GP Insights

GP Insights # 301, 18 March 2020

The United States: Strong public response, despite the late spike and Trump's slow reaction
Sneha Tadkal

The numbers
As on 18 March there are 6,524 cases, with 116 deaths, and importantly, 106 recovered. 

The first case of COVID-19 was reported in the US in Washington State in late January 2020. The first person infected with the virus happened to visit a family in Wuhan, China. Since then more than 6,300 people have been diagnosed with the virus in the US The national health protection agency, Centres for Disease Control and Prevention (CDC) is actively coordinating and directing the state and people of the US to contain the spread of the coronavirus. The source of the coronavirus can be categorized broadly as imported cases in travelers, cases among close contacts of a known case and community-acquired cases where the source of the infection is unknown. Three US states are experiencing sustained community spread - New York is the number one hotspot.

Government initiatives
The US was unfortunately slow to respond by three weeks at the beginning that resulted in missing the opportunity to contain like what Singapore has done. It was unfortunately politicized and called as a hoax. The person who has the loudest microphone in the White House did not send the right message to the public, kept shaking his hands and hosted events and gatherings while Singapore made its military to make N95 masks.
 
Finally, when the Government was ready to put its act together, the US had to straight go to mitigation skipping the containment. Significant problems were there, for example, the global shortage of masks and test kits. The US, being the big brother, did not seek help from the WHO in regards to getting the kits. Twelve million masks that were used during the SARS outbreak was never replenished. The US is still playing the catch-up game. 

There have been aggressive measures led by the White House task force Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. Finally, the President has started to listen to medical experts. Million test kits are made available this week with multiple drives by testing centres all over the country. 

Centers for Disease Control and Prevention (CDC) is studying the virus worldwide and helping communities respond locally. National emergency, state emergency has been called, FDA working with the medical community to develop vaccines, drugs and diagnostic tests. CMS (Medicare) offering new benefits for US citizens, so their insurance covers telemedicine, and they get their medical care without leaving their home. 

State governments are responding proactively like in New York and California, state emergencies have been declared before the national emergency and "Shelter in place" ordered for social distancing. Million ventilators are being purchased by the Government, medical supplies, preparation for makeshift hospitals, ICU beds etc. Tests are free for all American citizens regardless of insurance. Disability benefits for people who are unable to work due to COVID and or who require child care because of school closures. Travel restrictions to China, Europe and many other countries, scrutinized entry and screening at airports. Medical community's response is remarkable, working with CDC when things change by the hour. Retired doctors and nurses are requested to come back to work, and special benefits are announced to handle the staff shortage that is expected to happen as medical personnel get sick
 
Public responses
Life in America is changing so rapidly. COVID-19 has infiltrated every aspect of American citizen's lives. Two weeks ago, when the mainstream tech companies like Facebook, Google acted before Government requesting their employees to work from home and not to travel, it sent a strong message to the public.  The typical brutal airlines have been the kindest during this unprecedented crisis, and have been so flexible with cancellations and flight changes. Doctors are seeing patients through video visits; every hospital has set its own drive by testing centres to help with testing and quarantine. 
 
People are serious and following social distancing. Schools, colleges, restaurants, bars, gyms, libraries and parks are closed. Streets are deserted, stores are empty, even teenagers are not 'hanging out' with friends. Elderly people in the community are bring 'checked' to make sure they get the supplies they need without getting out of their homes due to the high risk. A religious ICU nurse shaved his beard today because the hospital was trying hard to find a N95 mask that can fit him and he simply went to the bathroom and shaved his beard to focus on what's more important . Stories like this by the public is heartwarming and people are coming together as a community to take care of each other. Not following "shelter in place" is a misdemeanour and the society is taking it very seriously.
 
The US is two weeks behind Italy and unfortunately, it has been a similar trend so far to repeat what has happened in Italy. Hope these aggressive measures by the Government, and public with strict social distancing and robust response by the medical community will flatten the curve.

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