Can This America Handle a Public Health Crisis?

Our trust in public institutions—and our trust in each other—is low.

Photo collage of Donald Trump gesturing with his hands in front of an image of empty store shelves.
Photo illustration by Slate. Photos by Samuel Corum/Getty Images and Jeenah Moon/Getty Images.

What if we’re already sick? Not with the new coronavirus, though that is proving far more serious and widespread today as compared just with yesterday. But what if the preconditions that have allowed the viral spread of this near pandemic are uniquely American, and frighteningly contagious, even as they are largely psychological and social? I’m referring not simply to a health care system and a health insurance and labor structure that are fundamentally inadequate to respond to a massive public health crisis, but to a larger set of ideas and beliefs that make even admitting that the virus is real, or dangerous, or larger than politics, worse than death. These are freakishly dangerous ideas and beliefs that have made large segments of the country unwilling to trust in science, media, and truth most of the time, yes, but certainly whenever it seems the information being delivered isn’t what they want to hear.

This goes beyond the disgraceful, sneering contempt of Rep. Matt Gaetz, who is now self-quarantining after coming into contact with the virus, or the president’s frankly horrific suggestion that he didn’t want the number of infected passengers on a cruise ship to be tallied on his watch because it would make him look bad. (It’s only “politicizing” the crisis when Democrats, scientists, epidemiologists, Italians, and the World Health Organization say anything about it, remember.) It also goes beyond the catastrophic set of decisions made by this administration to do away with the National Security Council’s global pandemic director, make cuts to the Centers for Disease Control and Prevention, and lie outright to the country about the number and availability of test kits in a concerted effort to downplay the risk of the virus. That’s all awful, but still, the real spadework done by this administration to ensure that this pandemic wreaks maximal havoc in this country has been achieved by a preexisting illness: the erosion of public trust in institutions and, more dangerously, in one another, in ways that make rational safety precautions partisan. This epidemic will rise or fall on our collective capacity to behave selflessly in the short run, to exhibit empathy to vulnerable communities that have been senselessly vilified in recent years, including the poor, immigrants, and the elderly. And yet the notion that we could come together to behave selflessly—even to save our own selves—now feels remote.

Polls show that by a two-to-one margin, Democrats are more likely than Republicans to believe that the coronavirus represents an imminent threat, and that Democrats are more likely to take the public health precautions that would limit its spread. That’s not because Democrats are better people than Republicans. It’s because the conservative media has squandered precious time and public trust downplaying the risks of the virus and constructing a narrative in which any steps taken to mitigate the harms mean giving in to a liberal hoax. If awareness of and attention to the pandemic is politically bad for Donald Trump, goes the logic, then denial and minimizing the risk is good. Whatever the cost. Weeks later, it’s clear that the coronavirus will have tangible costs for public health and the economy, but it is not evident that the truth has broken through, with the recent notable exception of Tucker Carlson. It’s going to be fashionable to deride precautions as hysteria and overreaction, long after it’s time for the virus to be taken seriously. For that we can blame media polarization that is predicated on the claim that the other side lies constantly, even over matters of life and death. Debates about whether to panic or mock those who panic are wholly beside the point; the point is that we know how to mitigate both spread and lethality, and can do so or fail to do so, but that needs to start immediately.

Virtually every thoughtful epidemiologist I have read on this says that the absolute worst thing to be done right now is hoarding surgical masks and putting yourself first. Conversely, the decision to put altruism before panic would redound not just to our own benefit, but to the actual benefit of the entire herd. The choice to stay home, to care for the elderly and the sick (and help them stay home), to figure out systems to look after children whose parents cannot take time off—all of that would be good for everyone. Yet it comes after years, if not decades, of being told constantly that vaccines cause autism, poverty should be punished and criminalized, and every government system is “rigged” to harm you and help others. Tell people that everyone’s a criminal and grifter long enough and it’s awfully hard to get them to look out for each other.

David Roberts at Vox has been writing thoughtfully about the political science literature around “social trust”; the phenomenon, as described by Kevin Vallier, wherein one has a “generalized trust” that extends to “strangers, persons within one’s society with whom one has little personal familiarity. Social trust can thus be understood broadly as trust in society. But trust to do what? Social trust is trust that persons will abide by social norms.” Social trust, writes Roberts, is a sense that “we are all in this together,” whoever “we all” may be, and without it, no law or policy or institution can be effective. With social trust and political trust working to undermine one another, societies can enter a “doom loop” that allows us to increasingly distrust both systems and each other.

It is that infection that makes us far more susceptible to the coronavirus; a preexisting social and psychological condition that allows critical medical truth to be suppressed in the name of politics, which in turn allows an entire society to doubt the veracity of both government institutions and the press. And as we grow mistrustful of two central pillars of liberal democracy, we become inclined to mistrust the very people around us, whether they’re grabbing the last rolls of toilet paper at the supermarket or walking around among us despite exposure to the virus. We’ve spent the past three years fine-tuning the notion that the other half of the country hates us. It’s hard to imagine turning on a dime now to be mindful of the needs of strangers.

The paradox of this moment is that we’ve trained ourselves to be maximally selfish and catastrophically distrustful in the very eye of a health crisis that will be exponentially worse for all of us unless we can reinstate norms, reflexive selflessness, trust in science, and facts. This will be a strange kind of natural experiment in whether altruism and compassion are in fact irretrievably dead in America, and thus far, neither the federal government nor the right-wing media that exists to support it appears fully aware of the downsides.

Americans have the infinite capacity to rally and fight altruistically when the national cause is deemed universally worthy—see: after 9/11, after Pearl Harbor, after earthquakes and hurricanes and floods. We regularly rush in to help strangers and children and the elderly. You can call that “social trust,” or just “the reason humans formed themselves into societies in the first instance.” What needs to be done right now—controlling the spread; buying some time; saving scarce medical resources, hospital beds, and emergency services for the most vulnerable—is eminently doable; it just fundamentally requires believing that the strangers we have stopped trusting will do the same for you. One needn’t be naïve about human nature in order to be human, whether or not you think the coronavirus will have a 3.4 percent mortality rate or a 0.1 percent mortality rate. Believe it or not, it appears that the most selfish thing any of us can do in the coming days and weeks will be to behave selflessly. That’s not a policy, it’s not a law, and it’s not even a norm in public life these days. It used to be what we called “community,” and if we cannot restore it now, for the most self-interested of reasons, it’s likely never coming back at all.