What a Pandemic in America Might Look Like

Movies like Contagion make a new virus seem like the dramatic collapse of civilization. Hospitals fill as the infection spreads and feckless elites dither, waiting too long to react and containing information to avoid panicking the public. By the time the news hits, it’s too late, and people are dying in the streets. Countries close their borders in an attempt to contain the outbreak in vain.

But movies like Contagion are stories about our fears and worst case scenarios, not accurate depictions of reality. The truth is, as long as everyone is talking and there’s plenty of supplies to go around, the world can ride out a new virus or disease until scientists develop a vaccine or the infection recedes. We’ve done it before, dozens of times.

Now that the novel coronavirus Covid-19 is spreading across the globe and prompting severe responses from the Chinese government including mass travel restrictions, many are worried about what a pandemic might look like in the United States. With only 15 confirmed cases in America, the United States is dealing with what could be the early stages of an outbreak if the virus continues to spread.

The good news is that the U.S. is part of the international community and is plugged into the global health system. This global health system is a vast machine spread across the planet, made up of groups such as the World Health Organization (WHO) and the U.S. Center for Disease Control (CDC), state agencies, local organizations at the city level, hospitals and clinics, and individual healthcare providers. This system is already up and running, spreading information and allocating resources.

“To be honest, we respond to outbreaks everyday,” Demete Daskalakis, Deputy Commissioner for the Division of Disease Control of the New York City Department of Health and Mental Hygiene, told Motherboard over the phone. “We do work that focuses on top notch epidemiology and surveillance to understand what’s going on with diseases and trends.”

The global health machine is always watching for signs of new disease, and it caught coronavirus early. “A very basic AI is scanning every news report, every tweet, every blog, to look for instances where people are talking about things like fever and outbreak,” Theresa MacPhail—a medical anthropologist, Assistant Professor at Stevens Institute of Technology, and author of the book The Viral Network: A Pathology of the H1N1 Influenza Pandemic—said over the phone.

BlueDot, a Canadian AI company, noticed the outbreak in China and told its customers seven days before the CDC warned the U.S. and ten days before the WHO warned the world. “We can pick up news of possible outbreaks, little murmurs or forums or blogs of indications of some kind of unusual events going on,” BlueDot founder and CEO Kamran Khan told Wired.

MacPhail was in Hong Kong during the H1N1 pandemic and learned first hand how the world’s health system responds to global outbreaks. “Most of global health is just national health systems communicating on a regular basis, either with the WHO or with each other,” she said.

In places like the WHO and CDC, experts gather to monitor the situation and disseminate information.

“They have a situation room, much like a military situation room,” MacPhail said. “They have a map with dots on the map representing outbreaks they’re watching continually. There’s always something on the map. Wuhan is on everyone’s mind right now but there’s probably about 30 outbreaks they’re also watching and those aren’t getting talked about.”

Bigger cities have similar systems in place. In NYC, the situation room is part of what officials call the Incident Command System (ICS). There are no confirmed cases of coronavirus in NYC, but ICS is already up and running. “[It’s] designed to pull resources from all over the agency to be able to make the response larger,” Daskalakis said. According to Daskalakis, NYC’s health officials constantly practice and drill ICS scenarios.

It runs tabletop games meant to simulate outbreaks and perform full scale drills that include running ambulances back and forth across the city and testing individual hospitals. “Interestingly enough, the full-scale drill that was scheduled for March would have simulated a highly contagious respiratory virus,” Daskalakis said.

Daskalakis in NYC’s ability to respond to the coronavirus, but cautioned that drills and training would only go so far. “We have great respect for the power of a new virus, but we’re already turned in to how to respond to a respiratory virus outbreak,” he said. “There’s a lot of unknown in this one, but our strategies already exist.”

“It’s inevitable that we’re going to get a case,” Daskalakis said. “Right now we’re in a zone of containment, but as things get bigger, we have to make sure we triage our resources so the healthcare system can actually deal with caring for the individuals who are at the highest risk for adverse outcomes.”

While the idea of an outbreak in New York City might conjure dystopian images of isolating Manhattan, containment doesn’t necessarily mean travel bans like the kind the Chinese government is using to try and contain the virus’s spread.

The first instinct of many governments and people is understandably to restrict the flow of people to control the flow of a virus, but current research suggests that travel bans don’t work and may make the problem worse. “The Committee does not recommend any travel or trade restriction based on the current information available,” the WHO said in the early days of the coronavirus outbreak).

“I don’t think we’ve seen compelling evidence that travel bans work at all, and they’re less likely to work for respiratory viruses like this, because they move too quickly,” Johns Hopkins epidemiologist Jennifer Nuzzo told Wired.

In some instances, quarantining asymptomatic people suspected to be infected creates a breeding ground for the diseased and worsens the pandemic and spreads fear. This happened on the Diamond Princess, a Japanese cruise ship that Tokyo quarantined after a man who disembarked in Hong Kong later tested positive for coronavirus.

"Basically the quarantine of a ship is a 19th century type of a strategy. But it was probably hard to make any kind of a decision," Hitoshi Oshitani, an expert on infectious disease at Tohoku University, told the Associated Press.

Thankfully, coronavirus is similar to other highly infectious respiratory diseases, which means that most American healthcare workers know how to handle it.

“In the early days, most of the steps are going to be the same whether or not you’re looking at SARs or influenza,” MacPhail said. “It’s the same protocol for all transmissible organisms so there is a basic level of training that they can have that will help them to come with whatever is coming.”

As infection rates rise, the global health machine starts worrying more about logistics. Do hospitals have enough beds? Do healthcare workers have the supplies they need to handle the pandemic? “What China is dealing with right now, is logistics,” MacPhail said. “Do they have enough masks? Do they have enough antivirals?”

China has a shortage of surgical masks, but its biggest concern was a lack of hospital space. As the source of the outbreak, its population is the hardest hit and it needs the most beds. To make up for the shortage, China built two brand new hospitals in just over a week.

NYC has a plan for shortages too, but it doesn’t involve building new hospitals. “There’s a lot of considerations that revolve around hospital capacity and medical systems capacity as well as the need to be nimble in terms of strategy given the magnitude of the outbreak,” Daskalakis said.

If the infection becomes bad and resources become more scarce, NYC would reserve hospital beds for those with the worst symptoms. In a worst case scenario, healthcare providers would send people with mild symptoms home. “Do we have enough capacity in hospitals to care for everyone? Do we need to have everyone go to a doctor in case they have mild symptoms? All of that is going to change depending on the magnitude,” Daskalakis said.

Smaller cities and rural communities don’t have robust systems and health departments, so they should pay special attention to both their training and supplies.

But for any of this to happen, the infection would have to spread far more than it has. The coronavirus appears to be deadlier and has infected more people than SARS did during its spread in 2003. But, at more than 75,000 infections and more than 2,000 dead, coronavirus is still less of a problem than the H1N1 pandemic of ten years ago, which the CDC estimated killed more than 150,000 people in a year.

The world, and the United States, isn’t anywhere close to dealing with a pandemic on the level of H1N1. “Right now, it’s about giving as much scientific information as we can to healthcare providers so they’re giving optimal care while preventing transmission,” Daskalakis

MacPhail said she feels that the world is handling the coronavirus well. The global health machine is working as intended. “When you think about global health, if you’re thinking about Batman in a Batcave, that’s wrong,” she said. “It’s always going to be your local public health officials responding to this. What happens is the information system goes into overdrive and, in the end, it’s all about logistics. It’s about getting supplies to people.”

And everytime an outbreak happens, that machine gets a little better at dealing with the next pandemic. “We learn how good we are at responding and then we fix the things that are broken,” MacPhail said. “This is always going to be a problem. Always.”

According to MacPhail, the coronavirus coming from China made it easier to deal with. People expect new diseases to come from China so they watch it more than other countries. She said there’s a perception that Beijing hasn’t been forthcoming with information about the disease, but she’s confident healthcare professionals will fill in the gaps. “Doctors everywhere want to save lives and they will talk,” she said.

Chinese doctor Li Wenliang first noticed SARS like symptoms among his patients in December. Chinese authorities silenced him, but word got out. Wenliang, who was 34, contracted the virus and died. Wenliang was one of eight whistleblowers who got word out about the coronavirus. That early spread of information saved lives. It’s all about logistics and communication.

“The people who are saving our asses are already in our community,” MacPhail said.