COVID-19 Resource Center
COVID-19 Resource Center
Source/Disclosures
Disclosures: Del Rio reports no relevant financial disclosures. Clancy reports being awarded investigator-initiated research grants from Astellas, Cidara and Merck for projects unrelated to this topic and serving on advisory boards or as a consultant for Astellas, Cidara, Merck and Scynexis.
March 27, 2020
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Experts say US surpassing Italy, China in COVID-19 cases was inevitable

Source/Disclosures
Disclosures: Del Rio reports no relevant financial disclosures. Clancy reports being awarded investigator-initiated research grants from Astellas, Cidara and Merck for projects unrelated to this topic and serving on advisory boards or as a consultant for Astellas, Cidara, Merck and Scynexis.
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Carlos del Rio
Cornelius J. Clancy

The United States now leads the world in the total number of confirmed COVID-19 cases, surpassing China and Italy by thousands.

According to the latest available totals from the Johns Hopkins University COVID-19 tracking map, the U.S. has 92,932 confirmed cases, whereas China and Italy have 81,897 and 80,589 cases respectively.

“I’m not surprised,” Carlos del Rio, MD, executive associate dean at Emory University School of Medicine, told Healio. “The U.S. epidemic is currently in an exponential phase of growth.”

Cornelius (Neil) J. Clancy, MD, associate professor of medicine and director of the extensively drug-resistant pathogen lab and mycology program at the University of Pittsburgh, told Healio this was inevitable.

Donald Trump

“We have a larger population than Italy,” he said, suggesting that it might be more useful for Americans to think of the country on a state-by-state level rather than nationally for perspective. In that regard, according to Clancy, metropolitan NYC has about the population of Lombardy, the hardest-hit region in Italy. Because community transmission in NYC was widespread before restrictions were enacted, the outbreak there is likely to be similar to or worse than that in Lombardy.

“U.S. cities in which community transmission was less widespread before restrictions were enacted may see blunted peak numbers of cases and may be more successful in flattening the curve,” Clancy said.

He added that the U.S. did a poorer job responding to the outbreak than China, who he says were “very aggressive after initially bungling things.” Clancy says the downfall in the U.S. response and the reason why case counts surpassed that of Italy and China is “testing, testing, testing.”

“The lack of testing is the biggest single reason COVID-19 has expanded like it has in U.S. After that, the major factor was a failure to take the risk of outbreaks here seriously or to outright deny the risk, despite what happened in other countries,” he said. “As such, we did not prepare.”

Del Rio agreed, telling Healio that “the failure of testing will need to be remembered as the biggest failure in the U.S. response to this pandemic.”

He also said that a coordinated response in the U.S. is necessary moving forward.

“We need a coordinated response and not the ‘patchwork response’ we have had up to now, where President Donald Trump has kicked the responsibility for decisions to the governors and many governors have kicked the responsibility to mayors and county leaders,” he said.

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Clancy explained that top priorities moving forward should be more widespread diagnostic testing, including rapid, point-of-care testing; ensuring the availability and distribution of adequate personal protective equipment and hospital and ICU beds, as well as supplies such as ventilators; enrolling patients in clinical trials and defining effective treatment; developing and deploying serologic testing; developing rational de-escalation plans for social distancing and other measures; and developing and validating an effective vaccine for COVID-19.

Each of these priorities should be driven by science and data, formulated with input from experts and divorced as much as possible from political considerations, Clancy said, adding that in the end, the final decisions are up to political leaders, locally and nationally.

“That's why they're there and that's how our representative government works. Our job in health care is to get the best information to them so that decisions are as informed and responsible as possible.”

He added: “Thus far, the quality of leadership and decision-making by political leaders has been uneven, to be charitable.” – by Caitlyn Stulpin

Disclosures: Del Rio reports no relevant financial disclosures. Clancy reports being awarded investigator-initiated research grants from Astellas, Cidara and Merck for projects unrelated to this topic and serving on advisory boards or as a consultant for Astellas, Cidara, Merck and Scynexis.