Jason Silverstein is a lecturer and writer-in-residence in the department of global health and social medicine at Harvard Medical School.
When Larry Brilliant, one of the physicians who helped eradicate smallpox, said that “outbreaks are inevitable, epidemics are optional,” he probably didn’t expect a major country to go with the epidemic option—but that’s effectively what the Trump administration has chosen when it comes to the novel coronavirus outbreak.
As of now, the answer to many important questions about coronavirus, aka COVID-19, in the U.S. is “who the knows.” This is the product of a years-long gutting of funding and staff from the nation’s scientific authorities. We have no reliable idea of how many people in the United States have coronavirus because we cannot widely test, but as of press time, at least 38 people have died, and the global death rate appears far worse than the seasonal flu—the most recent estimate is as high as 3.4 percent compared with 0.1 percent for the flu.
Here are some of the challenges we face as a result of bad decisionmaking on the part of the U.S. government—and the small things you as an individual can do to protect yourself.
Planning for a pandemic should have happened years ago and didn't
What is the best way to respond to coronavirus? “The solution is aggressive preparedness,” Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization (WHO), said in a press conference on March 5.
That’s...not what we did. “I think we are building the ship as it sails,” said Carlos del Rio, professor of medicine and global health at Emory University in Atlanta, Georgia.
The Trump administration has effectively made any disease outbreak worse than it needs to be. While most of their death-wish budget cuts haven’t been enacted—they tried their best in 2018 to burn $252 million set aside from the Ebola response and to reduce global epidemic prevention efforts by 80 percent—the Centers for Disease Control and Prevention’s public health emergency preparedness grants are 36 percent lower this year than in 2002, and the CDC overall has 10 percent less funding than it did 10 years ago.
Meanwhile, the people who might deliver us from coronavirus, skilled scientists, are in shorter and shorter supply—1,600 federal scientists lost their jobs in Trump’s first 18 months—and Trump doesn’t seem to be listening to the ones who have served multiple presidential administrations.
Instead, the person with whom we are told to place our faith is Mike Pence, the vice president who prayed on needle exchanges during an HIV outbreak instead of implementing them right away and refuses to be alone in a room with a woman (you know, like the White House’s coronavirus response coordinator), which may help explain why to get a seat at the table it appears one need not a PhD but a Y chromosome.
Combine the lack of funding with a lack of people who know what they’re doing and we’ve basically turned the United States into a petri dish for a pandemic.
“The cuts to the CDC have really left us in a precarious situation,” explained Kimberley Shoaf, a public health professor at the University of Utah.
This means even smart, compassionate health professionals have little idea what’s happening. Compare the situation today with what happened during the 2009 H1N1 influenza pandemic, or the "swine flu." While Shoaf explained that the CDC held regular Clinician Outreach and Communication Activity (COCA) calls for clinicians during H1N1, zero calls were held during the month of February. “The entire month of February we should have been getting things up to speed,” Shoaf said.
What you can do: Prepare, but do not panic. There is a good chance you will get COVID-19, according to reporting by James Hamblin at The Atlantic; 40 to 70 percent of people are likely to be infected, though how badly varies widely. Even scarier, Liz Specht did the math for STAT News on how quickly the healthcare system will be overwhelmed, and there’s a good chance all hospital beds in the United States will be full sometime in May.
Unless you are someone with the authority to hire scientists or ramp up production of ventilators and viral RNA isolation kits, wash your hands with soap or sanitizer that contains at least 60 percent alcohol, as per the CDC. There is no need to dig a doomsday bunker, but stock up with what you might need to stay home comfortably for two weeks (more on another suggested activity, calling your Congressperson, below).
Testing is far from what it should be
The ability to test people in the United States—something epidemiologists have called “not a difficult problem to solve in the world of viruses”—has been flawed or nonexistent. Last Monday the Trump administration said that “close to a million tests will be able to be performed” by the end of the week. But then the number of tests disappeared from the CDC website and The Atlantic reported that only 1,895 have actually been done; as of March 9, the number was 4,384.
“We knew this was coming like we know a hurricane is coming,” said Wendy Parmet, director of the Center for Health Policy and Law at Northeastern University. “We should have been ready to go just like South Korea.” South Korea has tested more than 195,000 people so far.
What this means is that we know far less than we should about who is sick, where they are, and how to help them—and this puts all of us at risk.
“I suspect there is community transmission happening in a lot of places,” said Caroline Buckee, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health. “Right now, patients aren't tested unless they are hospitalized, so we may be missing milder cases of the disease, which can spread the virus in the community.”
What you can do: It's time to practice social distancing, or what the CDC defines as staying away from "congregate settings" (aka crowded public places like shopping centers, movie theaters, stadiums), avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible. So, if it is possible for you to avoid the crowded subway commute and work from home, you can play a vital role in slowing down or interrupting pathways that allow the virus to spread.
Since it is unclear how much disease there is (something robust testing could tell us), we ought to avoid large groups, even religious services, if we can. “Use common sense and avoid non-essential group gatherings where people may or may not know they are sick,” advised Sandra Springer, an infectious diseases doctor at the Yale School of Medicine.
“Everybody’s health depends on everybody else’s health,” Parmet said. Remember: we are not only social distancing and washing our hands for ourselves, but for the health of people around us for whom the virus could be serious, like the elderly and people with disabilities and compromised immune systems.
The administration appears to be acting in its own self-interest
“My main concern is that the leadership of this country is much more concerned about their own self image than collective well being,” said Jenny Reardon, professor of sociology at the University of California, Santa Cruz.
With his patented loves-to-talk-hates-to-read energy, Donald Trump —who has said the moon is part of Mars, vaccines cause autism, and fracking is harmless—has repeatedly taken his sharpie to revise the WHO’s mortality rate for coronavirus, saying it is a “fraction of 1 percent” when the WHO estimates 3.4 percent, and speed up the timeline for a vaccine, saying “a couple of months” when in fact it will take between 12 and 18 months.
Trump has repeatedly put CDC Director Robert Redfield in the awkward position of correcting his lies. On January 22, Trump said everything is under control; Redfield was forced to admit “it’s definitely not controlled.” Then, Trump said “the heat kills this kind of virus” and soon “the rough stuff” would be gone; Redfield had to clarify that the virus is likely here to stay beyond this year. And a month after Trump said everything was under control, he said the first person to die from coronavirus in the US was a woman; Redfield had to again correct him that the first death was a man.
While Trump’s flexes are sometimes funny like eavesdropping on a bad date is funny—“All these doctors say, 'how do you know so much about this?' Maybe I have a natural ability” is something he really said—during a pandemic we need a calm voice who is concerned with something other than airing grievances or downplaying health risks to prop up his re-election chances. (One poll suggests he is hurt by his handling of the pandemic.)
“One of the most important aspects of controlling an epidemic is public trust, and the administration must be transparent and clear in its communication with the public,” Buckee said. “Right now, it doesn't seem as if that transparency is a priority, and the politicization by the administration of what is actually a public health crisis is extremely problematic.”
What you can do: Listen to the scientists, such as Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who has been brave enough to deliver bad news (“We have got to assume it is going to get worse and worse and worse,” Fauci told Congress on Wednesday), and health activists, such as Yale epidemiologist Gregg Gonsalves, who have been on the frontlines of epidemics in the United States for more than 30 years. Assume anything rosy-sounding coming out of Trump's mouth right now probably isn’t true.
Republicans may try to pin the blame on people of color (again)
“A public health issue requires a collective response,” Reardon said. But a collective response is fundamentally at odds with the project of the Trump administration and Republicans more generally, which might see the pandemic as too good an opportunity to let go to waste.
“We should worry about disaster authoritarianism—a reason to implement some of the more draconian policies that Trump wanted to implement anyway,” Reardon said.
Just last week, Trump said, “we’re doing everything in our power to keep the sick and infected people from coming into our country” and mocked “fringe globalists who would rather keep our borders open.” While China engaged in an aggressive and controversial quarantine to put coronavirus in check, Trump tweeting Tuesday that “we need the Wall more than ever” clearly serves zero public health purpose. What we have now is community spread within the U.S.—that is, international travel and immigration isn’t the issue.
Nevertheless, on Monday, GOP House Minority leader Kevin McCarthy called the virus “the Chinese coronavirus”; Turning Point USA’s Charlie Kirk likewise tweeted about “China virus.” Even outlets like The Washington Post are unfortunately playing into racializing the disease with a social media post that depicts a group of mask-wearing Asian people under the head “Health officials warn that the spread of coronavirus in the US appears inevitable.” And, earlier this week, a man on a train in Brooklyn sprayed Febreze at an Asian passenger; an SUV in Fresno was vandalized with “Fuck Asions and Coronyvirus.”
Yet the real culprits in what is making coronavirus spread and kill more viciously than it should are not people with some connection to where the disease first took off, but rather they are the nation’s lack of preparation for health crises, large and small.
“The fact that low-income communities may not be able to take measures like working from home, or may have no income if they take sick leave or self-quarantine, not only leaves them more vulnerable to the virus, it also means that the population as a whole is more exposed to the epidemic,” Buckee said. “The erosion of public health support and financing has left us very vulnerable to epidemics like this.”
What you can do: While the administration continues to bungle the response and look out for themselves, people should look out for each other—and call your members of Congress.
If you want to know what to ask for, check out the recommendations in this open letter from Yale’s Global Health Justice Partnership, which has been signed by more than 800 public health and human rights experts: People need to be able to afford care, immigration enforcement should be suspended at clinics and hospitals, and people who cannot afford to practice social distancing need sick pay and emergency cash.
“Politicians are risk-averse in the best of times, in this political climate many are more afraid of Donald Trump than coronavirus,” Gonsalves tweeted. “We have to make them more afraid of us.”
So, stay in, call your Congressperson, and order Chinese food.
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