How Prepared Is the U.S. for a Coronavirus Outbreak?

In 2005, the federal government sought to assess how a respiratory-related pandemic might play out in the United States. Its report estimated that a severe influenza pandemic would require mechanical ventilators for 740,000 critically ill people.

Today, as the country faces the possibility of a widespread outbreak of a new respiratory infection caused by the coronavirus, there are nowhere near that many ventilators, and most are already in use. Only about 62,000 full-featured ventilators were in hospitals across the country, a 2010 study found. More than 10,000 others are stored in the Strategic National Stockpile, a federal cache of supplies and medicines held in case of emergencies, according to Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention.

Tens of thousands of other respiratory devices could be repurposed in an emergency, experts say, but the shortfall would be stark, potentially forcing doctors to make excruciating life-or-death decisions about who would get such help should hospitals become flooded with the desperately sick.

Much about the coronavirus remains unclear, and it is far from certain that the outbreak will reach severe proportions in the United States or affect many regions at once. With its top-notch scientists, modern hospitals and sprawling public health infrastructure, most experts agree, the United States is among the countries best prepared to prevent or manage such an epidemic.

But the coronavirus, which appeared in China in December and has stricken more than 83,000 people around the world, killing nearly 3,000, has already exposed significant vulnerabilities in the ability of the United States to respond to serious health emergencies.

Across the country, educators, businesses and local officials are beginning to confront the logistics of enduring a possible pandemic: school closings that could force millions of children to remain at home, emergency plans that would require employees to work remotely, communities scrambling to build up supplies.

In plausible worst-case-scenarios given the pattern of the outbreak thus far, the country could experience acute shortages not just in ventilators but also health workers to operate them and care for patients; hospital beds; and masks and other protective equipment.

“Even during mild flu pandemics, most of our I.C.U.s are filled to the brim with severely ill patients on mechanical ventilation,” said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security and an expert on health care preparedness. “I hope and pray Covid-19 turns out to be a moderate pandemic, but if not, we’re in serious trouble,” he said, referring to the name given the disease caused by the virus.

Resources are concentrated in the most populous and wealthiest cities, leaving rural areas and other neglected communities exposed to greater risk. And public health experts worry that efforts to contain an outbreak could be hamstrung by budget cuts that have weakened state health departments.

Credit…Feature China/Barcroft Media via Getty Images

Sixty-five cases have been identified in the United States as of Saturday morning, most of them patients infected while abroad. But officials at the C.D.C. warned on Tuesday that number will almost certainly rise and urged Americans to prepare for significant disruptions to their lives.

Health officials are working to confine outbreaks to small geographic clusters, which would limit the impact on the nation’s health care system and buy time for the development of a vaccine, an effort that could take a year or longer. But flawed test kits distributed to states by the C.D.C. and strict criteria initially used for identifying potential cases may have slowed detection of the virus spreading within communities across the country.

On Friday, three new patients — in California, Oregon and Washington State — were detected who had not traveled outside of the United States and had no known contact with infected individuals, suggesting such community transmission has already begun.

Critics say a contradictory message about the threat posed by the virus from President Trump — who called Democrats’ criticism of his handling of the situation a “hoax” at a rally on Friday night — amplified on conservative media, has caused confusion, arguably slowing efforts to prepare.

The Coronavirus Outbreak

  • Answers to your most common questions:

    Updated Feb. 26, 2020

    • What is a coronavirus?
      It is a novel virus named for the crownlike spikes that protrude from its surface. The coronavirus can infect both animals and people and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
    • How do I keep myself and others safe?
      Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.
    • What if I’m traveling?
      The C.D.C. has warned older and at-risk travelers to avoid Japan, Italy and Iran. The agency also has advised against all nonessential travel to South Korea and China.
    • Where has the virus spread?
      The virus, which originated in Wuhan, China, has sickened more than 80,000 people in at least 33 countries, including Italy, Iran and South Korea.
    • How contagious is the virus?
      According to preliminary research, it seems moderately infectious, similar to SARS, and is probably transmitted through sneezes, coughs and contaminated surfaces. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
    • Who is working to contain the virus?
      World Health Organization officials have been working with officials in China, where growth has slowed. But this week, as confirmed cases spiked on two continents, experts warned that the world was not ready for a major outbreak.