Now that COVID-19 is over (at least according to the Republican National Convention, where it was only mentioned in the past tense), it's time for a pandemic post-mortem. I rely on Ed Yong's article in The Atlantic, "How the Pandemic Defeated America." It's full of ideas to help us next time.
Lesson 1: destroying the animal habitat the viruses originate in.
Sometime in late 2019, the wrong virus left a bat and ended up, perhaps via an intermediate host, in a human — and another, and another. Eventually it found its way to the Huanan seafood market, and jumped into dozens of new hosts in an explosive super-spreading event. The COVID-19 pandemic had begun.
"There is no way to get spillover of everything to zero," Colin Carlson, an ecologist at Georgetown University, told me. Many conservationists jump on epidemics as opportunities to ban the wildlife trade or the eating of "bush meat," an exoticized term for "game," but few diseases have emerged through either route. Carlson said the biggest factors behind spillovers are land-use change and climate change, both of which are hard to control. Our species has relentlessly expanded into previously wild spaces. Through intensive agriculture, habitat destruction, and rising temperatures, we have uprooted the planet’s animals, forcing them into new and narrower ranges that are on our own doorsteps. Humanity has squeezed the world’s wildlife in a crushing grip — and viruses have come bursting out.
Climate change might be behind COVID-19. I did not see that coming. But it makes sense. Or perhaps the pandemic and climate change both have a common cause — population growth. I hope Ed Yong offers us easier first steps to prevent pandemics other than "reverse climate change".
Let's follow this to its logical conclusion. I always considered the steady destruction of animal habitat leading to the increasing extinction of species to be an unmitigated disaster for humanity. Now, I'm forced to consider the possibility of one silver lining. If humans kill off all other species, we'll kill off zoonotic diseases as well. Fewer animals, fewer pandemics.
Lesson 2: millions for hospitals, pennies for public health.
America’s neglect of nursing homes and prisons, its sick buildings, and its botched deployment of tests are all indicative of its problematic attitude toward health: “Get hospitals ready and wait for sick people to show,” as Sheila Davis, the CEO of the nonprofit Partners in Health, puts it. “Especially in the beginning, we catered our entire [COVID-19] response to the 20 percent of people who required hospitalization, rather than preventing transmission in the community.” The latter is the job of the public-health system, which prevents sickness in populations instead of merely treating it in individuals. That system pairs uneasily with a national temperament that views health as a matter of personal responsibility rather than a collective good.
Today, the U.S. spends just 2.5 percent of its gigantic health-care budget on public health. Underfunded health departments were already struggling to deal with opioid addiction, climbing obesity rates, contaminated water, and easily preventable diseases. Last year saw the most measles cases since 1992. In 2018, the U.S. had 115,000 cases of syphilis and 580,000 cases of gonorrhea—numbers not seen in almost three decades. It has 1.7 million cases of chlamydia, the highest number ever recorded.
Since the last recession, in 2009, chronically strapped local health departments have lost 55,000 jobs—a quarter of their workforce. When COVID-19 arrived, the economic downturn forced overstretched departments to furlough more employees. When states needed battalions of public-health workers to find infected people and trace their contacts, they had to hire and train people from scratch.
I admit that I failed to see the distinction between personal medical care and public health. If, say, you get cancer or suffer a heart attack (and can afford good health insurance), there's no better place for top-notch personal medical care than America. We throw tons of resources at fixing diseased bodies. But lately, we've been scrimping and saving on public health measures to prevent the diseases in the first place. We pay the price when a novel coronavirus spills over into our unprepared world.
Lesson 3: The "free market" has the wrong incentives.
Compared with the average wealthy nation, America spends nearly twice as much of its national wealth on health care, about a quarter of which is wasted on inefficient care, unnecessary treatments, and administrative chicanery. The U.S. gets little bang for its exorbitant buck. It has the lowest life-expectancy rate of comparable countries, the highest rates of chronic disease, and the fewest doctors per person. This profit-driven system has scant incentive to invest in spare beds, stockpiled supplies, peacetime drills, and layered contingency plans—the essence of pandemic preparedness. America’s hospitals have been pruned and stretched by market forces to run close to full capacity, with little ability to adapt in a crisis.
This one should be obvious. The theory of free markets is that they incentivize the higher cost providers to get more efficient. There's another way this can play out. Eventually, when the effort to get more efficient exceeds the supplier's ingenuity, he just goes out of business. We're left with one supplier, maybe in China.
If there's a surge in demand and a business can't ramp capacity fast enough to meet it, the business loses an opportunity for sales. Paradoxically, he might be making money hand over fist while still losing market share as others ramp up production. It's an enviable problem for a private business to have. In the case of public health, it's a disaster not to be able to meet surge demand. The measurement of success is not how much money you can make, it's how many lives you can save. While you have to ramp up production, lives are lost.
As Ed Yong says, America "should strive to prevent disease, not profit from it."
Read Ed Yong's complete article. There are more lessons, many more.