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America Has No Plan for the Worst-Case Scenario on Covid-19

Noah Feldman

(Bloomberg Opinion) -- In the midst of the constant up-and-down of coronavirus news, both from science and the markets, it’s easy to lose sight of the scariest scenario of them all: the one where there’s no magic bullet. In this entirely plausible situation, there would be no effective Covid-19 vaccine or transformative therapy; the combination of testing and contact tracing wouldn’t successfully suppress the outbreak; and herd immunity would come, if at all, only after millions of deaths around the world.

Even raising this possibility is a big downer. But the fact that an outcome is terrible doesn’t make it impossible.

Since the end of February, I’ve conducted some 20 interviews with epidemiologists and virologists like Marc Lipsitch, Angela Rasmussen, and Carl Bergstrom; economists like Paul Romer, Stefanie Stantcheva and Larry Summers; and leaders at top hospitals and experts on government agencies whose names you may not know, but whose life’s work is preparing for moments like this one. Despite getting expert answers to dozens of my questions, the one question I haven’t been able to get an answer for is this: Who, exactly, is planning for the nightmare scenario in which we never get a vaccine or a breakthrough treatment?

Ideally, it would be the federal government’s executive branch, with its resources and bird’s-eye view of the problem. But the president, running for reelection, has every reason to insist on (unrealistic) optimism. In fact, the administration actually discussed disbanding its coronavirus task force.

The CDC and other public health agencies might be a good second option; but they’re busy (rightly) warning the public not to throw up our hands and let the virus spread unchecked. It’s not really a job for scientists — they are (understandably) devoting all their energy to searching for treatments and vaccines. Governors only have the authority to plan for their individual state. And the Fed is tasked with trying to save jobs and markets, not modeling the end of the economy as we know it.

I’m not one who enjoys doomsday scenarios. Yet realism absolutely demands considering every confluence of events that could occur with reasonable probability. If in fact there is no agency or department planning for the worst-case scenario, that is a major governance failure.

The fact that some 90 vaccines are being explored, with some clinical trials, is exciting and uplifting. It’s better than 80 vaccines or 40 or five or none. The sheer number tends to make us think that one or several will succeed. But the sum of many very low probability events doesn’t necessarily translate into a high probability that one will succeed.

There has never been a successful mRNA vaccine, like those being tested by Moderna and others, brought to market after approval. Ditto for a viral vector vaccine like the one the Oxford University group is pursuing. And traditional vaccines classically take many years to get to patients.

We’ve heard so many times that a vaccine will not be available for 18 months that we may have started to confuse that message for the very different idea that after 18 months, a vaccine will be available.

Transformative therapies are similarly very far from guaranteed. In a preliminary study, Remdesivir lowered mortality in hospitalized Covid-19 patients from 11.6 % to 8%. That’s statistically meaningful and could save lives. But even if broadly replicated, it won’t mean a fundamental change in how we accept the risks of contracting the disease. And when was the last time you heard the word hydrochloroquine?

The combination of testing and contact tracing is being heralded as a mechanism for reopening the economy. The challenges here include the reality that testing on a massive scale is not available now and is unlikely to be anytime soon. Manual contact tracing is only as good as the response rate and the willingness and capacity of contacting people to self-isolate. Digital contact tracing is new and raises challenging ethical questions, including around privacy. It, too, will work only if very large numbers of those who come into contact with infected people self-isolate.

Then there’s the little-discussed question of whether testing plus contact tracing can actually be used to suppress a disease that has achieved community spread on a massive scale like the novel coronavirus. The combination is classically applicable in situations where there are handful of cases and the disease has not yet spread widely; that was the situation in South Korea where it seems to have been highly effective. The technique is also said to have proven effective in the 2014 Ebola outbreak. But the epidemiologistsI have spoken to about the novel coronavirus have not been able to provide a truly comparable case where testing and contact tracing reined in a disease that was this diffused across a huge geographical area.

Usually, when all other scenarios have been discussed, the topic turns to herd immunity. But as Bergstrom has been arguing for weeks, in practice that likely means a huge percentage of the population being exposed to the virus. Depending on the true case fatality rate, that could mean many millions of deaths around the world.

It’s time to start thinking about how we should react to this horrible scenario. It isn’t defeatism to ask what the world will look like if we lose the war we’re fighting. It’s realism.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Noah Feldman is a Bloomberg Opinion columnist and host of the podcast “Deep Background.” He is a professor of law at Harvard University and was a clerk to U.S. Supreme Court Justice David Souter. His books include “The Three Lives of James Madison: Genius, Partisan, President.”

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