Paul Romer, a Nobel Prize-winning economist, envisions a day when all Americans are tested regularly for COVID-19, and they present proof when dining out or visiting a dentist.
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said if a "big peak" of coronavirus floods hospitals this winter, "We have the potential here to go through days we have not seen since World War II ... As a nation, we will not be ready."
“What we’re experiencing is a massive global destabilization of all our systems,” adds Brian David Johnson, a futurist and director of the Threatcasting Lab at Arizona State University. “We actually don’t know all the damage that has happened. We’re on life-support, globally.”
If the world premiere of COVID-19 caught you off guard, you may need to get prepared for a sequel.
Many scientists believe the pandemic likely will dissipate over the summer only to return late this year in a second wave that could be worse than the first. While that outlook is no certainty – just one of several plotted by public health experts – disaster planning is all about anticipating worst-case scenarios.
So, with months to go before a possible Round 2, is the United States prepared – medically, economically and emotionally?
The leading answer from epidemiologists, economists and futurists: Probably not. But tomorrow depends in part on what we do as individuals, communities and a nation during the time that’s left.
The destabilization described by Johnson is glaringly evident in three realms:
Medicine: Some U.S. hospitals, hit with stunning patient surges in COVID-19 hotspots, ran out of ventilators, personal protective equipment and other supplies. The Strategic National Stockpile was nearly emptied. Thanks to a global manufacturing binge, supplies appear to be catching up and, in key locations such as New York City, the disease is abating for now. But, if coronavirus returns with a second wave, will the health care system be ready?
Economy: Unemployment is higher than any time since the 1930s. Businesses – from mom-and-pop shops to major corporations – are going under. Global trade is crippled. Travel, sports and entertainment industries are mostly dormant.How much more financial trauma can the economy endure?
Emotional: Psychological, social and political strains of coronavirus, though not easily measured, are palpable products of a medical and economic nightmare. If the pandemic gets worse down the road, threatening our fabric of work, schools, homes and governance, will Americans be ready?
Preparedness is not easily defined. In biblical lore, Egypt endured 10 plagues – water turning to blood, swarms of locusts, even an infestation of frogs – and it’s still around.
But, if COVID-19 has delivered any lesson, it may be the value of looking ahead at a nation's ability to absorb catastrophic shock.
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Hoping for a miracle
On the health care front, it’s crucial to recognize that COVID-19 is, as University of Michigan epidemiologist Arnold Monto puts it, “a very strange virus.”
Its origin, transmission, symptoms and damage remain puzzles. And its future seems to defy computer modeling. Because of that, experts start any conversation by warning that the first wave is still cresting, and predicting the future of coronavirus is a fool’s game.
“If you don’t express doubt about what’s going to happen, you really haven’t done your job,” noted Monto, who has consulted for the World Health Organization and the Centers for Disease Control. “My take is you have to keep an open mind and prepare for all eventualities.”
Monto and others point out that COVID-19’s threat could be blunted by the development of a vaccine or a treatment.
But many epidemiologists share the view of Anthony Fauci, the nation’s top infectious disease expert, who testified during a congressional hearing Tuesday: “The idea of having treatments available or a vaccine to facilitate reentry of students into the fall term would be something that would be a bit of a bridge too far.”
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In the absence of a panacea, public health experts say comprehensive testing is the immediate solution. It would allow disease tracking and quarantines to significantly dull a second COVID-19 spike. Most argue that testing and tracing is the most important step in controlling the disease. But they also contend those efforts have been a bust in the United States so far.
“We still haven’t gotten our act together,” said Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University. “I think it’s inevitable that we’re going to have a second, if not a third, wave” because of the nation’s “erratic and disorganized policies.”
“The biggest single failure was the lack of testing in this country,” agreed Eric Toner, senior scholar with Johns Hopkins University’s Center for Health Security. “That influenced every single other thing that has gone wrong… And we still have problems in testing.”
Until the disease can be monitored and controlled, Toner warned, “We need to be really careful about dialing back social distancing. It has been amazingly successful – more effective than I thought it would be.”
Monto's big fear is a resurgence of COVID-19 coinciding with a deadly flu outbreak, overwhelming hospitals, healthcare workers and supply systems. “If they’re all synchronized, it may really break down,” he said. “To me, that’s the worst-case scenario.
I don’t think we’re ready now."
Medical supplies: The great unknown
Without a vaccine or treatment, and with testing problematic, hospital preparedness looms crucial.
But questions about medical supplies lead to a dead end. No one knows how many ventilators or personal protection outfits would be needed, how many are currently in stock, or how many may be produced by a ramped-up manufacturing system during the coming months.
In mid-April, Toner estimated supply demands in the United States for a 100-day surge of COVID-19: 4 billion gloves, 321 million gowns and 179 million medical-grade masks. But those numbers are no longer valid, he said, and the actual need is unclear.
Even if an accurate count was available, there is no national inventory showing the volume of supplies on hand.
Nor is there a calculation of worldwide manufacturing increases amid the crisis, which could meet the demand.
In a "National Action Plan" for medical preparedness issued this month, Toner and other researchers at Johns Hopkins portray the U.S. healthcare system almost like an intensive-care patient that is bleeding out – desperately needing an infusion of money to restock supplies and reinforce staffing.
While a federal bailout bill provides $175 billion to cover losses, the report says, that's not nearly enough.
While the price is high, authors concluded, “it will certainly cost less than the trillions now being spent spend because our public health and healthcare system was not prepared or equipped for this pandemic.”
Economy: Recovery or ruin?
In a recent op-ed for the New York Times, Romer and fellow economist Alan Garber wrote about the dueling threat coronavirus poses to America's public health and financial well-being. While shutdowns may allow some people to survive, they concluded, “It is our economy that will be dead.”
In an interview, Romer said whether COVID-19 stays on its present course or ebbs and surges the nation faces an unemployment rate of 30 percent, yet people seem to think it will just go away allowing life to resume as before.
"There's this optimistic bias, and a certain amount of denial," he added. "With no change in policy, they're just not going back to those jobs … and there's a good chance those jobs won't be there."
Unless or until a vaccine is developed, Romer said, the only hope is a biweekly testing requirement for everyone, with those who have the disease going into isolation.
An alternative would be to choose the economy over safety. But Romer said that raises a tragic question: "Are we willing to accept 2,000 deaths a day for months on end?"
“The longer it goes on, the more it’s going to imply we’re just not coming back to the same place,” agreed Ken Rogoff, economics professor at Harvard and former chief economist for the International Monetary Fund.
While declining to give the nation a letter grade for preparedness, Rogoff said COVID-19 has undermined much of the planet's economic structure. As one example, he said, “We’re going to see just a collapse of global trade. We may have a world where (nations) … become more like fortresses.”
Rogoff praised the “drastic measures” taken thus far in the United States to fight the pandemic, including huge relief allocations. But such tactics cannot be sustained, he said, and leaders in Washington, D.C., seem unequipped for prolonged viral waves. “The problem is, where is the economy heading?” Rogoff said. “Are they mentally prepared for that? I doubt it… It’s not going to be easy because the political system is really fragile.”
Colin F. Camerer, a professor of behavioral finance and economics at the California Institute of Technology in Pasadena, said COVID-19 may require intense, short-term pain to achieve a long-term gain. He and others pointed to South Korea as a model nation that used comprehensive testing and strict social-distancing to weather the economic storm while limiting infections. By contrast, Italy and the United States – which were slow to test or take precautions – have suffered heavy casualties and economic damage.
“The No. 1 thing is to get the first wave over, and then prepare for the second one,” Camerer said.
Surviving a psychic trauma
Almost everything about American life has changed: jobs, schools, homes, churches, entertainment.
Psychiatric journals are churning out articles on suicide and mental health issues triggered by fear, financial ruin and social isolation. An already polarized political system seems utterly askew, with dueling versions of reality. And the Internet's output of conspiracy theories, lies and apocalyptic visions has gone on steroids.
Johnson, the futurist at Arizona State University, said it’s not yet clear how we’re handling the first go-round of coronavirus, let alone additional waves. But dramatic upheaval is coming.
After the 9/11 attacks, Johnson noted, there were changes – from sweeping anti-terror legislation to relatively small things, like footwear: "We’ve normalized taking off our shoes at the airport.”
While Johnson prefers to focus on human resiliency, he acknowledged doomsday visions are part of the profession. With COVID-19, he said, "There are ways of looking at this destabilization where it does not restablize."
Thomas Frey, a futurist and founder of the DaVinci Institute in Colorado, said the pandemic may be “the most explosive crisis in all of world history” — a potential paradigm shift not just economically, but culturally.
Fundamental gestures, such as the handshake, are likely to vanish or change.
Yet Frey also questioned whether worldwide “hysteria” over the disease is rational, and he suggested that shutting down a country may be over-reactive unless the death toll borders on a million.
“It’s a bizarre balancing act we’re trying to maneuver,” he said. “I think our emotional preparedness – societal preparedness – I’d give that a failing grade. I actually don’t see us having the political will do go through this again.”
Nancy Berlinger, a research scholar with The Hastings Center, a non-partisan bioethics institute in New York, said it’s clear America is unready for a second viral peak “because we were not prepared for the first.”
Berlinger, who lives in one of the world's hardest-hit communities, speaks with evangelical passion about displaying virtues during catastrophe times: Compassion. Open-mindedness. Unselfishness.
While the pandemic has created wrenching dilemmas for leaders, she said, daily personal decisions such as social distancing also fall within the ethical prism, and selfishness may empower a pandemic to take more lives, cause more suffering.
“It’s about the moral choices each and every one of us make,” Berlinger said. “I hope we will in every way possible have a stronger sense of who our neighbor is, who our fellow citizen is.”
Reporter Erin Mansfield contributed to this story.
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