For Americans, coronavirus went from being a mysterious affliction that occurred in far-off lands to 1m confirmed cases on US soil within 14 weeks. Now, just six weeks later, the US has broken through the grim milestone of 2m positive tests for Covid-19, according to the Johns Hopkins University tracker.
The anguish of life lost, of a severely wounded economy and wrenching political turmoil have taken a harrowing toll upon a fatigued American public. But further, perhaps far greater pain is yet to come, pandemic experts have warned, even as authorities wave people back into reopened shops and offices and the US president’s political rhetoric on an epochal crisis dwindles away to near silence.
“Everyone has just looked at the first 100 yards of this marathon,” said Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Everyone has just looked at the first 100 yards of this marathonMichael Osterholm
Osterholm said a society usually becomes resilient to a virus once at least 60% of the population has been infected, either naturally or via a vaccine, and develops antibodies. This is still a far-off point for the US, with no firm guarantee a working vaccine will ever be developed.
“At most, perhaps 5% of people have been infected,” he said. “If all that pain, suffering and economic destruction got us to 5%, what will it take to get us to 60%? That’s a sobering thought. All of that suffering and death is just getting started. People haven’t quite got that yet.”
The true figure of infection in the US is almost certainly “multiples more” than the 2m confirmed cases, said Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University, but is obscured to the lack of testing.
Problems in developing and rolling out an effective test dogged the initial US response to the pandemic and although testing has now ramped up, only around 6% of the population has received one.
People with Covid-19 most likely experience either no noticeable symptoms or only minor symptoms such as a dry cough and mild fever.
“We are very much seeing only the proverbial tip of the iceberg,” said Redlener. “We are hampered by the lack of sufficient testing, especially as businesses are reopening across all 50 states.”
Deficiencies in the stockpile of testing kits, swabs, ventilators and protective equipment for medical staff marked the opening stanza of the pandemic in the US. It was a muddled and sometimes astonishing response embodied by Donald Trump, who predicted the virus would vanish in the April sunshine, squabbled with state governors and pondered the merits of injecting bleach or taking hydroxychloroquine, an unproven anti-malarial drug.
A nurse cleans personal protective equipment after being part of a team that treated a coronavirus in San Jose, California. Photograph: Justin Sullivan/Getty Images
“From the beginning there has been misrepresentations and fabrications from the White House,” said Redlener. “Whatever the opposite of ‘mission accomplished’ is, that’s what this is. It’s essentially been an American fiasco.”
Yet even as the US has surged past 100,000 deaths from Covid-19, around a quarter of the entire global total, the crisis has faded from the political agenda.
Trump, preoccupied with sending in the military to crush roiling anti-racism protests over the death of George Floyd, has stopped daily press conferences on the pandemic. Re-openings have been left down to the states, conducted in a somewhat haphazard way with at least a dozen states still experiencing rising rates of infections.
Dr Anthony Fauci, the administration’s top infectious disease expert, has admitted not seeing the president in weeks despite the ongoing public health crisis. “Where is it going to end? We’re still at the beginning of it,” Fauci said this week.
A disconcerting element of the crisis for epidemiologists is that so much about Covid-19 is still unknown. The World Health Organization had to clarify it still doesn’t know how often asymptomatic people pass on the virus, after previously saying it was very rare.
It’s not known why some people grouped together, such as meatpacking workers, have become infected at high rates while others, such as prisoners, haven’t to the same degree. There’s uncertainty over how the virus will react to the summer heat or how big a second or third wave of infections will be. Even the symptoms of the virus, previously thought to always include a fever and cough, have confounded previous expectations.
“There are a lot of things we just don’t know and we need a great deal of humility. We aren’t driving this tiger, we are riding it,” said Osterholm.
The decisions made as the virus rumbles on will invariably become as political and moral as they will scientific.
With more than 40 million people already out of work in the US amid an economic downturn that may rival anything seen in the past century, any escalation of lockdown to stop the spread of the virus will risk unbearable mental and financial pain. On the other extreme, attempting to revert to previous patterns of life without a vaccine would likely overwhelm hospitals with the sick and dying.
“We need to really thread the needle between those two things,” said Osterholm. “I worry we have passed over having that difficult conversation. We’ve already decided that it’s over and done with. It’s not.”