The good news is that the United States has flattened the curve in the spread of the coronavirus. The bad news is that "flattened" does not mean "reduced to a minimal amount," and in a lot of jurisdictions, the infection rate is starting to climb again.
According to the New York Times's Julie Bosman and Mitch Smith, "As of Saturday, the daily number of new coronavirus cases was climbing in 22 states, shifting course from what had been downward trajectories in many of those places." This cannot be explained only by improved testing regimens; in Florida, the positive test rate has nearly doubled, from 2.3% in mid-May to 4.5% at the start of June.
The news is not all bad. The U.S. case fatality ratio is considerably lower than in much of Western Europe, for example. In terms of infection rate per capita, however, the U.S. performance is bad, bad, bad.
Why are Americans not doing a better job of avoiding infection? Let me suggest three possible explanations that are not mutually exclusive.
First, Americans do not understand the reason for wearing masks. The evidence supporting the use of masks is pretty robust. Both observational studies and high-profile anecdotes seem to confirm that mass mask-wearing, particularly in indoor spaces, reduces the chance of infection significantly.
This sounds like important information, and yet an awful lot of folks are not wearing masks. The NYT story noted that at Houston's Galleria Mall, "people stood in a tightly spaced line for pretzels at an Auntie Anne's kiosk. At California Nails, two women sat maskless during pedicures. Signs urged social distancing, but in crowded walkways outside stores, shoppers brushed past one another, only inches apart." It's not just Houston.
Why aren't more people wearing masks? It could be that the issue has become politically polarized, but it could be something else. Let's quote from this Annie Karni and Maggie Haberman story about GOP officials attending the upcoming Republican National Convention. When J.R. Romano, chairman of the Republican Party in Connecticut, was asked about the need to wear masks, he responded: "We're adults. We all know the risks. If someone wants to wear a face mask, they can. If someone doesn't, they're taking a risk. I don't think they had to make this mandatory."
Actually, Romano doesn't know the risks. Wearing a mask reduces the likelihood of catching the coronavirus from someone else, but what it does even better is prevent someone who has the virus from spreading it to others. The nature of this disease is that people can be asymptomatic or mildly symptomatic for long stretches. Therefore, even if you think you are healthy, it is wise to wear a mask.
This is an accepted fact in Pacific Rim societies that had to deal with severe acute respiratory syndrome (SARS) and other infectious diseases. But I fear this is not how Americans think about it; they see a mask as protecting themselves from others, not protecting others from them.
Second, there is a random element to observing the spread. The Times story notes that not all states that opened in early May have experienced the same spike in infections. There is, at present, no explanation for that variation. And there may not be a clear explanation for quite some time. Read Laura Spinney's 2017 book "Pale Rider: The Spanish Flu of 1918 and How It Changed the World" to see a welter of mysteries about the pattern of 1918 influenza infections that were able to be explained only in this century.
We are not hard-wired to calculate risk and uncertainty terribly well. Most societies will defer to trusted experts to cobble together some cognitive certainty. In the United States, however, a low level of trust in institutions exacerbates the problem. And it is worth remembering that health officials have reversed themselves on both the utility of masks and the dangers of, say, public transport. In some cases, experts disagree with one another. The result is that ordinary Americans will rely more on common sense and word of mouth, which are, let's say, "flawed."
Finally, we are three months into a pandemic and no U.S. official has a narrative about how any of this will end. Wait, that's not fair, Donald Trump has claimed that it will just "go away." Let me rephrase: No U.S. official has a non-magical narrative about how this will end.
Absent therapeutics and vaccines, the most plausible way to get back to normal is through quality contact tracing. But as The Washington Post reported June 14, that is a tough sell in the United States:
"Contact tracing failed to stanch the first wave of coronavirus infections, and today's far more extensive undertaking will require 100,000 or more trained tracers to delve into strangers' personal lives and persuade even some without symptoms to stay home. Health departments in many of the worst-affected communities are way behind in hiring and training those people. The effort may also be hobbled by the long-standing distrust among minorities of public health officials, as well as worries about promising new technologies that pit privacy against the public good.
" 'We don't have a great track record in the United States of trust in the public health system,' said David C. Harvey, executive director of the National Coalition of STD Directors. Ever since the 40-year Tuskegee experiment, which withheld treatment for syphilis from poor black men, officials have had to make special efforts, he said, to reach those now 'disproportionately impacted by covid who are African Americans and Latinos.' "
An awful lot of Americans were willing to radically change their behavior in the short term in response to the pandemic. The implicit understanding, however, was always that by the time the curve had been flattened, public authorities would have a regimen in place for testing and tracing. Public authorities at both the state and federal levels have not delivered on that quid pro quo.
Without a vision for how this will end beyond waiting years for a vaccine, at some point something has to give. Unfortunately, what is giving is best practices for coping with a pandemic that shows no sign of disappearing.
Drezner is a professor of international politics at the Fletcher School of Law and Diplomacy at Tufts University and a regular contributor to PostEverything. This piece was written for The Washington Post.
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