Fauci says he 'doesn't understand why' the entire US is not under a stay-at-home order. Here's why its absence could make America's coronavirus problem even worse.

More than 90% of the country is under a stay-at-home order, which enforces social distancing and helps minimize the spread of the COVID-19 outbreak.
Two experts told Business Insider only of the best ways to curb the American outbreak is to enforce social distancing across the whole country.
However, President Donald Trump has left it up to state governments to decide when, where, and how to implement these stay-at-home orders, if at all.
Anthony Fauci , one of the US's top disease experts, told CNN the US "really should be" under a nationwide stay-at-home order, adding: "I don't understand why that's not happening."
Visit Business Insider's homepage for more stories .

The US has roughly one-quarter of the world's coronavirus cases. At least 257,000 Americans have been infected with the COVID-19 virus, and about 6,200 have died.

And the number of new cases per day in the US continues to grow at a startling rate : the case count has more than doubled in the last week.

At least 90% of the country 297 million Americans are affected by some kind of stay-at-home order. State governments have asked residents to shelter in place and go out only for essential services, with the goal of encouraging social distancing, and thereby reducing the spread of the coronavirus and " flattening the curve " so healthcare systems aren't overwhelmed.

Yet not every state is enforcing such orders, and those that are don't all share the same definition of essential services. President Donald Trump said Wednesday that he would be leaving such decisions up to state governors, because "states are different and there are some states that don't have much of a problem."

But Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, is frustrated with the lack of a federal mandate. When asked about whether states should be "on the same page" about these lockdowns during an interview with CNN's Anderson Cooper on Thursday, Fauci said, "I think so, I don't understand why that's not happening."

"The tension between 'federal mandated' versus 'states' rights' to do what they want is something that I don't want to get into," Fauci said. "But if you look at what's going on in this country, I just don't understand why we're not doing that. We really should be."

A haphazard response to a growing pandemic

A road sign over Interstate 80 in Omaha, Neb., directs motorists to contact 511 for Covid 19 quarantine guidance, Tuesday, March 31, 2020. Nati Harnik/AP Photo

The importance of getting all 50 states on the same page can't be overstated. On Tuesday, Trump and his advisers said that statistical models indicated between 100,000 and 240,000 Americans could die from COVID-19 that is, if Americans observe the strict social distancing guidelines issued by the Centers for Disease Control and Prevention (CDC).

This optimistic scenario is not currently happening.

Thirty-eight states, Washington DC, and Puerto Rico have all issued complete stay-at-home orders.And at least three states and one territory Alabama, Iowa, North Dakota, and Guam have ordered nonessential businesses to close but haven't asked all residents to stay home.

But Arkansas, Nebraska, and South Dakota have no known stay-at-home-orders or business closures in place.

The statewide orders are represented on the map below in red. Partial state lockdowns are represented in pink on the map, marking the states in which at least one city or county has issued a stay-at-home order for residents.

Trump said on Sunday that federal social distancing guidelines will remain in effect through April 30 . However, he said Wednesday that he wanted states less hard-hit by the virus to have some leeway, given that the closing of nonessential businesses is having a devastating effect on the US economy .

"You have to give a little flexibility. If you have a state in the Midwest, or if Alaska for example doesn't have a problem, it's awfully tough to say, 'close it down,'" Trump said.

The problem with that flexibility and lack of federal guidance, however, is that it states can then interpret CDC guidelines as they see fit and decide which businesses are essential or not.

For example, the governors of Texas and Florida have deemed churches as "essential," meaning these places of worship where groups of hundreds of people could congregate are permitted to stay open during stay-at-home orders meant to promote social distancing.

If experts had magic wands, some would institute a nation-wide lockdown

Two experts previously told Business Insider they would put the entire US on lockdown if they were given a magic wand. That's because strict, nationwide social distancing is the best way to stymie COVID-19's spread.

"Pretend that everyone 100% of people everywhere would stay at home, not go out, and not get near anyone else," Dr. Mark Roberts, a professor of health policy at the University of Pittsburgh, told Business Insider. "There would be no new infections. Infections are caused by the actual infectivity of the virus, the number of contacts, and the length of contacts. Social distancing decreases the last two components of that."

An infectious-disease epidemiologist from Washington, DC whose identity is known to Business Insider but is being kept anonymous because their employer has prohibited them from commenting publicly on the coronavirus said they would immediately issue "a full, nationwide stay-at-home order for a minimum of two weeks but ideally four weeks."

"Viruses don't stop at borders," the researcher said, adding that the "lack of coordinated public-health response" in the US and the degree to which state officials have been left to "left to figure it out on their own" is concerning.

Empty NYC Coronavirus Reuters/Jeenah Moon

Dr. Scott Braithwaite, a professor of population health and medicine at NYU Langone Health said that, if it were up to him, he would put the entire country on lockdown for three to eight weeks.

"If people think, 'Well, if I change my life in this unpleasant way for three to eight weeks and just weather through it, then maybe in order to get things back to normal,' [they] could do it," Braithwaite told Business Insider.

That would buy doctors time to solve unknowns about the virus and create new tests, antiviral drugs, and potential vaccines. Otherwise, healthcare systems around the nation will be pushed beyond their limits and many more people could die than the models suggest.

The absence of social distancing has stark consequences

During a Thursday press conference, White House coronavirus advisor Dr. Deborah Birx said that she could tell Americans had not been diligent in their efforts to practice social distancing just by looking at the day-to-day growth in the US's epidemic curve.

"I know you've seen the slope on the US versus the slope in Italy, and we have to change that slope," Birx said. "What it means in the US is not everyone is doing it."

Last month, spring-break partiers flocked to Florida beaches despite the CDC's warnings to limit gathering sizes. This week, pastors in Baton Rouge, Louisiana and Tampa, Florida were arrested and charged with violating state orders barring public gatherings. Police broke up two weddings in New Jersey on March 24.

social distancing US Washington AP Photo/Jacquelyn Martin

Birx said that the US could bend its curve "if everyone takes that same responsibility," adding: "We're only as strong every community, every county, every state, every American following the guidelines."

It's challenging to expect Americans to follow guidelines when they differ from state-to-state. But all available data suggest avoiding a national lockdown will cost American lives.

NOW WATCH: 3.3 million Americans filed for unemployment and an economist predicts it could be far worse than the Great Recession