Three months ago, almost no one knew that SARS-CoV-2 existed.

Now the virus (COVID-19 is the disease it causes) has spread across the world, infecting at nearly a million people whom we know about — and many more whom we do not.

It has become the perfect storm we feared; crashed economies, smashed medical systems, filled hospitals, and emptied communal spaces. It has torn people from their workplaces and their friends. It has disrupted modern society on a scale that many who are alive today have never witnessed.

Being based in the US, and specifically Los Angeles, I have never heard highways so quiet and fear so loud.

Within a few months, nearly everyone in the United States will be one degree of separation from someone who has been infected. Like World War II or the 9/11 attacks, the pandemic will permanently damage the nation’s psyche.

Today there are children being born and raised into a society profoundly altered by COVID-19. They are Generation C.

But first, a brief reckoning.

The Global Health Security Index, a report card that evaluates every country on its pandemic preparedness, scored the United States with an 83.5 — the world’s highest. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, and it failed.

More transmissible and fatal than seasonal influenza, the new coronavirus is also stealthier, spreading from one host to another for several days before triggering obvious symptoms. The most important aspect of this virus, other than its highly viral nature, is that it is new. No vaccine exists. No biological countermeasures can be developed faster than it can spread.

To contain such a pathogen, the unquestionable response is to develop a test to identify infected people, isolate them, and anyone they may have had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect during the most critical periods. It is what the United States did not.

The Centers for Disease Control and Prevention developed and distributed a faulty test in February. Independent labs created alternatives, but were mired in bureaucracy from the FDA. During this critical early period, as new infections shot into the tens of thousands, only hundreds of people were tested. That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable.

This single systemic flaw undermined every other countermeasure — a building without foundation.

If the US could have accurately tracked the spread of the virus, hospitals would have had time and agency to properly enact their pandemic plans — allocating treatment rooms, stockpiling necessary supplies, training personnel, and assigning specific facilities to treat new cases.

None of that happened.

Instead, a system that was near-capacity due to severe flu season suddenly became overstretched by a new virus that was spreading, untracked and unknown, through communities around the country. Overstretched hospitals became overwhelmed. Basic protective equipment, such as masks, gowns, and gloves were expended. Beds will soon follow, as will the ventilators that provide oxygen to patients whose lungs are where the virus attacks and how it kills.

The New York Times puts the number of hospital ventilators in America at about 160,000. With the total number of cases approaching that number, it is already causing ventilator shortages which, in turn, could lead to difficult questions about rationing.

America’s healthcare system operates on the assumption that unaffected states can help beleaguered ones in an emergency. That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition; some worried hospitals have bought out large quantities of supplies, in the way that panicked consumers have bought out toilet paper.

Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis. The US may very well end up with the worst outbreak in the industrialized world.

1. The Next 6 Months

Having fallen behind, it will be difficult — but not impossible — for the United States to catch up.

What’s certain is that near-term future is set because COVID-19 is a slow and long illness with a protracted incubation period. People who were infected nearly a week ago will only start showing symptoms now, even if they isolated themselves in the meantime.

They’ll be in the hospital by early April.

Italy and Spain offer grim warnings about the future. Hospitals are out of room, supplies, and staff. Unable to treat or save everyone, doctors have been forced into the unthinkable: rationing care to patients who are most likely to survive, while letting others die.

The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked and mishandled, those beds will all be full by this time next month.

In 3 months, there will be 15 times as many patients as beds.

In 6 months, the pandemic will have directly killed anywhere from 500,000 – 2.2 million Americans, notwithstanding those who will indirectly die as hospitals are unable to care for the usual slew of heart attacks, strokes, and car accidents. By contrast, WWII killed 418,000 American service members and civilians.

Absolutely, we need to prevent this worst-case scenario.

To avert it, four things need to happen — and quickly.

The first and most important is to rapidly produce supplies — masks, gloves, and other personal protective equipment (PPE). If health-care workers can’t stay healthy, the rest of the response will collapse.

In the U.S., the Strategic National Stockpile — a national larder of medical equipment — is already being deployed, especially to the hardest-hit states. The stockpile is not inexhaustible, but it can buy some time. Donald Trump could use that time to invoke the Defense Production Act, launching a wartime effort in which American manufacturers switch to making medical equipment.

Some manufacturers are already rising to the challenge, but their efforts are piecemeal and unevenly distributed. Just like WWII, a massive logistics and supply-chain operation is needed across the country. That can’t be managed by small and inexperienced teams scattered throughout the White House. Instead, this should fall to the Defense Logistics Agency — a 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.

This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests. So far they have been slow to arrive because of ancillary supply shortages, such as masks to protect those administering the test. Many of these shortages are, again, due to strained supply chains.

Thankfully, some shortages are being addressed. The FDA is now moving quickly to approve tests developed by private labs. At least one can deliver results in less than an hour, potentially allowing doctors to know if the patient in front of them has COVID-19.

Even now, as capacity expands, tests must be used carefully. The primary priority is to test healthcare workers and hospitalized patients, allowing hospitals to quell any ongoing fires. Only later, once the immediate crisis is slowing, should tests be deployed in a more widespread way to those who are asymptomatic.

Even if those two needs are met, the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. The spread of the virus — and the nation’s fate — now depends on the third need, which is maintained social distancing.

Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediately, and they must continue for several weeks.

In these moments, when the good of all hinges on the sacrifices of many, clear coordination matters — the fourth urgent need. The importance of social distancing must be impressed upon a public who must also be reassured and kept constantly informed with clear and concise information.

I will break my own political quarantine to express that as President Trump has repeatedly played down the problem, telling America that “we have it very well under control” when we do not, and that cases were “going to be down to close to zero” when they were already rising, he has exacerbated the damage and delayed the response time.

What concerns me most is that Trump already seems to be wavering on the need for social distancing.

In recent days, he has signaled that he is prepared to backtrack on those policies in a bid to protect the economy. Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work.

Such thinking may sound alluring, but it is flawed. It overestimates our ability to assess a person’s risk, and what would be required to wall-off the ‘high-risk’ people from the rest of society. It also severely underestimates how badly the virus can hit ‘low-risk’ groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.

Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.

None of this has been fun to read, I’m sure. But, here’s the silver lining:

If Trump refrains from premature policy reversal, if people adhere to social distancing, if testing can be rolled out effectively, and if enough supplies can be produced, there is a chance that the country can still avert the very worst predictions.

It won’t be easy and no one knows how long that will take, but it won’t be quick. “It could be anywhere from four to six weeks to up to three months,” Dr.Fauci has said, “but I don’t have great confidence in that range.”

Tomorrow we’ll discuss the endgame of getting the pandemic under control and to begin looking at what comes after.