is relying on a new adviser, Scott Atlas, a conservative physician he saw on Fox News who doesn’t have a background in public health or infectious disease but holds views aligning with Trump’s desire for faster and broader economic reopenings.

The pandemic peaked once in late April before settling at about 20,000 new cases a day. When the country rushed to reopen, the virus pounced, this time in the South. Infections peaked again around July 24, at a whopping 60,000 cases daily and then slowly flattened to around 40,000 now. That’s still dangerously high; one influential model just upped its estimate for U.S. deaths by January to more than 400,000 — just over double the current death toll of nearly 190,000.

“We squandered February and March. We squandered April and May. And now, there has been progress in a lot of areas — but we need to see much more,” Thomas Frieden, who led the Center for Disease Control in the Obama administration, said in an interview. “And we are a global laggard.”

Entering the final stretch before the Nov. 3 election, Trump is addressing largely mask-free campaign audiences and doubling down on his prediction that a crisis-ending coronavirus vaccine is just around the corner. His own vaccine chief told NPR last week that’s “extremely unlikely” in October or November.

“We need both a public health and a biomedical response,” said Ashish Jha, a global health expert newly installed as the dean of Brown University’s School of Public Health. Mixed messaging from the government, he said, “driven by a desire to say everything is going great” doesn’t get people to wear their masks.

Even during the devastating summer, the country has made gains. Testing is more widely available, though it’s still troubled and now shifting away from broad surveillance of asymptomatic people, who can still spread the virus. Masks are more common, though not universal. Health care workers have more protective gear, though there are still dangerous gaps. Doctors have become more adept at preventing Covid-19 deaths, even as they await a more powerful arsenal of drugs to treat it.

Given the early chains of contagion in schools and colleges, cases could start spiking again – within one, two or three weeks, said Geraldo Chowell, a professor of epidemiology and biostatistics at Georgia State University.

“The next generation of cases is going to start to show up,” he said. “And then the next generation. And the next generation.”

So any attack on the virus has to be fast and forceful, involving Washington, the states, and the public, said Marta Wosinka, deputy director for policy at the Duke-Margolis Center for Health Policy.

People won’t stick to what Wosinka referred to as the “Three Ws” — washing hands, wearing masks and watching their distance — for the long haul without clear and consistent explanations for why it matters. States have a hard time imposing unpopular disease control measures like shutting bars or requiring masks without those same messages, although some states hit traumatically hard in the brutal early stage of the outbreak are more vigilant.

But instead of consistency, Americans are getting a cacophony of confusion, starting from the top. Trump has clashed with top scientists, including some whom he himself appointed to high government posts. He’s made overly optimistic forecasts about how quickly a vaccination campaign could vanquish what he himself calls “the invisible enemy” or “the plague.”

Trump has consistently defended the U.S. response, calling it “amazing” and “incredible.” He often says for instance that the country has done the best testing in the world and now has a surplus of ventilators. Some of his advisers have spoken of the virus in the past tense – which doesn’t convey any urgency about masks and distancing.

Even when a vaccine becomes available, it will take time to widely distribute it. It will also take time for people to generate an immune response once they’ve gotten the shot — or more likely, a pair of shots. That means the early phase of a vaccination campaign is a “very vulnerable time for us,” said Lurie. People could mistakenly think “Our vaccine is here — we are safe now!” – and discard social distancing and masking, putting themselves and others at risk, she said.

And it’s a vicious circle. The overemphasis on the vaccine’s imminence and impact undermines any sense of urgency at this critical time. The country hasn’t gone back to its pre-pandemic life, but it’s not maximizing all the ways it can fight the virus.

The Institute for Health Metrics and Evaluation at the University of Washington, which has been doing influential modeling that shows the country heading for 410,000 Covid-19 deaths by year’s end, has examined how much people are still sheltering at home by looking at cell phone data. Americans reduced their movement to 52 percent of normal pre-pandemic levels in in early April. But it crept back up to 23 percent of normal by mid-August. That’s not insignificant, but it’s not a virus-crushing level either. As Chowell of Georgia State noted, school openings will probably bring that number down further.

And even if many people are staying home a lot, there are enough big gatherings to keep spreading the disease — frat parties, motorcycle rallies or deceptively dangerous family events.

More governors have mandated masks but compliance is spotty. Trump himself has talked about them as optional and has been seen wearing one only a few times. Just a few days after the Republican National Convention, where masks were few and far between, he began an indoors community roundtable in Wisconsin by telling attendees to remove their masks if they wanted. Later, he mocked his Democratic opponent Joe Biden for wearing one, as he did earlier in the summer.

Contact tracing — identifying people who may have been exposed, testing them and isolating them as needed — is a weak point. Both the old-fashioned telephone-call approach and the newer app-based methods are lagging. That’s because of privacy concerns, limited public investment and the fact that there’s just too much virus spread in the community to track everyone down. The monitoring group Covid Exit Strategy found only about a dozen states have contained the coronavirus well enough to make contact tracing feasible.

James Lawson, a global health security expert at the University of Nebraska’s Medical School who also directs research at the National Strategic Research Institute there, isn’t optimistic the country can make major progress in the near term. But Lawson, who recently dropped his son off at college in Massachusetts and saw way more masks on campus than back home in Nebraska, thinks America will learn its lessons — after the elections.

“Whoever wins, it will become less of a political football to play with,” he said. “Messaging will be different, and people may see it less through a political lens.”


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