Public health experts raise alarm as coronavirus spreads

A global pandemic outbreak of a new coronavirus will almost inevitably spread to the United States, public health experts are warning, putting new pressure on the Trump administration to act as cases begin to mount outside of the Chinese epicenter.
Those experts, many of whom were on the front lines of the battle against an Ebola outbreak six years ago, said the coronavirus represents an even greater threat to the United States. Though much is still unknown about the virus, which first appeared late last year in Wuhan, China, it’s clear it spreads easily between humans.
“We’ve seen what this disease can do. We’ve seen what it did in China. We’ve seen what it did on the cruise ship,” said Jeremy Konyndyk, a senior fellow at the Center for Global Development who directed USAID’s Office of Foreign Disaster Assistance during the Ebola outbreak. “This is a highly transmissible disease, and there’s nothing magic about China that means it’s going to spread there and not here.”
Experts have watched with growing alarm as clusters of cases have popped up, and multiplied exponentially, both in poor countries with weak health infrastructure like Iran and in wealthy countries with strong infrastructure like Italy and South Korea. The latest case counts showed nearly a thousand cases of the coronavirus in South Korea, just days after cases numbered in only the single digits.
“This is going to continue to spread around the world like a pandemic, not like SARS or MERS, and you can’t stop it with traditional public health measures,” said Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “The only thing that would stop it is if you have a vaccine for the world. And we don’t and we won’t.”
Nancy Messonnier, who directs the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), told reporters Tuesday that the virus’s spread inside the United States is now inevitable. She said she had spoken to her children about the virus Tuesday morning.
“It’s not a question of if this will happen but when this will happen and how many people in this country will have severe illnesses,” Messonnier said. “Disruption to everyday life might be severe.”
In a series of briefings and hearings on Capitol Hill, top American health officials told members of Congress that the government is making plans to fight the virus here in the United States. Senators expressed skepticism about the administration’s planning, and even Republicans urged the White House to seek more funding to fight a potential outbreak.
“I am very concerned that we are not prepared for this or for anything like it in the future, especially with the budget that came out, it cut CDC, it cut NIH, we’re seeing firsthand right now why it’s so important,” Sen. Patty Murray (D-Wash.) told reporters after a briefing Tuesday morning.
Later on Tuesday, two senior administration officials seemed to contradict each other on when a potential vaccine might be available. Speaking to a Senate subcommittee, acting Homeland Security Secretary Chad Wolf said a vaccine could be only a few months away. Hours later, Health and Human Services Secretary Alex Azar said a vaccine might be a year off.
The Trump administration has sought $2.5 billion in emergency spending to combat the coronavirus, a little under half the amount Congress appropriated to fight the Ebola virus in West Africa. Sen. Richard Shelby (R-Ala.), an administration ally, said he is concerned that HHS was “lowballing” the amount that would be required.
Public health experts agreed that the money necessary to fight the virus is multiples of what the administration has sought.
“This is going to cost, it looks like, at least $100 billion to the world. Maybe 10 times that,” said Tom Frieden, the former director of the CDC who now directs Resolve to Save Lives, a nonprofit aimed at preventing epidemics and chronic disease. “Even once the funds are appropriated, it takes a really long time to move them through the system. So the sooner things get moving, the better.”
The coronavirus poses global threats beyond those who may become infected themselves, Osterholm said. He pointed to the potential for supply chain disruptions in the pharmaceutical manufacturing industry in China, which could lead to shortages of common drugs used to treat other conditions.
Osterholm’s group, CIDRAP, has identified 153 generic drugs that are at risk of disruption in the coming months. Medical experts recommend keeping a three-month supply of prescription medication on hand in case of such disruptions. 
Personal protective items such as face masks are already in short supply, both in the United States and around the world. Some of that equipment is also manufactured in China, though an already-bad influenza season has taken a toll on global stockpiles. Azar said Tuesday that the government has a stockpile of 30 million masks, but that 300 million would be needed to protect health care workers alone.
Several public health officials said they were worried about the messages coming out of the White House, and President Trump’s Twitter feed especially. On Monday, Trump sought to calm stock market jitters over the disease’s spread.
“The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart. Stock Market starting to look very good to me!” Trump tweeted
On CNBC, Trump’s top economic adviser echoed his call for calm.
“We have contained this. I won’t say air-tight, but it’s pretty close to air-tight,” Larry Kudlow said as stocks took a dive for the second straight day.
Veterans of the Ebola outbreak said the projected optimism recalled the mistakes made by the Obama administration six years ago, when the White House said the Ebola virus posed a low risk to Americans. Public confidence was rattled when a man with the Ebola virus showed up at a Dallas hospital, and shattered when two nurses treating the man came down with the viruses themselves. The man died, but the two nurses recuperated.
“If you mislead [the public] and tell them it’s going to be okay and it’s not, then you have the double impact of a real problem on top of major distrust,” Osterholm said.
The risk coming from the promise that the virus is under control now is even greater, experts said, because of the likelihood that widespread transmission is so much higher for the coronavirus than it was for Ebola. The coronavirus spreads through droplets in the air, while contracting Ebola requires coming into physical contact with an infected person’s bodily fluids.
“When the president tweets something, that carries weight,” Konyndyk said. “He seems more focused on keeping the markets calm.”
“The overarching priority of White House messaging seems to be to project calm and to project that the risk is low. And that is responsible if in fact the domestic transmission risk is low, as it was about Ebola,” Konyndyk went on. “In this case it is not.”
Several Obama administration veterans said they were concerned, too, that the administration has not put one person in charge of the response to the coronavirus. President Obama eventually tapped Ron Klain, a former chief of staff to Vice President Joe Biden, as the administration’s Ebola response coordinator. Even before the outbreak, the Trump administration drastically cut the number of staffers at the National Security Council who were dedicated to coordinating responses to viral outbreaks.
The experts said the early strategy of simply containing the virus has not worked, and that governments around the world need to be focused on mitigation strategies if and when transmission chains pop up. That raises a host of other questions, both for national and sub-national governments, about the types of guidance to give to hospitals and health care systems. 
“It’s inevitable that it will be spread within the US. Now how widespread it is, how much harm it causes, that only time will tell,” Frieden said.
Among those questions: How will hospitals handle a surge of patients who may outnumber the beds available in which to treat them? How will hospitals mete out their supply of protective gear if it runs low? How will hospitals protect their health care workers, a question of particular significance after 3,000 Chinese health care workers have come down with the virus.
“If we see health care workers go down, that’s what will cause panic among the people,” Osterholm said.
Peter Sullivan, Niv Elis and Nathaniel Weixel contributed.
Tags Chad Wolf Donald Trump Joe Biden Larry Kudlow Patty Murray Richard Shelby
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