Some of the current forecasts for infection rate in the US is very scary but way too pessimistic.  The dire worst-case forecasts of 200,000,000 infections in the US this year is certainly possible if nothing is done at all.  Fortunately the US has taken some steps already that will help to mitigate these disastrous scenarios:

  1. Imposed stringent international travel restrictions first on China then Iran, Italy, and South Korea and then extending it further to most of Europe all helped to stem the inflow of infection.  The US should have imposed restrictions on countries quickly and scientifically, based on their hotness, rather than politics. Moreover, now that the infection is inside the US most of these travel restrictions will have minimal impact.
  2. Declared a national emergency to deploy all necessary resources to fight this internal plague and imposed restrictions on congregation, but fell short by not deploying the National Guard to expand hospital facilities.
  3. Reducing structural handicaps such as improving the speed and efficiency of testing, tracking and treatment.  This requires paid family leave, free testing and free treatment (to cover the high percentage of under-insured patients) and tons of liquidity to ease financial strains on the system.  Should be done soon.
  4. Encouraging best practice individual behavior such as social distancing and institutional practices such as work from home and temporary business closure.
  5. Begun imposing internal traffic restrictions.

Step 5 we believe is very important and must be done as soon as possible.  The infection has spread inside the US but could be still be isolated into a handful of metro areas that must be quarantined.  If these areas cannot be effectively isolated, the total population of the US at 330M could be exposed, and the worst case could become reality.  If US citizens are allowed to move freely within the country 330M is the total possible exposure.  Cities that have been relatively unscathed such as Houston and St. Louis will become infected soon without these travel restrictions.  If the US adopts the inhumane UK philosophy of “herd immunity” at this point and allow the virus to spread widely inside, 200M US citizen could get infected.  However if the hot zones could be segregated to pockets of contagion then the total possible exposure number could be reduced to possibly below 100M, and the total infections could be reduced to 60M rather than 200M. This proposal would be similar to the Wuhan model that has worked in China. 

In China, the coronavirus infection has basically ended with just 158 infected per million citizens.  If this were possible in the US it would have meant only 52,000 total infections.  This may not be possible now because there are already 6–10 metro areas in the US that are Wuhan-hot that need to be quarantined.  Seattle, San Francisco, and New York City are already past the 400 or so confirmed case level when China isolated Wuhan.  But 90% of the cases in the US are still concentrated in major metropolitan statistical areas (MSAs) — see this very useful NY Times map.  Each of the top 50 US MSAs should view themselves as a Singapore for this fight and adopt Singapore’s best practices. One objection is that no city in the US is like Singapore, an autonomous city-state.  Imposing internal travel bans could allow each of them to act like Singapore temporarily.  Trump needs to authorize each MSA real powers, or manage this process at the national level.  Singapore saw their first case of COVID-19 on Jan 23, just a couple of days after the US.  They have managed to maintain their zero death record for 8 weeks and has limited their total infections to just 42 per million citizens.  This would translate to a total of just 14,000 infections for the US.  Singapore’s infection has not ended so the number of total infections will grow, but it seems to be under better control without the exponential growth seen in much of the US now.  If we have the will to restrict domestic travel so that each MSA can manage itself like a Singapore with full national support we can limit our losses.  Not doing this could make the dire forecasts of 100,000,000 infections real.