My resourceful American friends,

It is now the time to use your political and social influence to save US. We are at a critical juncture in our fight against the COVID-19 and will lose badly if we don’t act now. Simply put, we are at a situation similar to China in early January or Italy two weeks ago. While I was hesitant to write this post because I am not an epidemiologist, it is my responsibility to offer you information and assessment that I have gained in the past month to call to your attention the immediacy of this issue. I will try to make my six points straightforward and clear, with six illustrative figures.

First, coronavirus is the "perfect" virus that we have only seen in sci-fi movies: it has the best balance point between fatality rate and spread speed (Figure 1). Its mortality rate is about 3%, which is lower than other similar viruses such as SARS (10%) and MERS (30%), but 50-100 times higher than the seasonal flu (0.02%-0.1%). It is NOT “coronaflu.” Meanwhile, unlike SARS or MERS, 1) coronavirus spreads much easier and faster; 2) carriers of the virus can be asymptomatic from one week to the entire infected period; 3) it is contagious even when there is no symptom. Globally, there were only 8,000 infected with SARS in 2002-2003 and 2,500 infected with MERS in 2012, but more than 100,000 people have been infected with COVID-19 within just three months.

Second, coronavirus is especially fatal to the elderly, though it can also kill young people (Figure 2). Anyone over 50 or with underlying illness or immunocompromised is at much higher risk. Within the family, asymptomatic but infected young adults (and perhaps children too) may spread the virus to the elderly, making the latter vulnerable to serious health issues.

Third, coronavirus in the US has reached a point in the spread curve similar to that of China in early January or Italy two weeks ago (Figure 3). With community transmission, the US cases have been increasing at an exponential speed from dozens two weeks ago to hundreds last week and more than 1,000 yesterday. It will increase to more than 10,000 within from one week (increase by 40% per day) to 10 days (increase by 30% per day). Some of you may know that Chinese authorities covered up the virus for three weeks between December 30, 2019 to January 20, 2020, and Chinese citizens paid a great price for that. Since Jan. 23, China took drastic measures for almost 45 days over the entire country to contain the virus, with great economic and social cost. We will simply repeat their mistakes on a greater scale if we don’t react now.

Fourth, the US doesn’t need to take as drastic measures as China, but we need to learn from other countries such as Japan and South Korea (see Figure 3 for the spread curve of Japan). While the Chinese measures were very effective in combatting the virus (see Figure 4 for a cross-national comparison), these measures are not plausible or viable options for most other societies. China’s draconian control of the entire society, universal travel restrictions, coercive/coherent policy coordination (e.g., 42,000 doctors/nurses were dispatched to Hubei after 1/23), and unmatchable manufacturing capacity (e.g., it makes 100 million masks per day right now) is not attainable or conducive to other societies. Furthermore, these measures are unnecessarily expensive—economically, socially, and emotionally. We don’t need to move from inaction to overreaction. The Korean and Japanese model is a more viable and less costly option. With much lower economic and social cost, South Korea and Japan gradually contained the virus. But the bottom line is their governments and societies have responded to the crisis quickly and collectively. No need to panic, but it is vital to make both the state and society work.

Fifth, therefore, you need to pressure the Federal, state-level, and local governments—either executive, legislative, bureaucratic, or professional branches—to react rapidly. We have already squandered time and opportunities. Due to the lack of vision and under-preparation of the current administration in the past one and half months, the shortage of testing kits, reagents, and lab capacity in the US are simply outrageous (see Figure 5 for a cross-national comparison about testing kits). In the current global supply chain, furthermore, there is also lack of masks, medicines, and other health resources in the United States. China, the largest producer of these goods, has been limiting the export in the past month for understandable reasons; it is unclear whether it will soften the export control to the US (although it is supporting Iran, South Korea, and Italy). Medical commodities are now the most strategical resources. If the US cannot import as much as it wishes, you need to push the governments to invest or subsidize the production of these critical resources and the provision of them to anyone in need.

Sixth, you also need to exert your social influence to urge people to increase social distancing and reduce social contacts. We need to do much more than frequently washing our hands. We need more proactive and protective measures: cancelling or limiting public events in churches, schools, and political gatherings, greatly reducing networking and meetings, and self-quarantining whenever there is a symptom. Social distancing is the major way to slow transmission and flatten the spread curve, so as to not overwhelm the health system (Figure 6), which is what happened in Wuhan in late January and Northern Italy right now. There, hospitals were overwhelmed, patients were dying without sufficient care, doctors and nurses were exhausted, infected, and dead. The death rate will be much higher if the health system breaks down: for example, the death rate is more than 5% in Wuhan but about 0.8% in other areas of China.

Let me end my post with a sad fact: in the Hubei Province alone, more than 3,000 people lost lives within 60 days, and more than 15,000 patients will have serious sequelae even after they were “cured.”

Dear friends, please act NOW!

(Special thanks to my colleague, Nina Yamanis, who has provided me great feedback with her expertise in epidemiology and public health.)

Yang Zhang

Assistant Professor

American University