Virus Poses Dilemma for States

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In the past week, total reported Covid-19 deaths in the United States increased from 20,608 to 39,090, an increase of 89%. However, the rate of increase was once again lower than the previous week, when it was 142%. The rate of increase slowed in every state except three, Montana, New Mexico and Vermont, all states with relatively few cases to begin with.

Also encouraging is the fact that death rates per 100,000 population remained low in most states. Death rates of 10 per 100,000 or more have only been seen in nine states—New York, New Jersey, Connecticut, Louisiana, Michigan, Massachusetts, District of Columbia, Rhode Island and Illinois. Their rates range from 90 per 100,000 in New York to 10 per 100,000 in Illinois. In the other states fewer than 10 per 100,000—or fewer than one person in 10,000—have died from this disease.

“Opening Up America Again”

Now that the mortality rate is slowing overall, as well as remaining low in most states, is it time to roll back stay-at-home orders and put the country back to work? This week the Trump administration released a set of guidelines for the states to follow in making that decision. It included some “gating criteria” for states to “satisfy before proceeding to phased opening.” One criterion was a “downward trajectory of documented cases within a 14-day period.” Another was that hospitals have a “robust testing program in place for at-risk healthcare workers, including emerging antibody testing.” The guidelines also listed “core state preparedness responsibilities,” one of which was the “ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results.”

Where do we stand on new case trajectories and testing capabilities? For the country as a whole, new cases per day peaked on April 10 and fell for the next four days. Then on April 15 they jumped back almost to the April 10 peak and leveled off. We have not yet seen a downward trajectory for 14 days. With regard to testing, the country is falling hundreds of thousands short of the 500,000-750,000 tests per day that epidemiologists recommend. States that are most anxious to ramp up testing, such as New York, maintain that they need far more money and materials from the federal government to be able to do so.

Looking state by state, I was unable to find any state with a sustained decline in new cases over a two-week period. Washington state, whose largest number of new cases came on April 6, comes closest. Some of the higher-mortality states—New York, New Jersey, Connecticut, Louisiana, and Michigan—are starting to decline, but without a very consistent trend. In Massachusetts daily cases are fairly level; in Rhode Island and the District of Columbia they are still rising; and in Illinois they fell for a few days and then rose again. And to my knowledge, no U.S. state has succeeded in implementing a comprehensive testing program yet, although some foreign countries have done so.

Although the situation is very fluid, states are well advised not to rush into lifting restrictions before the virus is under better control. Even states that have not yet had a serious outbreak must be cautious, since they may owe their success largely to the number of people who have been staying home. We have just seen in South Dakota—a state with few cases before last week—how quickly the disease can spread in a workplace, if we are unable to test workers, quarantine the sick, and track their contacts.

The politics of “liberation”

This was also the week that the virus issue became most politicized. Many states saw the beginnings of a protest movement led by Fox News commentators, other conservative media outlets, Trump supporters, and now the President himself. The ink had hardly dried on the “Opening Up America Again” guidelines when Trump expressed his support for the protesters clamoring for an end to the stay-at-home orders, tweeting out a call to “liberate” Michigan, Minnesota and Virginia. None of those states have met the administration’s own stated criteria for reopening. New cases per day in Michigan are only starting to subside, while they are level in Minnesota and rising in Virginia. Then why single out those states? Because they have large populations of Trump supporters, but Democratic governors. The main objective seems to be to portray them as the enemies of their own people, when they are doing basically the same things that other governors are doing.

President Trump’s role in this matter is deeply frustrating to the state and local politicians and hospital workers who are on the front lines of this battle. He wants to get credit for liberating the economy, but he refuses to take responsibility for the federal initiatives needed to halt the epidemic, especially in the areas of testing and hospital supplies. He wants to be the star of the show, scoring political points while someone else does the heavy lifting. This is, after all, the president whose promise of a cheaper but better replacement for Obamacare ended in his plaintive whine, “Who knew that healthcare could be so complicated?”

A president fit to lead in a national emergency would be great. But even more is at stake here. We need a national culture that respects science and expertise, balances individual freedom and the public interest, defines a strong role for the federal government, and stops blaming our problems on foreigners. The epidemic started in China, but our lack of preparedness despite repeated warnings is something we did to ourselves.

Inevitably, states will differ in their approach to lifting restrictions, and we will have a natural experiment in economic and health policy. I only hope that the experiment is not lethal in many parts of the country.

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