We the people confront COVID-19

American companies, organizations, universities, state and local governments, and individual citizens have heeded the advice of scientists and medical experts with a massive response to limit the spread of COVID-19. 

Universities have sent students home and put all classes online, Disneyland is closed, Broadway is dark, and the NBA and March Madness have canceled play. This overwhelming response was launched in the absence of a national response.

American citizens, companies and institutions deserve much credit for valuing public health above comfort and profit and enacting measures to slow the spread. This is something to be proud of.

For the virus causing COVID-19, it is estimated that every infected person will infect 2-3 other people. In epidemiology, this is called the basic reproductive number or R zero.  

Everything that is done to limit the spread of COVID-19 — hand washing, social distancing, canceling gatherings, travel restrictions, and closures — is done to lower R zero from 2-3 to 1.5-2. This is how we limit the spread and “flatten the curve” so that our health system is not overwhelmed.  

The impact of lowering R zero has been proven many times. The 1918 influenza pandemic killed an estimated 50 million people worldwide.  

The responses of two American cities, Philadelphia and St. Louis illustrate the impact of lowering the R zero. After the first case of flu was reported in Philadelphia, the city government did not immediately respond, notably allowing a city-wide parade to proceed. 

In the following four weeks, there were 50,000 new cases of influenza, resulting in 12,000 deaths. 

Seven days after the first case was reported, Philadelphia instituted closures and social distancing, but by that point, the medical infrastructure was overwhelmed. On the other hand, St. Louis reacted quickly after the first case was reported, curtailing gatherings and instituting social distancing. There were no spikes in deaths or infection; St. Louis effectively lowered R zero and “flattened the curve.”  

In the present COVID-19 pandemic, Taiwan offers another striking example. Lying 81 miles off the coast of mainland China, and with extensive travel between the two countries, Taiwan was expected to be hit hard as COVID-19 spread.  

However, owing to their experience with the previous SARS epidemic, they had the infrastructure in place which was activated within a week of China announcing “strange pneumonia” on December 31, 2019.  

The 124-point plan, launched as soon as they suspected a viral outbreak, limited the spread of the virus and to date, Taiwan has only 59 confirmed cases and one death. Taiwan lowered R zero.  It is important to note that a similar government infrastructure to respond in the event of a pandemic and protect lives in the U.S. was dismantled in 2018.  

Clearly the speed of the response is key. Viruses like SARS-CoV-2 that cause COVID-19 spread exponentially and a one-day difference in response time results in a 10- to 100-fold increase in infections and deaths. In stark comparison to other countries, such as South Korea, there is still no widespread testing for COVID-19 available in the U.S., even though the Trump administration announced plans to increase testing Friday, March 13th.

The lag in the federal U.S. response has left us scrambling to get on top of COVID-19 spread and the number of confirmed cases jumps by hundreds each day. How many lives might have been saved had the government acted in January with the first cases were known? The negative economic impact of COVID-19 would have also have been reduced.

Yet through the efforts made by citizens who have stepped up, we the people will make a difference. Companies and institutions have put the lives of Americans above economic gain. These efforts will make the COVID-19 pandemic less deadly; they will lower R zero. 

If we are very successful and the pandemic is less than expected, there will be those who will say it was all over-hyped, even a political hoax. They should be reminded that this is what happens if appropriate measures are taken to lower R zero. They should be reminded that, thankfully, we will never know what could have been if we had done nothing. 

Americans should be proud of the way they stepped up and responded to the COVID-19 threat in the face of no coherent national leadership.  This is truly what makes America great.

Felicia Goodrum Sterling is a virologist and professor at the University of Arizona, a fellow of the American Academy for Microbiology and a 2018 Public Voices Fellow. James Alwine is a virologist and professor emeritus at the University of Pennsylvania, a visiting professor at the University of Arizona, a fellow of the American Academy for Microbiology and of the American Association for the Advancement of Science.