The Daily - Why the American Approach Is Failing

Episode Date: March 24, 2020

So far, the United States has been losing the battle against the pandemic, with a patchwork of inconsistent measures across the country proving unequal to halting the spread of the virus. Today, we ask: What will it take to change the course of the crisis?Guest: Donald G. McNeil Jr., a science and health reporter for The New York Times. For more information on today’s episode, visit nytimes.com/thedaily. Background reading: President Trump has played down the threat of the virus, while at least 16 states institute stay-at-home orders. Here are the latest updates.The rampant spread of the coronavirus has left a trail of loss across most people’s lives. Here is some advice on how to cope.

From The New York Times, I'm Michael Barbaro. This is The Daily. Today. So far, the United States is losing the battle against the coronavirus. Donald G. McNeil Jr. on what it would take to turn the corner. It's Tuesday, March 24th. Donald, it is about 4.20 on Monday. Where are we in this pandemic in the United States? How would you characterize it at this moment? I would say it's wildly out of control, but we have not recognized it yet. it yet. Certainly wildly out of control in New York state. The epicenter in the U.S. is now clearly New York with more than 12,000 cases, most of them here in New York City. In Washington.

The state of Washington has the second highest number with almost 1,000 cases. And then there's California. We have the third highest number. In Northern California, in South Florida. We saw pictures of Disney World jammed, packed with people. Aerial photos of beaches in Florida jammed with people. There are still so many Americans that don't understand they are spreading the virus. We've just begun to do tests, really. We've got 42,000 positive cases.

We've got 513 deaths. You know, some people have said this is like a war. And it's as if your army has been marching forward and the enemy has been shooting at you for two to three weeks now, and nobody has yet looked down to see whether or not they're bleeding. But very soon, we will see how many people have been hit. Because, you know, you get sick within four, five, six, seven days of getting infected. You know, you get sick within four, five, six, seven days of getting infected.

But usually you don't need hospitalization if you're going to need hospitalization until about 10 days to two weeks in. It's known as the second week crash. And some people crash even after they thought they were starting to get better. So we're facing something like that. A lot of people are sick. Huge numbers of people are about to fall seriously ill. But it just hasn't happened yet. Well, I want to talk about what the U.S. government and states have done so far. How would you describe what has been done to try to mitigate this?

It's a giant patchwork across the country. This is a moment we need to make tough decisions. This is a moment where we need some straight talk and we need to tell people the truth. I mean, you see California ordering people to stay inside their houses. So we're going to put out an executive order today. New York State on pause.

New York requesting that people stay inside their houses and closing down all non-essential businesses. A stay-at-home order for all of Ohio. You have Ohio and Louisiana. Today I'm issuing a stay-at-home order for the entire state of Louisiana. Moving in the same direction. Which will become effective tomorrow, Monday, March 23rd at 5 p.m. The federal government has recommended no gatherings of more than 10 people. Some states are enforcing that even more harshly than that, like California. Other states are setting their own policies. Right. And as patchy and inconsistent as this approach may be, there's beginning to be real blowback to this government-mandated social

distancing and shutting down our society, given that it is putting people out of work, it's closing businesses. The president has said just in the past few hours... We cannot let the cure be worse than the problem itself. We're not going to let the cure be worse than the problem. He doesn't want the cure to be worse than the illness itself. So I want to understand why we're pursuing this approach rather than a variety of alternatives. And let's start with the South Korean approach, right? Not closing all businesses, not closing all restaurants, focusing instead on aggressively tracking the sick and testing as many people as possible. And it seems to be working, right? So why can't we do that here?

Why isn't that a viable alternative to shutting things down? Well, we could do that here if we had a time machine and we could travel back in time to about January 20th, because January 15th is where we know one of the first cases arrived in the United States and started spreading. That was the case in Washington. The idea that we could try to start cracking down now when we have over 40,000 cases and 500 deaths, it's just utterly impossible. It's not close to anything that South Korea faced. I mean, South Korea, they were doing this kind of crackdown when they first saw cases arriving

before there was a single death. So we're just behind the eight ball on that kind of thinking. And mostly they had small scattered cases, and then they had this gigantic explosion inside one church. I think it was more than 500 cases inside that church. All right. They managed to do contact tracing on 210,000 members of that church. Los Angeles just gave up contact tracing today. Wow. Just knowing that they don't have the test to do it. Meaning tracing those who were in contact with somebody who has tested positive. Tracing everybody who was in contract with somebody who was tested positive. Not only everybody they've been in contact with since

they knew they were infected, but everybody even 48 hours before that. So not only is it too late to follow the South Korean model, you're saying as an alternative in the U.S., we just don't have the capacity or the resources to follow it. Correct. Okay. So we can dispense with that. Another possible alternative to just shutting everything down is isolating the most vulnerable in American society to the coronavirus.

So the elderly, those with pre-existing conditions, underlying medical problems, rather than asking everyone to isolate in some form or another. And in that scenario, most Americans would be treated as we treat most Americans during the regular flu season, right? Take some precautions, be careful, but don't fundamentally alter your life. And there are doctors who seem to be advocating for this isolate the most vulnerable scenario. And one of our colleagues, columnist Tom Friedman, gave voice to their views over the weekend.

And it seems President Trump is interested in this kind of a concept. What do the experts that you have talked to say about the viability of that? This was an idea that was floated for a while in the Netherlands and was floated for a while in the UK and dropped because they realized that it was ridiculous. Why is it ridiculous? One, how do you only isolate the elderly? Elderly people in this country very often live with their families. Elderly people need services, which people deliver to them in their houses, or they go to community centers or to their relatives' houses for services they absolutely need, from everything from food to company. How do you isolate the vulnerable? How do you isolate

everybody who's obese in this country? Why do you mention obese? Because many have diabetes, and diabetes is one of the conditions that renders you more susceptible to dying of this disease. Everybody who's got high blood pressure, not all high blood pressure, but uncontrolled high blood pressure, which a lot of people do in this country, is more susceptible to this disease. Anybody who's taken any sort of immunosuppressive drugs or is fairly recently beyond cancer treatment may be more susceptible to this disease. There's some data suggesting now that people who vape may be more susceptible to developing pneumonia from this disease. There's some data suggesting now that people who vape may be more susceptible to developing pneumonia from this disease. Vaping is not something that's common among the elderly in this country. So you're saying there are just too many vulnerable populations for this to be practical? Yes. So the idea that you can just isolate all the most vulnerable people in the U.S. is simply wishful

thinking. So given that, Donald, I want to talk through another possible alternative, one that President Trump seems to be talking up a lot in the past couple of days. It's a common malaria drug. It's been available, so therefore the safety level we understand very well. It's been relatively safe. Which is the idea that we are close to a treatment to the coronavirus, something that would reliably combat it and mean that we don't need to shut down societies. We're also studying this and other promising therapies, which is a therapy produced by Gilead. And that would be REMS.ir, and it shows great promise. So tell me about these drugs that President Trump has been referring to,

and whether he is right to suggest that they might be a solution here. Okay. The drugs that President Trump has mentioned over the past week are chloroquine and hydroxychloroquine, which are two versions of a longstanding malaria drug. It goes back 70 years. And the other drug is called remdesivir. And it's a drug made by Gilead, and it doesn't actually have any use. I think they may have hoped it would work against HIV, and it didn't. It definitely did not work against Ebola when they tried it.

Now they're hoping it works against coronavirus. There's some evidence to suggest it does. I mean, there's evidence in animal testing to suggest that both of these drugs might possibly work. Those drugs have been used in China. But this was by doctors who were desperate, who were basically throwing everything they had at patients. And in some cases where doctors had a certain number of patients, they said, gee, these patients seemed to do better when I gave them that drug. Now, that doesn't mean, you know, this was some sort of Lazarus-like, rise from your hospital bed and walk away, smiling, miracle drug.

This was a drug that seemed to let these patients have better outcomes. But they weren't able to do, for several reasons, real clinical trials where you have two groups of patients who are basically exactly equal to each other and half of them get the drug and half don't. That's what you need in order to be sure that a drug really works. Once you license a drug, then doctors start giving it all over the place.

Actually, chloroquine is already licensed, so doctors are giving it in the hopes that it will work. And patients are demanding it in the belief that it will work, the belief partially spread by the president. And we don't really know how well it works. And these drugs are not completely safe. They shouldn't be taken, especially by children, without medical supervision. And, you know, the fear is that false hopes will be raised and that also people get so excited about it that some may start taking the drugs to protect themselves out

of fear if they've managed to get a hold of a bottle and they may end up poisoning their kids. You know, these are bad outcomes. There is a case where the cure is worse than the disease. So beyond the fact that there's not yet enough medical evidence that this is a legitimate set of treatments, there's potentially real medical risk in people starting to take them because they might actually make people sick. Yes. Okay, so with all those options basically deemed impractical, that would seem to bring us back to social isolation. But is that working? Because my sense is, so far in the United States, it is not working.

No, it's not working, and that's because we're not doing it right. And, you know, to write the articles I've been writing recently, we have to imitate China because we've got China-like spread. We're not going to be able to catch it up with a South Korea-like program. And we're going to have to do a whole lot better than Italy and Iran did. And we're not on that track right now? What would it entail? So in an ideal world, if you could wave a magic wand and make everybody in the United States freeze in place, sitting six feet apart from each other for two weeks, we could stop the epidemic in two weeks. If we had enough.

Yeah, because within two weeks, the virus would die out on every surface that it was. People wouldn't be interacting, so they wouldn't transmit it. And everybody who has symptoms, the symptoms turn up in two weeks at the most. So you'd know who was sick. And even for the few asymptomatics, you'd be able to find them by doing tests. And so that'd be it. Epidemic over. I mean, you'd have a lot of people in the hospitals, but that would be the end of it. Knowing that we don't have a magic wand, but wish we did, what do we do? What's the playbook for how to keep people away from each other in the United States, given where the virus is? As much as possible, we have to stop everything in places where we know the virus is. That is what China did. They knew the virus was incredibly hot in Wuhan and the surrounding province. And so they put that

entire province on lockdown. Unfortunately, that means not just stopping all air travel, it means basically stopping all travel. I mean, people can't be together on buses. People can't be together on planes. People can't be together in cars unless it's just them and they're going to socially isolate together when they get to the end of their journey and stay in place for, unfortunately, an indefinite amount of time. The loosey-goosier the freeze is, the longer it lasts and the longer it's going to

take us to get our economy started again. Because the looser it is, the more transmission there is. The more transmission there is, the more people end up overcrowding hospitals. The more people overcrowd hospitals, the more people diecrowd hospitals, the more people die. Okay, so that's transportation. And you're suggesting that in many ways, we have to further restrict that. What about businesses? What about restaurants all over the country? Do they need to be shut down? Yes, all of these things. Transportation, restaurants all over the country, schools all over the country, workplaces all over the country, bars and restaurants all over the country. And different places are turning into hotspots even as we speak because people are now traveling all over the country and still spreading the virus, starting new clusters. The only way to get on top of this disease is to stop the clusters.

In this scenario that you're describing, what can be open? What's an acceptable reason for anyone to be out and about? Doctors, nurses, people who work in the healthcare field, police, fire, the people who keep the water mains open and the electrical grid running and Wi-Fi reaching houses, and food delivery and medicine delivery. That's the ideal, is that those are the only people who are allowed out and that keep the country functioning. We need people to freeze in place and we need to make sure they have enough calories and water and medicine to stay alive. You know, not that they are worried about how their business is running and how their investments are going or whether or not they're collecting their rents. And we have to do things like tell landlords that they can't collect their rents, tell banks that they can't collect their mortgages. The idea

is to keep the country alive until the virus slows down. It may be impossible, but if you want to try to use any sort of social distancing tactic, it has to be much more intense than it is now because we're not slowing the virus. It's still spreading wildly. And this slowdown, how would it be enforced in a place like the United States? Let's say that suddenly every state, every mayor locks down a community along the lines of what experts say needs to be done now to freeze this in place? How does it actually get enforced? Who is in charge of punishing those who violate it,

roaming the streets and making sure it actually happens? Well, I mean, legally, you can do it. The governor and the health commissioner have the power to use the police to enforce these laws. In Italy, as in China, they went to roadblocks everywhere. You couldn't drive down a street without a permit that had been issued by the government that said, I'm an emergency worker. I am allowed to drive down the street. That's what will have to happen if people don't do it voluntarily.

And I fully expect that Americans are not going to do this voluntarily, but then we're going to suffer the consequences. So what happens if we don't do all the things that experts are saying we must do, the social isolation, the lockdowns? I mean, it doesn't seem we're headed there. So what happens if we don't implement any of these measures? any of these measures? If we don't implement these measures,

we will have a Wuhan in New York and a Wuhan in Seattle and a Wuhan in South Florida and a Wuhan in Wheeling, West Virginia and a Wuhan in Helena, Montana, and so on. Because hospitals will get overwhelmed everywhere. And in Wuhan, in the early weeks of the epidemic, the death rate was 4% to 6%. It's a little unclear because there were people who couldn't make it to the hospitals and just died at home. But if you go on the South China Morning Post site and you look for the videos that were shot then, you'll see hospitals with people crowded in the corridors

and literally dead bodies lying in the halls that nobody's had time to take away. You'll see nurses and doctors screaming, having breakdowns, screaming in frustration, I can't take it anymore, I can't take it anymore. You will see lines of coffins outside the crematories just sitting there waiting for their turn to go into the furnace because there's too many coffins for the flames to burn fast enough. I mean, we have seen that in Wuhan and we've seen it in Italy where they were having to stack coffins on the pews of the churches that have been closed down because there was no place to put the coffins and they couldn't dig graves fast enough. So that's what we're headed for.

I mean, it's horrific. Yeah, yeah, yeah. And I've been looking at this stuff since late January, early February, and frightened by it. The visions are nightmarish, and I don't see anybody taking it seriously. But that's what we're headed for. It's kind of hard to process this because what you're suggesting is that a short-term, essentially shutdown of much of our life in the U.S. would potentially bring this whole pandemic to an end. And yet there are a lot of practical reasons why that would be very, very hard to imagine. But for those who are very skeptical of it, who think, as the president said, that the cure may be worse than the illness, it would seem

like a short-term version of this would be kind of ideal, right? Because it would happen- Who said short-term? I said, if there were a magic wand, you could do a short-term shutdown. I think for this shutdown to be effective, given how lax Americans are about staying in the shutdown, we are going to have a shutdown that lasts for months and months. So there's no short-term version of this, given the way the U.S. operates?

There's no magic wand. There's no 15-day cure. That's pretty depressing because it means that there's almost nothing we can do right now. The genie is out of the bottle. The horses have left the barn. The pandemic is too deeply in our system. In New York, I think that's true. We don't know exactly how many people have been infected, but we know that it's been

incredibly hot with virus out there for a while now. And yet people are really struggling because, you know, they haven't had their Rock Hudson, here's somebody I know who's got the disease, so now I believe in it moments. People are still, you know, they're beginning to hear about colleagues who are sick, colleagues who are infected and stuff. But that only began four or five days ago. The people beginning to need to be hospitalized in large numbers is usually 10 days. And the deaths don't usually take place until three to six weeks. So we have a lot more pain in the future. But is it possible for other cities in

the US, smaller cities, maybe even mid-sized cities, not New York, not Seattle, maybe not Los Angeles, to do these things and spare themselves? Yes. And it will take those Bruegel-esque visions of New York to convince them that this is what's headed their way. And maybe they'll take the actions they need to. And maybe they won't. is handling this right now as a patchwork. Do you think, Donald, that we are going to be ending up in a kind of awful middle place where many of us are at home, we are isolating in lots of big parts of the country, but it's not enforced significantly enough and uniformly enough to have meaningful impact. And so rather than having the magic wand version of this, we have the worst version of this, which is there's a lot of burdens, social and economic, and still the virus keeps spreading and spreading. Yes, I think that's exactly what's going to happen. There's going to be a great deal of

economic impact, but we're not going to be able to find the political will or the fear as a people to shut down the spread of the virus. I don't see us flattening the curve as everybody has talked about. Maybe some other cities will be able to flatten the curve later. Once they see what's going to happen in New York, they'll begin to believe that they have to flatten the curve and they'll go in, but then you'll find out how many people were infected in the meantime. I mean, we're going to come out of this

as a different nation, a different people. If we essentially don't shut down so that the chain of transmissions don't stop, you know, we're going to be looking at hundreds of thousands of dead, I think, unless some drug turns out to be a miracle preventive. And that's the high hope for chloroquine. But we don't really know that yet. And we know there's not going to be a vaccine for a year. So short of that, we may have to shelter in place for a year until a vaccine rolls

out. Look, I hope for better. But I'm not trying to sugarcoat it. I'm trying to explain what the worst case scenario is. I hope we don't reach the worst case scenario, but I fear that we are a long way down the road towards it. Well, I would like to say thank you, Donald, but it just doesn't seem like that kind of a conversation. Thank you. Anyway, we appreciate it. Thank you.

Sorry. I'd love to be proved wrong. On Monday, during his daily briefing on the pandemic, President Trump continued to promote medications that have not been widely proven as effective in treating the disease and said that thousands of doses of one of them, chloroquine, would be distributed to New York City despite misgivings from federal health officials. America will again and soon be open for business, very soon. At the same time, the president said that he was eager to quickly end the economic shutdown, now in place to halt the spread of the virus, in defiance of advice from his medical advisors. Our country wasn't built to be shut down. This is not a country that was built for this.

It was not built to be shut down. We'll be right back. Here's what else you need to know today. The time has now come for us all to do more. From this evening, I must give the British people a very simple instruction. You must stay at home. On Monday, Britain issued a virtual lockdown, closing all non-essential shops, banning meetings of more than two people, and requiring citizens to stay in their homes except for trips for food or medicine. except for trips for food or medicine.

The way ahead is hard, and it is still true that many lives will sadly be lost. In the United States, where there are now about 42,000 infections, federal officials warned that the virus was spreading at an alarming rate in New York, where 28% of tests are coming up positive, compared with a national rate of 8 percent. So to all of my friends and colleagues in New York, this is the group that needs to absolutely social distance and self-isolate at this time. Clearly, the virus had been circulating there for a number of weeks to have this level of penetrance into the general community. In Congress, Senate Democrats again blocked a nearly $2 trillion stimulus bill, which they argue favors corporations over workers, infuriating the

Republican majority leader, Mitch McConnell, who accused the Democrats of seeking to exploit the crisis. They ought to be embarrassed, Mr. President. In fact, I've heard from some of them who are embarrassed. Talking like this is some juicy political opportunity. This is not a juicy political opportunity. This is a national emergency. That's it for The Daily. I'm Michael Bavaro.

See you tomorrow.