America Might Be Least Prepared for What’s Coming

The Capitol as seen at the end of Pennsylvania Avenue.
An almost empty Pennsylvania Avenue is seen at noon in Washington on Friday. Eric Baradat/Getty Images

A few weeks back, I saw a tweet that included a time lapse of a hospital being built in Wuhan, China. When I first saw it, I thought that it might be fake, maybe because the sight of the building emerging from nothing was really very hard to believe, or maybe just because the whole idea of it seemed just so extremely odd—that it was possible, that it was necessary, that it would have actually happened.

I looked that video up today. I’m no longer interested in whether it is real; I’d like to know how they did it. Because we need to figure out how to do it too.

This is, somehow, not where I thought things would end up in America. And yet the people who are telling us how to think about this risk have cycled through warnings and landed somewhere bleak. First it was to wash our hands, then it was to wash our hands and not touch our faces (the most fun part of this news cycle so far), and finally, to wash our hands and not touch our faces and start shunning people in an effort to “flatten the curve.” Finally, though, we are realizing where we might be on the curve, and even though we still don’t have good testing, it looks bad. As the head of the Department of Health in Ohio put it on Thursday, there are five confirmed cases in the state, but they actually think there are 100,000 cases in the state.

And so now we have moved on to what Aaron Carroll at the Upshot called “the biggest thing to worry about with the coronavirus,” or I would argue, the latest thing to worry about with the coronavirus: our ICU capacity. Carroll’s piece lays things out simply, numerically. “Our country has only 2.8 hospital beds per 1,000 people,” he writes. “That’s fewer than in Italy (3.2), China (4.3) and South Korea (12.3), all of which have had struggles. More important, there are only so many intensive care beds and ventilators.” For ICU, beds we’ve got 45,000; for ventilators, 160,000. The demand for ICU beds in America is already high. Building a hospital does not seem so wild anymore.

What is remarkable to me, and shouldn’t be, is that we are the lowest number on that list—we have fewer hospital beds per 1,000 people than Italy, China, and South Korea. There’s a reason for that, Carroll explains: “Hospitals don’t survive financially in the United States by keeping beds open and equipment idle.” Hospitals don’t survive financially in the United States by keeping beds open and equipment idle. Even the system that is meant to keep us from dying answers to the gods of economics.

The people who are supposed to make sure we were prepared for this kind of thing—the government—did not prepare for it; they kept minimizing the budgets and firing the people who are supposed to be around to deal with this stuff, should it occur. Nor did anyone working in the current administration seem to pause a few weeks ago, back when I was watching the video of Wuhan building a hospital, to consider whether they should maybe change their approach. David Wallace-Wells cataloged the disturbing reality of what, exactly, we are currently experiencing—not just Donald Trump’s inability to lead in a crisis but the absurdity of private businesses taking better precautions than our public institutions—and what it means about the future of our country. “What kind of society behaves this way, with a complete lack of institutional guidance and coordinated purpose, subjecting the vulnerable and scared to the terrors of pandemic disease? America, apparently.” Wallace-Wells concludes his essay, after reminding his readers that America might be the first failed rich state, by making what has become a familiar comparison, between us and the other countries experiencing outbreaks. How do we compare to Italy, to China, to South Korea? We’re worse off than all of them when it comes to our response, he concludes, just like we are with the hospital beds. We’re somewhere more in the vicinity of Iran, probably, but it’s hard to know exactly where we stand, given the lack of testing and the lack of reliable information coming out of the federal government. But, you know, somewhere around there.

Even as many smart thinkers have done the work to underscore what is certainly true—that Trump is a symptom of a broader disease pushed by a Republican Party set on destroying the concept of government and enacting minority rule, that America has been plagued by such problems since its inception—it is still hard, particularly in this election year, to internalize where we currently are as a nation, particularly compared with our “peers.” It’s difficult to fully internalize this change with the likes of Joe Biden on the stump trying to make the case that Trump could be an aberration and things could all return to normal by the next election for America. And yet, this moment, which will be defined by death and systemic failure and enormous economic fallout (that will have extremely disproportionate effects on the poor and the working class), will also be another one of realizing exactly how our country stacks up.

It’s the difference between knowing, immediately after the election, that our new president is the only world leader not to accept the science on climate change and watching, in June 2017, him withdraw our country from the Paris Agreement. There’s the unbelievable ignorance and stupidity to contend with, yes, and a sense of disappointment over what this means for our self-conception as a world leader. But ultimately the emotion that lingers is terror. What is going to happen to us?

There has been an interesting line of thinking that I’ve watched emerge as this crisis unfolds and brings the world to a standstill. If there is any upside to entire nations shutting down, it is that we are suddenly, rapidly, emitting way less carbon and air pollution, and that if you do the math in a certain way, maybe the coronavirus will end up saving more people than it kills. Maybe we will realize that we cannot continue to live as we once lived, as a result, and that too would save even more lives in the long run. These are crude calculations. They have a disturbing resonance with the decisions already being made in Italian hospitals over who is well enough to be worth saving and who we must let die—a resonance, even, with the problems inherent to the horrible, oft-repeated line that coronavirus doesn’t kill most people, as if that makes everything fine. But it kills some people. And it will kill many Americans.

The real lesson is to stop comparing death counts and to instead realize that both situations represent enormous, systemic, disturbing failures. The American obstinance against climate change represents a pathological inability to consider and properly value long-term consequences. Until the pandemic hit, the inability to prepare for a modern-day plague could be slotted into the same category, as another example of our inability to prioritize our safety in the long term. It’s still one of those, but as the growth continues to spread, exponentially, it will expose our inability to respond in the short term as well. This disaster’s consequences will be immediate and visible, like the aftermath of a forest fire, without being concentrated in one place. America has forgotten how to prioritize people in the short term, and in the long term. The coronavirus is only making that obvious.