It’s been just six weeks since the first suspected case of community transmission was identified in the United States, and just five since the number of cases first reached 100. Now, with case counts over three orders of magnitude greater, those numbers seem almost impossible. But what’s really amazing is that the fundamental problem facing the nation hasn’t changed at all: the ability to conduct adequate testing, case tracing, and isolation.

Republicans, especially Donald Trump, keep talking about the desire to “reopen” the country. But that simply cannot happen without testing and isolation of infected individuals. To relax social distancing guidelines at this point in order to “restore the economy” would be like throwing buckets of gasoline onto a fire that hasn’t even begun to go out.

Here is where things stand as of April 8.

COVID-19: Confirmed cases

Looking at the nations that currently have the most confirmed cases, both Italy and Spain have made definite progress toward not only straightening out the line of infection, but genuinely bending the curve. Italy in particular has continued to push its daily rate of new cases down, though even its rate of growth is still too high to suggest that the outbreak there is in any sense “contained.”

COVID-19: Rate of growth

As each nation has implemented and maintained suppression and mitigation procedures, the rate of growth in Italy, Spain, and the United States has fallen. Italy has managed to reach a level of about 3% growth and sustain that level over the last week. On its own, that is still too high to permit the beleaguered nation any kind of relief, because it means that 4,000 new cases are being identified each day. But Italy has reached a point where its testing efforts are extending beyond those who are symptomatic. While the total number of cases remains high, the hospitalization rate of those new cases has dropped dramatically. So even though only about 2,000 people are officially being marked as “recovered” each day and the total number of active cases is continuing to grow, the pressure on their beleaguered health care system is easing. The number of deaths per day, while still fearsome, is about half of what it was two weeks ago, and the case fatality rate in Italy is actually improving.

Spain, where the outbreak began a little later and the rise was even sharper than in Italy, has achieved a similar outcome, though deaths in that nation have not marched downward as clearly as they went up. It appears that, having achieved a growth rate only 0.1% higher than that in Italy, Spain is still outpacing its ability to deliver health care and in the last couple of days the data there has shown a “bad bounce” in terms of new cases and deaths. Spain’s rate of growth—around 4%—is very near the limit of what can be achieved through any “social distancing” measures short of the most draconian, and it is still barely enough to keep that nation treading water.

The United States is not treading water. The United States is still drowning. There are obvious signals of improvements in the worst hot spots, including a falling hospitalization rate in New York City and signals that the testing in New York state is finally starting to reach meaningful numbers (net positive results have fallen from 45% to 40% in the past three days as the number of tests has expanded to 365,000). But with the number of new cases still matching 35% of tests completed each day, it’s clear that New York currently lacks the ability to test at the level necessary to define the outbreak there.

Total new cases in the United States were slightly down on Wednesday, but they were down from insupportable highs, and deaths remained very close to the peak that was reached on Tuesday. It is possible that the United States is beginning a trend that will see fewer cases and deaths over the next week, that a peak really has been established, but it’s too early to say that definitively. What is clear is that the social distancing measures as implemented in the United States continue to allow a 9% rate of daily increase in new cases, even though that case count is severely constrained by the limits of our ability to test.

The idea that there can be any “relaxing” of suppression measures in these circumstances is inviting a level of tragedy that is impossible to define.

Back on March 13, Donald Trump held a press event where he brought up that executives from Walmart, Target, Walgreens, and CVS promise drive-thru testing in parking lots across the country. It was the same event where he claimed "1,700 engineers" at Google were building a website. The idea was to present two things:

There was going to be a nationwide system of widespread testing available to everyone There would be an online site to coordinate this testing, providing scheduling and directions to the nearest site

Wall Street loved it. The Dow took an abrupt upward jog that Trump bragged about for days. The only problem was:

But the real problem is that the system Trump described back on March 13 is exactly what the nation needs if there is ever to be any real “reopening” short of a vaccine: A national program of readily available, high-volume testing coordinated with a website that directs citizens to the nearest facility, schedules appointments, and provides results by text or email. That is exactly how South Korea brought the outbreak there under control and protected both their people and their economy.

There are other methods. Suppression measures really can be ramped up sufficiently to flatten the curve. For example, every cell phone can be loaded with a required app making it possible to track and ticket those who violate stay-at-home orders; the personal information of violators can be published on websites that encourage neighbors to view them as threats to public health; and hundreds of thousands of people can be fitted with ankle bracelets and other tracking devices with enormous fines for just stepping out of their house. Those aren’t theoretical measures. These systems are already in place in multiple nations. Because that’s what it takes to keep the outbreak in check through suppression. None of them sound like measures that would be readily accepted in the United States.

Test, track down contacts, and use isolation and quarantine to genuinely break the transmission chain rather than simply slowing it. That should have been the U.S. process from the beginning. But just because the initial response on testing was screwed up beyond belief doesn’t mean there is some other viable approach. There is not. Test and track, track and test.

Anything else is gasoline. And when that fire flares up, it will be in a nation that’s sicker than before, more tired than before, poorer than before, and in every way less capable of fighting the flames than we are now.