If you wanted to write a book on how not to respond to a serious public health crisis, the Trump administration has provided all the material you would need. Failing to put a testing regimen in place, eschewing tough containment measures, playing down the potential for a pandemic to take root, and the president’s outright lies about the risks of the coronavirus have brought the nation to a crisis point.
While it’s easy and appropriate to point fingers at the president’s astonishingly incompetent response, the issues that have compounded the coronavirus crisis are much larger than the failures of one man. They are an American failure.
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Underfunded health infrastructure, the lack of an adequate safety net, and inattention to public health capacity and infrastructure has made this situation so much worse. Even the best presidential response would be hamstrung by a larger set of institutional shortcomings that make America more vulnerable to a pandemic than other developed nations.
First and foremost, millions of Americans lack health insurance. That means people are forced to balance potential illness against the costs of seeing a doctor. In most places in the world, that’s not a choice that has to be made.
Second, America is the only industrialized country that fails to provide paid family leave for its citizens.
An estimated 70 percent of low-wage workers don’t receive paid sick leave from their employers. That’s a serious problem on a good day. On a bad day — like a pandemic — it compounds what is already a major crisis. While many Americans can work remotely, those who have hourly jobs or work in service industries do not have such luxuries. Not being able to stay home from work, even when sick, has the potential to make a public health crisis, like the coronavirus, that much worse.
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But it’s not just sick people who are affected. What about parents when schools are shut down? The fact that the United States does not subsidize child care and has an under-regulated and expensive system of caring for kids only makes this situation more difficult.
Next is the issue of health care infrastructure. In South Korea, there are 12.3 hospital beds per 1,000 people. In France, it’s 6.0. In China, it’s 4.3. In America, it’s 2.8.
That means when coronavirus patients head to the emergency room, it puts enormous strain on a health care system trying to care for both the coronavirus patients and those who are afflicted with other illnesses. We may be getting a glimpse of America’s future with what is happening in Italy, which has only 3.2 beds per 1,000. With not enough medical care to go around, doctors in the eighth-largest economy in the world may soon find themselves having to decide which patients receive care and which do not.
Finally, there’s the much larger issue of how we prioritize public health in general.
As Harold Pollack, an urban public health researcher at the University of Chicago, said to me, “Public health has taken a back seat for a long time,” and in health care debates “people are much more excited about universal coverage than flu vaccinations and making sure we’re prepared for a major public health crisis.” America is paying a price for that now.
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Little attention, says Pollack, has been paid to preventive measures — be it public health messaging or the stockpiling of masks and ventilators before something like the coronavirus hits.
The US health care system is focused on providing the best possible care for individual patients, which, Pollack says, sometimes comes at the cost of the overall health of Americans. “We have billion-dollar hospitals that provide great individualized care,“ he says. “But compare that to local public health departments. We have spent generations underfunding these institutions and then wonder why, when crisis hits, they sometimes underperform.”
Make no mistake, the president’s failed leadership has made the coronavirus far more serious than it should have been. When other countries were putting in place testing procedures and containment protocols, Trump was telling people the number of US cases is “going very substantially down” to “close to zero” and saying the situation is “under control.”
His actions have heightened the economic disruption and almost certainly cost lives.
But replacing Trump with a functional president — while obviously important — is only half the battle. There needs to be a larger recognition that we are paying too little attention to major public health threats. Universal child care and health coverage, paid family leave, and serious investments in public health infrastructure will not just help Americans respond to the next deadly virus, they will improve the lives of each and every American on a daily basis. Coronavirus might have come to America from overseas, but the real threat to our well-being is here at home.
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Michael A. Cohen’s column appears regularly in the Globe. Follow him on Twitter @speechboy71.