WASHINGTON — It was possible until now to view the novel coronavirus pandemic in the U.S. as a crisis concentrated in a few densely populated regions: New York City, Seattle, the San Francisco Bay Area. New York is now considered the global epicenter of the pandemic. Some of the most searing images and stories of the past few weeks have come from long-term care facilities in Washington state and emergency rooms in New York City.
But the pandemic is entering a new phase, medical and public-health experts say. In the past week, new coronavirus hotspots have emerged in other major metropolitan areas including New Orleans, Chicago, Miami, Detroit, Atlanta, and Los Angeles. L.A. Mayor Eric Garcetti told reporters this week that his city is “six to 12 days behind New York.” (As of Friday, New York City had nearly 40,000 positive tests and 365 deaths.) Garcetti said that L.A. “certainly will see” the rapid spread of the coronavirus that we’ve seen in New York City and its suburbs.
“This is a national epidemic,” Dr. Sarah Fortune, chair of the Department of Immunology and Infectious Diseases at Harvard’s T.H. Chan School of Public Health, tells Rolling Stone.
“It’s clear we have a bunch of hotspots,” adds Dr. William Schaffner, a professor of preventive medicine and an infectious-disease expert at the Vanderbilt University School of Medicine. “The next three or four weeks will see a lot of hospitalizations. This will lead to the greatest strain yet on the medical care side.”
In Nashville, where he works and teaches, Schaffner says he’s starting to see a surge in patients testing positive for COVID-19 that he didn’t see several weeks ago. Even that initial uptick in coronavirus cases, he says, is revealing breakdowns and problems with the medical supply chain and the equipment needed to slow the virus’ spread.
Schaffner says the local health department for Nashville and Davidson County is already having trouble securing the most basic of products: swabs. The county has scaled up the number of testing sites available to residents, but, according to Schaffner, county officials can’t find enough swabs to carry out COVID-19 tests.
Nashville isn’t alone. A new survey by the U.S. Conference of Mayors found that nearly 90 percent of cities said they didn’t have enough face masks, ventilators, or other personal protective equipment to deal with the coronavirus pandemic.
Schaffner, who is a former president of the National Foundation for Infectious Diseases and past member of the executive board for the Infectious Diseases Society of America, says he’s hearing from other jurisdictions about bottlenecks with the pace of laboratory testing. Labs that run COVID-19 tests are overwhelmed by the number of tests they’re being asked to run.
“I keep hearing that there’s a substantial delay in getting the results back,” he says. “They are getting the specimens, they’re being sent to the lab, but the bottleneck is the laboratory testing capacity, which is uneven across the United States.”
To slow down the spread of the coronavirus nationwide, far greater testing capacity is needed to identify contagious individuals, isolate them from the broader population, and reduce transmission of the virus. Experts say the criteria for those who can get tested must expand to people without obvious symptoms. “We still have to assess from whom we’re taking specimens,” Schaffner says. “You have to have at least some moderate kind of illness, so people with lesser illnesses are not having specimens obtained even though we’d like to do that.”
The mixed messages from Washington haven’t helped. While President Trump has said that “anyone who wants a test gets a test,” one of Trump’s senior health officials, Health and Human Services Assistant Secretary Admiral Brett Giroir, recently told a conservative radio host that the testing “priority is for the hospitalized and sick, health care workers and first responders, people 65 and over who are sick…If you are healthy, don’t worry about it. If you’re mildly ill, you do not need a test.”
Trump’s suggestion that he would loosen social-distancing measures by Easter — contradicting the advice of the scientists on his coronavirus task force — also alarms experts. Dr. Ian Lipkin, a Columbia University professor and director of the Columbia’s Center for Infection and Immunity, says doing so could lead to an “explosion” of cases in New York and elsewhere in the weeks ahead. “I’m now looking at the projections in New York alone; they show us having a big spike as far as four weeks out,” Lipkin says.
Lipkin, who traveled to China earlier this year to study the outbreak and recently tested positive for COVID-19 himself, says the opposite needs to happen. National leaders should put in place the kinds of strict measures used in Wuhan, the Chinese city where the coronavirus was first detected in humans. “They did tests once people were isolated to see who was clearly infected, potentially infected, and not infected. Then they began separating those people within the community,” Lipkin says. “That’s what we would be shooting for.”
“We’re all in jeopardy,” he adds. “As I keep telling people, we’re going to have to do something like that eventually. The shorter the duration, the shorter the pain.”
Dr. Fortune, the Harvard infectious-disease expert, says cities and states that could soon face a crisis similar to New York’s must act now by building more medical-care infrastructure, buying equipment, and hiring the people needed to meet the coming demand for care. “You see what New York is having to do, like appropriating the Javits Center,” she says. “All these big metropolitan areas should be doing that. It should be happening everywhere.”