A hideous U.S. Covid curve has a simple explanation

(Bloomberg’s Opinion) – The alarming picture below has been going around. It illustrates the poor job the United States has done in containing Covid-19 compared to the European Union, a larger region of independent countries that suffered a previous outbreak. Why the big difference? What is America doing wrong?

There are many possible answers to those questions. A slow initial response and an inability to scale up tests allowed the virus to spread everywhere in the U.S. And instead of coordinating a consistent and aggressive national response, President Donald Trump has consistently downplayed the threat of infection. and has left decisions to states with insufficient support. As a result, decisions about locks and reopens have been chaotic and have ignored the guidelines set by federal public health officials.

Amidst all this, a particular difference between the American and European approaches stands out. Many states were happy to reopen after simply “rounding the curve,” that is, slowing growth upward and ensuring additional hospital capacity. These states continued to expand economic activity on a high plateau with many transmissions in progress. In contrast, most European countries waited to reopen until they flattened the curve or reached its far slope, with a substantially lower incidence or dramatic reductions in viral spread. It is not the only explanation for a growing gap, but it is compelling.

Italy is an exception, as it opened with a relatively high case count. However, the country was recovering from a particularly large and concentrated outbreak, and its incidence was on a strong downward trajectory. Its average daily count was less than 20 cases per million within a week of its initial limited opening, a measure that none of the most troublesome states has handled since early April.

So why is low incidence so crucial to a successful reopening? It is simple math. More viruses circulating in a community means more opportunities for it to spread. It makes each precaution that people and officials take less effective and each activity more risky. This does not necessarily translate into immediate outbreaks, as people emerged from the confinement quite cautiously. But as the activity expands to include things like indoor bar service, a high base level of infection is increasingly likely to cause problems.

Persistently high levels of cases in the midst of a substantial reopening also make it much more difficult to identify and isolate a high percentage of infected people – again, a number problem. At a certain point, there are too many cases and contacts to hope to track them down.

The gap with Europe argues for more moderation of the fast-opening states in the future, and indeed, some governors are taking an example. In Texas, where cases are increasing at a dangerous rate, Republican Governor Greg Abbott has suspended the reopening of businesses and has ordered the taverns closed. North Carolina has also frozen its reopening efforts, as have Utah and Nevada. And, of course, there is the example of New York and New Jersey, who waited until their steep curves were tamed before beginning reopening efforts; now, even as activities resume in both states, new cases have slowly declined.

The chart tells the story: declaring victory too close to the top of the curve seems like a great way to return to new heights.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Max Nisen is a Bloomberg opinion columnist on biotechnology, pharmacy and healthcare. He previously wrote about corporate strategy and management for Quartz and Business Insider.

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