“If one virus can wipe out the entire economy
in a matter of weeks and shut down societies, then that is proof that our
societies are not very resilient. It also shows that once we are in an
emergency, we can act and can change our behavior (sic) quickly.” [ii] If America,
the world, is not different after the COVID-19 pandemic ends, then we will not
have learned anything from the experience. The most realistic timelines for
starting the trek back to a working economy and normal lifestyle are months
away. Some political leaders would like to declare the country open within a
week or two.
There is good reason to want the country to open again: the
economy is likely in a recession, stores are closed, factories shuttered and twenty-two million people have filed for unemployment. We have heard warnings for
years that most families could not withstand a $400 emergency expense. Many
thought that to be hyperbole at best. Now we see thousands of cars lined up at
food banks because they have no money to feed themselves and their families,
much less to pay the rent and make the car payment. The government has punched trillions
of dollars directly into the bank accounts of millions of people, created
forgivable loans for businesses that will keep people on the payroll, and it
isn’t nearly enough. Trillions more are needed, and quickly. It will take years
for the economy to recover to its former all-time highs. In a matter of weeks, the virus created an abyss not seen since the Great Depression.
The pandemic shines “a very bright light on the real
weaknesses and foibles in our society.”[iii] What we see
is a nation unprepared for large-scale surprise events. We see hospitals,
overrun with patients, lacking basic protective equipment for nurses and
doctors. We see a lack of tests to determine who has the virus. As the sickness
and death spread from large cities to the less densely populated urban and
rural areas, we wonder how they will handle the coming tsunami of cases. In the
last fifteen years, 170 rural hospitals have closed, 19 last year, and eight
this year, even during the height of the virus attack. We see nursing homes and
assisted living establishments that are overrun by the virus and deaths
mounting quickly but not counted in the statistics. We see Veteran
Administration hospitals with mounting deaths each day. We see governors
adlibbing fifty-plus approaches to contain and mitigate the spread of the
virus. We find sick people holding off going to the emergency room because they
have no health insurance. We see a nation where healthcare insurance is tied to
employment, and with a loss of work, comes a loss of insurance. We see patients wanting to try untested and
dangerous drugs they hear about on television. We see Blacks contacting the
virus and dying from it at six times the rate of Whites. We see nursing homes
and senior living facilities become Petri dishes for the virus resulting in a
high percentage of deaths. We see the fragility of our nation.
Emergencies require quick, almost automatic responses, the
result of good planning and consistent training. We all remember the fire
drills when we were in school. After a few drills each fall, we all knew where
to go when the alarm rang. If a real fire had occurred, the effort would have
saved lives. Would that we could have that level of security when an epidemic
starts to take over our country. How will we react if there is a chemical
attack on the country? How will we behave when we are told to shelter in place?
How will our government react to the next national crisis?
We knew this pandemic was coming. We had US scientist in
China telling us about it. We saw the results of China taking six days to tell their
people about the virus and to take action to confine it to Wuhan. The city of
twenty million people was shut down almost immediately. Warnings about the
spread of the virus came from military intelligence, the CIA, the WHO, and a
number of US security agencies, and several health agencies, including the CDC
and NIH. At the highest levels, the warnings were ignored for 27 days or more.
Dr. Fauci[iv] held a closed-door-session with most of the nation’s governors at their annual meeting in January,
at which he warned them of the oncoming invisible enemy. Many left the meeting
acutely aware that they must take immediate action in their states. Others
chose to ignore most of the warnings and failed to implement recommended
actions. One has to wonder why a national crisis is limited to state action
rather than a federal response. A key step to dampen the spread of a virus is
to keep people at least six feet away from each other and keeping people at
home. Some governors refused to take even that simple step to protect their
citizens even as hundreds and thousands of deaths mounted. This
everybody-on-their-own approach to a national emergency is ill-begotten. The
result of our haphazard approach is that the US has the most confirmed cases of
the virus, has tested less than two percent of the population, and has more
deaths than any other country. We blew it!
The Federal government was not ready for this pandemic. The
stockpiles of supplies were inadequate, some were out of date, and the current
administrations closed down, refused to fund, the office charged with worrying
about pandemics, reduced funding for the CDC, and ignored well-published
warnings. Our leaders were reluctant to mount a quick attack on the virus. They
are still arguing over the role of the states and the national government, over
the use of what national stocks we have in storage. After pleas from governors,
the Army Corp of Engineers, specialists in doing big things well and in a hurry,
was allowed to help the states set up field hospitals. They did it in a matter
of days, not months. When one hospital was no longer needed, they moved it to
another state. They showed what a good government agency can do when they are
allowed to do it.
Our nation has debated, gently for the most part, about the
type of healthcare system we should have. Some believe strongly that a universal
single-payer system is the best choice. Others believe just as strongly that
our current system is better. The pandemic encourages us to think
about what is, what should be, and what could be.
The large hospitals in the virus-centric areas are
overwhelmed. We have all seen what happened in New York, Washington, and California.
We watched the epidemic move to the Big Easy, on to Mississippi and Georgia,
and now into other rural areas. What will happen when the virus starts
spreading into areas that have no hospitals or doctors? Rural hospitals are
usually small, maybe 25 rooms, with smaller staffs. They have stopped a lot of
non-emergency operations and doctor visits. They encourage people to stay at home
except for emergencies. These hospitals rely on low paying Medicare and
Medicaid payments to survive. We expect hospitals, private or non-profit,
forced to exist only if they are commercially viable. Why doesn’t the richest
country in the world ensure that people in rural areas have doctors and
hospitals?
A surgeon from New York who recently spent time in a third
world country working with Doctors Without Borders was interviewed on TV. He works in an NYC hospital where he tested positive for
the virus. He quarantined himself for fourteen days and is back to work. He
spoke about the lack of PPEs (Personal Protective Equipment). He said his
hospital in New York City resembled those in the third-world conditions, and
sometimes worse.
The federal government has taken the position that they are
simply a back up to the states, that the states are responsible for buying
their own protective equipment on the world market. At the same time, however,
we read story after story about the federal government commandeering planeloads
of PPEs purchased by states and cities when they arrive at local airports or other
ports of entry. We read about FEMA outbidding states and cities on the open
market. We read about a fire department in Massachusetts that was raided by the
FBI who took all of the recently acquired PPEs. We read about countries that
manufacture PPEs closing their borders to exports. PPEs are essential materials
in the fight against novel viruses. If the medical staffs get sick, who will
take care of everyone else?
The pandemic is illustrating, every day and in every way,
that healthcare is a human right. Doctors and nurses, and first responders, the
best in the world, are risking their own lives to help stricken patients who
have a right to live. Hospitals are opening the doors to patients regardless of
insurance coverage because they were told that the government would reimburse
them for their expenses. This scourge lays bare the need for taking a new look
at how we distribute healthcare in America. It shows the weaknesses of a
commercially driven system rather than a medically driven system. It shows the
results of healthcare and healthy living distributed on an income level basis,
or a racial basis, or on an age basis.
We want to open the country back up as quickly as possible.
The President has encouraged the governors to act as prudently as possible. The
problem that exists in every town in the country is that we don’t know who is
infected, who is likely to be seriously ill, who had the virus and now has the
antibodies to help others get well. We don’t know because the government has
not made testing a priority. We should not open any section of the country
before we have tested large percentages of the population. Think about the kids
returning to school in the fall. Would you let your child enter a classroom of
untested kids? Would you let your son or daughter go back to college and live
in a virus laboratory dorm? Some governors indicated that most parts of their
states should not fully open for business until we have a vaccine for the
virus. The list goes on. There is reason to be paranoid.
The President has proposed a framework for opening the
economy that is based on good science and medical advice. Not one state in the
nation can meet the criteria that must be met before Phase One of three phases
can begin. We just don’t have the test kits to measure the degree of the virus in
the population. We don’t have a vaccine. We don’t have the measured indicators
that we need to go willy-nilly about the next move. For this reason, the President
asked the governors to make a judgment about the best time to open their
states, if they bothered to close them in the first place. Let’s hope for the
best!
We need a deep-dive analysis of our health system and its
outcomes. America deserves better than it has and that the lobbyists on K Street are willing to pay our Congress to deliver. It’s not a political party issue
anymore, or an economic issue anymore. It’s a healthcare issue, a medical
issue, a science issue, and a human issue. We can’t go back to the BC way of
doing things.
[ii] Greta Thunberg was Time
Magazine’s Person of the Year at age 16. She has been a leader in the drive to
improve the climate
[iv] Dr. Anthony Fauci, MD,
is the Director of the National Institute of Allergy and Infectious Diseases, a
part of the National Institute of Health. He was appointed in 1984. He is
the leading American expert on diseases, including epidemic Dr. Anthony Fauci, MD, is the Director of the National Institute of Allergy and Infectious Diseases, a part of the National Institute of Health. He was appointed in 1984. He is the leading American expert on diseases, including epidemic management and control. management and
control.
