Vital plan needs the White House United States
A national plan to fight the coronavirus pandemic in the United States and return Americans to jobs and classrooms is emerging – but not from the White House.
Instead, a collection of governors, former government officials, disease specialists and nonprofits are pursuing a strategy that relies on the three pillars of disease control: ramp up testing to identify people who are infected. Find everyone they interact with by deploying contact tracing on a scale America has never attempted before. And focus restrictions more narrowly on the infected and their contacts so the rest of society doesn’t have to stay in permanent lockdown.
But there is no evidence yet the White House will pursue such a strategy. Instead, the president and his top advisers have fixated almost exclusively on plans to reopen the US economy by the end of the month, though they haven’t detailed how they will do so without triggering another outbreak. President Donald Trump has been especially focused on creating a second coronavirus task force aimed at combating the economic ramifications of the virus.
Administration officials speaking on the condition of anonymity say the White House has made a deliberate political calculation that it will better serve Trump’s interest to put the onus on governors – rather than the federal government – to figure out how to move ahead.
‘‘It’s mind-boggling, actually, the degree of disorganisation,’’ said Tom Frieden, former Centres for Disease Control and Prevention director. The federal government has already squandered February and March, he noted, committing ‘‘epic failures’’ on testing kits, ventilator supply, protective equipment for health workers and contradictory public health communication. The next failure is already on its way, Frieden said, because ‘‘we’re not doing the things we need to be doing in April’’.
In recent days, dozens of leading voices have coalesced around the test-trace-quarantine framework, including former FDA commissioners for the Trump and George W Bush administrations, Microsoft founder Bill Gates and top experts at Johns Hopkins, Columbia and Harvard universities.
What remains unclear is whether this emerging plan can succeed without the backing of the federal government. Some states such as Massachusetts and Utah are already trying to implement parts of it. In the absence of federal leadership – as happened last month with stay-athome orders – other states may follow suit. But without substantial federal funding, states’ efforts will only go so far.
In America, testing – while still woefully behind – is ramping up. And households have learnt over the past month how to quarantine. But when it comes to the second pillar of the plan – the labourintensive work of contact tracing – local health departments lack the necessary staff, money and training.
‘‘All people are talking about right now is hospital beds, ventilators, testing, testing, testing. Yes, those are important, but they are all reactive. You are dealing with the symptoms and not the virus itself,’’ said Tolbert Nyenswah, who led one of the most successful contact tracing efforts in Africa during the 2014 to 2016 Ebola epidemic. ‘‘You will never beat a virus like this one unless you get ahead of it. America must not just flatten the curve but get ahead of the curve.’’
Six years ago, Nyenswah watched an even deadlier disease, Ebola, tear through his homeland. Liberia’s president tapped him to lead its response, and Nyenswah began immediately hiring an army of surveillance officers to do ‘‘shoe-leather’’ tracing. It involved going door to door to find anyone who interacted with someone with a confirmed case of the haemorrhagic disease and persuading them to stay indoors, even providing food and services to make that more likely.
Testing on its own is useless, Nyenswah explained, because it tells you only who already has the virus. Similarly, tracing alone is useless if you don’t place those you find into quarantine. But when all three are implemented, the chain of transmission can be shattered.
Until a vaccine or treatment is developed, such nonpharmaceutical interventions are the only tools countries can rely on – besides locking down their cities.
In 2014, Nyenswah’s army of 4000 public health workers used tracing to eradicate Ebola in Liberia under even more difficult circumstances. Many homes didn’t have phone lines, much less house numbers, street names or zip codes to navigate by.
‘‘We didn’t have the sophisticated systems you have in the US,’’ Nyenswah said. ‘‘Many of the people we dealt with weren’t even literate, but we were able to win. What that tells you is that this can work.’’
But to expand that in a country as large as the United States will require a massive dose of money, leadership and political will.
Nyenswah, who now lives in the United States and teaches at Johns Hopkins, has watched the disjointed US response on television with growing alarm.
‘‘You cannot have leaders contradicting each other every day. You cannot have states waiting on the federal government to act, and government telling the states to figure it out on their own,’’ he said. ‘‘You need a plan.’’ – Washington Post