Enlarge /. Calling the government's response to the pandemic unstable would be an understatement.
In difficult and scary times, it is normal for a certain amount of confusion and misinformation to spread. The existence of social media and non-partisan "news" providers undoubtedly exacerbates the problem, but even those are just exaggerated versions of things that have been with us for some time.
But two things make the flow of coronavirus misinformation clear. The first is simple: much of the misinformation starts at the top where President Donald Trump seems ready to say what comes to mind when he's in front of a microphone.
But the second is more difficult: unlike a national disaster or a terrorist attack, we have no models for how long the coronavirus pandemic will last or how we will recover from it. There is no "we're going to rebuild" mentality that people can use to make sense of what's going to happen and guide their expectations.
Here's how we could create one.
No miracle heals
There are many really promising indications of possible treatments that can reduce the effects of the coronavirus in infected people. While many of them involve screening or developing new chemicals and will therefore take months, others involve testing drugs that are already approved for human use. Many of these tests are just shots in the dark – Chemical X inhibits a protein from an unrelated virus, so it may block a protein that is used by the corona virus. However, some drugs have solid biological reasons.
The good news is that much of the testing is done by private companies and takes place in other countries, freeing them from the shambolic response of the US to the pandemic. Even within the United States, much of the effort is coordinated by agencies such as the FDA and the NIH, which were largely able to do their own thing by the time official US politics appeared to dismiss the threat from the virus . As a result, we already get some preliminary results from small trials.
But these studies are still so small that the results are little more than an anecdote. Many, including President Trump himself, were thrilled with the first results with chloroquine, a drug that was originally developed for malaria. However, a recent attempt shows that chloroquine is no better than doing nothing. So what's right? Taken together, these two studies barely involved more than 100 people – not enough to tell us anything useful.
Still, the president went on television to tell everyone how excited he was about the drug. And that had consequences. Chloroquine and its derivatives are standard treatments for things like malaria and lupus, and now they're in short supply as people – including doctors – buy and hoard panic. Unfortunately, chloroquine is also very sensitive to dosages, and the side effects have already been fatal both here and overseas.
In the meantime, medical experts within the U.S. government have to point out that we don't know if these drugs work. Not only is this confusing to the public, it also means that experts like Dr. Anthony Fauci, who has been with the US government since Ronald Reagan’s presidency, may become unemployed.
At the moment the conversation about certain treatments should stop. It will be months before we know if something is really safe and effective.
It is difficult to restart an economy in a pandemic
The US government's public response to the pandemic has been to downplay its importance. Several Trump statements suggest that the problem may go away as soon as warmer weather arrives. Then the corona virus was declared an emergency and began a short period of time in which the pandemic was taken seriously. But Trump is already working to limit isolation, restart companies in which people interact, and bring the US economy back to normal levels.
But during such a pandemic, there is no normal economy.
By now everyone in the government should know what easing the restrictions will increase the infection rate, making what happens in New York looks like a warm-up. There are two ways to look at this, and we'll do both.
The first way is for people to look at the virus death rate, as well as the high-risk populations, and point out that it is not too much of a sacrifice if some people die. (The Vice Governor of Texas accepted the opportunity.) However, the crux of the epidemiological studies done is that the infection exceeds our ability to care for people with this disease. People who could otherwise survive die from lack of medical care. This means that more people outside the risk group will die and the mortality rate directly attributable to the coronavirus will increase.
Such an approach also means that anyone who needs critical care for other reasons may not receive it. As a result, there will be many deaths that are not directly related to the virus, but caused by it. Trying to enable normal economic activity also increases the number of people who need critical care because of the risks of everyday activities: car accidents, construction site accidents, etc. The relaxation of restrictions therefore carries the risk of a mortality rate that is higher than that worst reported death rate for the virus lies – which is why public health experts strongly argue against it.
There are great economic risks beyond the deaths. What happens if the virus penetrates the staff of a nuclear power plant and the power plant has to be shut down? What about the people who run public transportation systems? These kinds of problems will spread in the economy. Our dependence on interdependent supply chains means that the closure of a single company due to widespread infections can have an impact far beyond that company.
At the individual level, lifting these restrictions will force every company to make decisions to resume normal operations, and each company is likely to make a different decision. With every cold, every employee has to make decisions about whether they could endanger a family member at risk or the rest of their office – or whether they experience normal seasonal allergies. Many employees will make the wrong decision.
For this reason, even economists say that we will face chaos and economic disruption even if social distancing and local protection end.
We have no test guidelines
Good news in this mess was the rapid expansion of the virus testing. The bad news is that the expansion was spurred almost immediately against a rapidly growing infected population (over 50,000 cases confirmed in the U.S. at the time of this writing) and a lack of raw materials for testing.
Despite the lack, there is evidence that the rich and powerful – such as NBA players – have managed to be tested even though they do not meet any of the criteria recommended for using these tests. And the federal measures that opened up more extensive tests have also left us a patchwork of local regulations for using this still scarce resource.
Testing when and when appears to be a secondary problem, but it is actually central to the problem of restarting the economy. Countries that have managed to either get their economies back on line quickly or limit the disruption have done so because they have strategically used tests: to identify new cases and then review all those who may be newly diagnosed People were exposed.
This is, or should be, the endpoint of the stringent restrictions that many countries are now imposing: new infections are limited enough and testing capacity is high enough to control the problems caused by each newly identified infection. We are far from close to this point, but without a national test guideline we will never get there, even if housing is an option.
We need a plan – and some clearly marked lanes
The fact that there is a potential way to end serious restrictions before treatment or a vaccine is probably news for people. That's because nobody took the time to explain to the public what options we have and what risks they have.
Trump's press conferences on the subject were extensive ad hoc affairs with no clear structure. Trump not only made statements that need to be corrected by medical experts, but also announced programs that came closer to half-hearted ideas and that apparently surprised the companies involved. If we have a comprehensive plan that reflects our actual options – and, to be clear, we could if we wanted to – no one in charge would share it.
Having a plan and communicating is critical to such a public crisis. But it is particularly important for a crisis that has had no real history for over a century. The clearest model for a pandemic like this is the 1918 flu, decades before we even confirmed that DNA was the source of genetic information and that business and travel were not nearly as globalized. So the public cannot know what to expect. This is in sharp contrast to natural disasters, where we have many previous examples, so no recovery framework needs to be made available to the public.
In the absence of a clear national plan, governors were able to make decisions about how to deal with the crisis, which, to say the least, differed dramatically in quality. And the public reacted to the leadership vacuum with confusion and uncertainty.
When a plan is in place, everyone who communicates aspects of it has a simple role: stay on track. Anyone who is not a medical professional should not say anything about the prospects for treatment, a vaccine, or the capacity of a hospital system. At the same time, medical experts should not promote specific political decisions. Policy makers need to weigh up issues that are beyond a doctor's expertise – including whether life is worth the price it takes to save it.
Everyone involved in public communication must recognize the limits of their specialist knowledge
A reality-based plan, clearly communicated by those who understand it, will help the public understand three things: what sacrifices need to be made, what will we get for them, and most importantly, how will those sacrifices be brought to an end. It is tragic that almost three months after this growing crisis, we still lack such clear communication from our leaders.