Rewinding back 3 months - what was the rosiest possible scenario for the United States?

Say we take politics out of the equation - either Trump becomes a super-competent president, or a super-competent individual other than Trump were president at the moment:
Say we rewind back to around the middle of January 2020, when this coronavirus was first starting to become a big thing in the news. What’s the most effective approach a U.S. presidential administration could have taken?

I’m guessing an immediate lockdown of everything, coupled with essentially a ban on all international flights (if U.S. citizens return home, then they must be immediately doused with disinfectant upon return home, and forcefully quarantined for 2-3 weeks.) An end to all foreign immigration until further notice. Probably immediately invoke the Defense Production Act, get ventilators mass-produced, everything revved up in production. Maybe force all quarantined individuals to wear ankle GPS locators, etc. Have huge quantities of toilet paper, hand sanitizer, etc. manufactured in the crucial month of February in preparation for March and April.

Would that have kept the U.S. under 10,000 infections, maybe under 500 deaths in total when the year is all over?

There should have been a production order for large quantities of ventilators, PPE, and other medical supplies in January when the early reports were coming in from China. If that had been done in January, they would be getting delivered now when they’re most needed.

I really doubt anyone could have foreseen that toilet paper would be in short supply. But perhaps we might be in a better place if additional production lines for melt-blown fabric were started back in January. From what I’ve read it takes up to six months for the machines to be built and another month or two of testing and tweaking but we would be closer to having the ability to make more N95 masks if the process had started in January.

The seeming best practice measures different countries have taken before there was significant community infection are:

  • Clampdown on international movement for all returnees, which would include your own nationals, backed with enforced self-isolation for a couple of weeks.

  • Escalating domestic production of necessary medical supplies from masks to ventilators, backed with a program to reward home inventors who can adapt non-medical grade devices to clinical use (I’m thinking of some Italian guys with 3D printers and diving masks which have apparently been good enough to use for something, or at least free up the real thing for major problems).

  • Taking a national approach to a national approach, so getting a national governing consensus among national and state leaders for priority action, areas of need, recruiting a hierarchy of expert panels of qualified and experienced people to provide advice on what to do. Added - and listen to them.

  • Take responsibility for your actions.

  • Communicate preparedness. From the nation that gave us instructional videos like ‘Duck and Cover’ there seems to have been a real weakness in conveying simple preventative measures. Get the annoying jingles and community messaging into peoples’ brains before it matters.

  • For the leaders - show some leadership.

All these are currently in effect in Opposite Land.

Usage of the defense production act early to make PPE and medical equipment.

Passing a stimulus earlier

Prioritize a public and private sector partnership to make diagnostic tests and antibody tests widespread.

Make all medical care related to the virus free to end users.

Encourage everyone to wear masks in public since asymptomatic people can spread the virus.

Mandatory temperature checks at workplaces, grocery stores, medical facilities, public transit, etc. to test for people with fever. Test people with fevers for the flu and coronavirus. Encourage anyone who has a fever at home to get a coronavirus test, or have traveling workers who can come to your home to test you.

Appointing a competent “czar” to coordinate and oversee various agencies.

Prioritize getting test kits produced and distributed massively. Immediately start screening in the influenza surveillance network. Do extra screening in areas that would be likely ports of entry. Contact trace and quarantine.

Prioritize getting the testing for antibodies up to speed and coordinate with China some sampling of the population in Hubei to determine the true incidence of infection in different age groups. Do studies to determine definitively how contagious kids are at the first hint that they may not be so very much.

Inventory various hospital systems capabilities, space, staffing, and supplies. Use lead time to act on deficiencies and to develop contingency plans.

I think the key would be to make massive amounts of tests available. Several hundred million, maybe up to a billion. HIPAA would have to be amended as well to make it easier to track those who have it and who they’ve been in contact with. In addition banning all international travel and ordering a nationwide lockdown (which many people would none the less ignore, this the need for massive numbers of tests). The list of essential personal who would be allowed to travel outside of their hometown would be extremely limited. Truck drivers, cargo flight pilots and crew, and medical personnel.

The OP reminds me of our efforts to prevent forest fires by catching and stopping every little wild fire observed. We now recognize that is not the best way to handle such outbreaks. It works out better for all to let such wild fires run their course and to limit how much harm such outbreaks can wreak.

This is not the first, or last, time Mother Earth has tried to prevent domination of Homo Sapiens over the planet. She will just get more and more aggressive as time goes on.

The biggest challenge in this 21st century is how to maintain a healthy, vibrant economy with a decreasing population. All of our current economic models are based on increasing (or, at least, static) growth. We need models that will work for a decreasing population. Two to three billion humans is probably what we should be supporting on this planet. Trying to support 6 billion results in climate change, loss of habitat of wildlife, and the ability of a virulent disease to upset the whole applecart.

What do you think 10 billion will do?

These two steps would have been key for slowing the progression of the outbreak. Even if we couldn’t do a New Zealand-like complete lockdown with surveillance, trace & track, and verified self-quarantine of everyone coming into the country (although I’m not persuaded that it isn’t possible) we could have at least made significant efforts to protect vulnerable populations and deployed public awareness campaigns. Getting antibody testing isn’t going to stop the spread of the virus, but it is crucial to being able to understand if the virus is going to become endemic and to able to inform people if and when they are immunized and can go back to work and public life.

HIPAA has specific exemptions for being able to provide information to trace and track infectious disease (45 CFR 164.512(b)(1)(iv). The problem is that aside from the CDC National Respiratory and Enteric Virus Surveillance System we don’t really have a mechanism to do this kind of tracing, and that system is kind of a patchwork that depends upon how each clinical labs report data although there has been significant effort to communize methods and criteria.

There is the CDC Influenza Surveillance System which is specifically focused on influenza epidemics (which, by the way, we slightly exceeded the epidemic threshold in the 2019-2020 flu season with scarcely a mention by media) but because it is specifically focused on seasonal influenza it may have mistaken signs of an emerging influenza-like coronavirus epidemic for a mild late-season flareup of flu infections. It’s actually a pretty good system overall and has been steadily improving, and it would be a good basis for a more generic epidemic surveillance system but right now it is primarily focused on Influenza Type A viral epidemics.

Stranger

You do realize that Mother Earth is just a big rock, right? Nobody is plotting to eliminate the human race. We’re fighting a random mutation of a virus.

If this is earths attempts to get rid of us, it is pretty feeble. A disease that kills 10-20% of the elderly but mostly doesn’t kill anyone under the age of 50? Thats not going to affect humanities survival much.

A more realistic (retrospective) scenario would be, travel warning and testing for China in mid Jan, rest of the world at the end of Jan, travel ban China mid Feb, the rest of the world end of Feb. The testing would have required that the USA pull it’s thumb out of its bum in December, which is no more unrealistic than travel bans.

With the travel warnings, a strongly supervised/enforced 1 day quarantine with testing for all foreigners, (and isolation for the sick) which would have started giving good numbers much earlier, moving to 14 day with self-reporting for all Americans once travel bans of others were in place. (Actual testing was taking 1+ day, so I haven’t assumed fast testing)
I don’t think that would give less than 500 deaths, but it would put the USA into the Sth Korea group, not the Italy group.