American hospital capacity is lean. The 46,500 beds in intensive care in the United States are mostly occupied. Covid-19, if uncontrolled, might lead to up to 1.9 million I.C.U. admissions, according to projections presented to the American Hospital Association. With sufficient notice, hospitals could have begun reallocating space and resources to expand intensive care, as well as establishing pandemic preparedness committees, reinforcing infection prevention and determining how to ethically allocate finite treatment resources if overwhelmed.

But hospital executives need a clear signal from federal authorities to trigger these costly and burdensome measures. And there was no such signal. Instead, federal authorities spoke of a low risk to the United States. Rather than urging specific actions, they passively suggested that hospitals “review” their crisis plans…

In keeping with the narrative that the virus could be walled off, the administration decreed that only those who had traveled from China, been in contact with someone who had traveled to China or had been exposed to a lab-confirmed Covid-19 case would be tested. This left officials blind to the domestic spread that was already occurring. It was not until Wednesday that the C.D.C. finally said that anyone showing symptoms of the disease could be tested (but implementation of this remains slow).