The Memo: Signs of optimism in coronavirus fight bring new dilemma

The first moderately hopeful signs are emerging regarding the coronavirus crisis — but those will also bring new challenges, both in public health and in politics.

In Europe, the two worst hot spots, Italy and Spain, are beginning to cool, even though their problems remain severe. 

In New York, by far the worst-hit U.S. state, there has been a notable drop in new hospitalizations related to the coronavirus — even as the Empire State recorded its highest one-day death toll, with 731 new deaths, on Monday.

Deaths are, however, a grim lagging indicator of the spread of COVID-19. New admissions to intensive care units in New York have fallen sharply. Having run at a rate of more than 300 per day for the six days from March 29 to April 3, there were only 89 such admissions on April 6.

The danger, as far as public health officials see it, is of social distancing measures slackening too fast and allowing the coronavirus to establish a new foothold. A related dilemma is how to manage public expectations and behavior if people feel either that the nadir is past or that some worst-case scenarios won’t come true.

As experts including Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, have noted, one of the problems with strict mitigation efforts is simple: If they work, they appear in retrospect to have been an overreaction.

Experts are far more worried about the alternative scenario, where Americans try to resume normal life too soon.

“It’s an enormous danger. I am very concerned,” said Lawrence Gostin, a Georgetown Law School professor who specializes in public health. 

“All the data tell us that if you relax physical distancing too soon, you get a resurgence of cases. Still, the vast majority of people in the United States and Europe have no immunity. And so, as soon as they start circulating again, we know this is a highly transmissible virus.”

The balancing act — trying to maintain public morale while also offering accurate facts and realistic projections — would be a big challenge for any president, especially given how much remains unknown about the coronavirus.

But the conundrum is particularly stark in President Trump’s case. 

On Monday morning, the president tweeted that there was “light at the end of the tunnel.” Trump had at one point pushed for the United States to get back to business as usual by Easter Sunday, April 12, before backing off that idea in the face of bleak projections from public health experts.

Trump has struck a more somber tone at times, as over the weekend when he sought to prepare the nation for an especially grim week.

In the public health field, the fear is that talking up the situation is more dangerous than talking it down.

“We are setting ourselves up for disappointment,” said Kavita Patel, a nonresident fellow at the Brookings Institution and a veteran of former President Obama’s administration. “It is universal that we all want to go back to normal. So when the president makes those statements, we want to believe them. And then when the reality is different, we feel disappointed, we become even more anxious and resentful.”

Patel also worried that any sense of division between a president cheerleading for a return to normal life on one hand, and the scientific community urging caution on the other, risks casting scientists as the “bad guys.”

“It creates an enemy out of science,” she said. “Who is telling us to stay home? It is science. It creates an antagonistic attitude toward science and data. … It makes an enemy out of everything we need to be friends with right now. Our best friends now are public health experts and data and science.”

Supporters of the president, however, emphasize that he will have to make inherently tricky decisions whenever the worst of the crisis appears to be past. They argue that a president cannot be as much of an absolutist on public health as doctors might be, because he must also balance imperatives about the economy and the general state of the nation.

Brad Blakeman, who served on the senior staff of former President George W. Bush’s White House and is a Trump supporter, said there would come a time when the president would have to adopt the mindset of an actuary as much as a doctor.

The kind of risk assessment common in the insurance industry represents “exactly the kind of principles that the president has to evaluate,” Blakeman insisted. “If the doctors have their way, they will always opt on the side of extreme caution, but you do have to weigh the balance as to whether the cure will be worse than the sickness.”

Blakeman noted that, with a vaccine for the coronavirus likely a year or more away, it seems virtually certain that the country will have to open up again while the risks posed by COVID-19 are still significant.

“The president will have to make some tough decisions based on risk,” he said, moving the nation toward a normal footing “with the risk of [the coronavirus] being something we should still be concerned about.”

Many in public health argue that could be a false choice, however. 

They worry about a loosening of restrictions, whenever it comes, unleashing new waves of infection — an outcome, they say, that would spoil any prospects of economic recovery as well as exacting a death toll.

“You may be bringing the pandemic to other places” in such a scenario, said Gostin. “You might see a flattening off in places like New York and you could see a significant rise in other parts of the country.”

Even if there are some buds of hope, the overall situation remained bleak, he warned.

“I think the pandemic is going to move across the country in waves,” he said.

The Memo is a reported column by Niall Stanage, primarily focused on Donald Trump’s presidency.