Hard-hit coronavirus "hot spots" like New York City are two to three weeks away from hitting peak COVID-19 cases, according to former federal official Scott Gottlieb.
Many other cities and states could be two weeks behind.
"I’m worried about Florida; I'm worried about cities like New Orleans and cities where mass transit systems were late to implement mitigation strategies like Chicago," said Gottlieb, M.D., former Food and Drug Administration Commissioner, during a Wall Street Journal Health Forum hosted virtually this week.
Asked by WSJ reporter Anna Wilde Mathews whether the U.S. was on track to look like Italy or South Korea, Gottlieb responded: "We're in between. We lost the chance to be South Korea, and I don’t think it will be as tragic as Italy. I certainly hope not on a per capita basis."
To prevent hospitals from being overrun, population-based tactics such as closing businesses and schools and urging people to stay home need to continue for several weeks, Gottlieb said.
"We need to stick with these tactics, as painful as they are. There are public health implications and economic costs of these interventions. But we have to take these steps now to break the chain of transmission," he said. "There is no public health in this country if the hospitals are overwhelmed. As long as coronavirus continues to spread in this fashion, the hospitals are not going to be functional."
Gottlieb's recommendations, which are in line with public health leaders such as infectious disease expert Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, contrast sharply with President Donald Trump's call to ease restrictions. Tuesday, Trump told Fox News he hoped to have the country reopened by Easter on April 12.
"New York is not going to be there" by April 12, Gottlieb said. "You need to wait to see what happens to other American cities before making any decisions," he said.
Public policy leaders will not be able to "hit the brakes" on social distancing measures until the epidemic curve begins to drop, he said. At that point, there will need to be a transition to less intrusive mitigation measures.
While data suggest cases could drop in the warmer summer months, the U.S. will need to have broad surveillance in place and point-of-care diagnostics to do early detection and aggressive case-based interventions by the fall, he said.
Those measures, coupled with a therapeutic that helps treat COVID-19, could "make this a threat that we can live with," he said.
"There is no on-off switch. This is going to be a gradual transition. Certain aspects of life are never going be the same until we get a vaccine, and maybe after we get a vaccine," he said. "This has changed American life and it’s changed the globe. It’s a historic event."
Sustained mitigation tactics will likely become a permanent way of life. This could include the use of ultraviolet lights in airports and other public areas to kill airborne flu viruses and deep cleaning methods used by mass transit, airlines and ride-sharing companies.
"I don't think you can crowd on an elevator anymore," Gottlieb said.
The payoff could be less severe flu seasons and less morbidity from flu illnesses going forward.
To address immediate needs, there are actions that public policy leaders should be taking, he said.
Customs and Border Protection should be authorized to have enforcement discretion to allow the importation of unapproved personal protection equipment (PPE) and ventilators from foreign countries such as China. This will enable hospitals, in conjunction with their supply distributors, to alleviate the critical shortage of PPE.
"We don’t want to do it for a long period of time because we don’t want to discourage manufacturers like 3M from investing in long-term manufacturing to help with capacity," Gottlieb said.
The healthcare industry and public health officials need to get to work on building out a massive health surveillance system to prepare for the next wave of COVID-19 or the next virus.
"When the next virus comes along we'll have the capacity to do rapid sequencing and rapid surveillance to detect it. We didn’t have a robust influenza-like illness surveillance network, not robust enough to detect this and track it. The public health labs were quickly overwhelmed," he said. "We weren’t prepared for an epidemic the way we thought we were."