People wear face masks as they walk down a street in Flushing area of Queens on Monday in New York City. Photo: AFP

Editor's Note:

Amid the ongoing coronavirus (COVID-19) epidemic, over 480 US public health and legal experts jointly signed an open letter to US Vice President Mike Pence and other federal, state and local officials, calling for a "fair and effective COVID-19 response." Chen Zhuo (Chen), an associate professor at the University of Georgia, was among the signatories. Prior to joining the University of Georgia, Chen was a senior health economist with the US Centers for Disease Control and Prevention (CDC). How severe the epidemic is in the US? Can the US healthcare system withstand COVID-19? What impact will the open letter have on the US government's decisions? Chen shared his views on these issues and more with Global Times (GT) reporter Yan Yunming. 

GT: US experts suggest the outbreak might be worse than reported in the country. How serious do you see the epidemic in the US?

Chen: The number of new cases in the US could be on the rise. COVID-19 testing capacity in the US had been limited due to a shortage of testing kits. But the good news is that the US Food and Drug Administration has allowed labs outside the CDC to test for COVID-19, which will greatly improve the country's capacity to test and identify COVID-19 cases. 

The number of confirmed COVID-19 cases in the US is more than 300, with the death toll rising to 15. Based on the mortality rate in Wuhan - the outbreak's epicenter, the number of infections in the US could be much higher than 300. Community spread of COVID-19 has been suspected in Washington, California, and other states. With an enhanced testing capacity, the country might see a sharp increase of new cases soon.

GT: How would you evaluate the steps taken by the US government so far?

Chen: The US government has taken effective measures. For example, screening  travelers entering from China has been in place. The measure has expanded to travelers from Iran, Italy, and South Korea. 

The situation is rapidly changing. Perhaps it is time for the US administration to take more decisive and extensive steps. 

Dr Nancy Messonnier, CDC's Director of the Center for the National Center for Immunization and Respiratory Diseases, has warned, "It's not so much of a question of if this will happen in this country anymore but a question of when this will happen - and how many people in this country will have severe illness." 

Although CDC Director Robert Redfield walked back a bit from her warning, many in the US - including some who signed the open letter - believe that the possibility of a pandemic has grown higher. More effective measures are needed. 

And Washington is starting to take action. US Congress approved a $8.3 billion spending package to counter the outbreak. This funding will help the federal government to cover testing and treatment costs to relieve the public's worries.

It is probably too early to judge whether the US government's response has missed the opportunity to curb the epidemic. Though the limited testing capability has resulted in the failure to identify several cases later found to be positive.

GT: In the face of the coronavirus, a few countries such as China have been going all out to fight the epidemic, and some like Japan and Italy have taken less stringent steps. Which model is more likely to be adopted by the US?

Chen: The US response probably will be more like what is happening in Japan. Because state governments, not the federal government, have extensive "policing power" to protect public health, so it is possible that some states will adopt more stringent measures than others. 

For example, some districts in Washington are considering school closures. Of course, the president has the right to declare a state of emergency, under which the federal government will have more extensive executive powers. But during an election year, the White House administration will be very cautious in implementing extreme measures.

GT: The open letter warns that the US healthcare system will face "severe burdens under all plausible scenarios." Will the US healthcare system be able to bear the burdens?

Chen: Situations will vary across states. There is a significant geographic disparity in access to healthcare resources. There are more hospitals in New England states than the rest of the country. Certainly, some states with less medical resources are sparsely populated, so the epidemic might spread more slowly in those regions, giving them some protection. 

As elderly populations are more susceptible, Florida could be a concern as elderly residents comprise close to 20 percent of the 20 million population. If a COVID-19 outbreak occurs, Florida's healthcare system might face greater pressure than elsewhere. Other states with a high percentage of elderly populations might face similar problems.

Under the US constitution, the federal government only has enumerated powers in the area of public health. The leading federal public health agency, CDC's responsibilities include preventing cross-border transmission of cases into the US as well as preventing and controlling disease transmission across states, while the "policing power" of public health within each state resides in each state's health agency. The outbreak will bring up many issues and could be challenging in coordinating efforts between federal and state health agencies.

The federal government may offer help to states suffering from the outbreak. The CDC provides funds to local health agencies for training and capacity building. Major hospitals are working with the CDC and the CMS to prevent and reduce healthcare acquired infections. When a public health emergency is declared, the federal government can deploy the US Public Health Service Commissioned Corps to areas affected by the epidemic.  

GT: Although the US government is considering paying for hospitals to treat  COVID-19 victims, some uninsured Americans are still concerned about the costs if they get infected. Do you think the US can achieve "a fair and effective COVID-19 response" like the letter calls for?

Chen: Disadvantaged populations may suffer disproportionally during an epidemic. White-collar employees may be able to weather an outbreak with different means, but many minimum wage earners will lose income if they stay indoors so they might have to take on a higher level of risks. In addition, uninsured or underinsured populations will need the government's support should they contract the disease. 

Another group are immigrants, to whom the current administration is not very friendly. Under the "public charge" rule, it will be difficult for immigrants to apply for green cards or citizenship if they use public welfare. As a result, once infected, immigrants who lack resources may be less likely to seek treatment, which would be a challenge to efforts to prevent and control the outbreak. By helping those with limited resources, documented or not, during this difficult time, the federal and state governments may be able to better contain the epidemic.

GT: What impact do you expect this open letter will have on the government's decisions?

Chen: It is the elected officials that have the final say, but I sincerely hope that this letter could make a difference. At least the letter will let our voice - calling on the government to treat every group fairly, regardless of their color, sex, gender, income level, and legal status, and to take all aspects into consideration in combating the epidemic - be heard.

In addition to the federal government, state and local leaders have decision-making power as well. Hopefully local authorities will respond positively to our letter. I am confident that this open letter could have a positive impact.

GT: You are also an expert in economics. How will the epidemic influence the US economy?

Chen: The economy will certainly suffer a short-term shock. Take the travel industry - United Airlines from April will cut 20 percent of its international flights and 10 percent within the US. It is hard to make a long-run prediction of the impact of the outbreak, as the forecast of many things. If the epidemic drags on for too long and disrupts the supply chain, not only the US but also the world economy will be impacted. Hopefully this epidemic can be brought under control as soon as possible.