On a recent episode of The Gist, Mike Pesca spoke with science writer Ed Yong of the Atlantic. Yong’s recent piece, “How the Pandemic Defeated America,” documents the missteps and foundational problems that allowed the coronavirus to wreak havoc on the U.S. Pesca and Yong discuss what went wrong and how to prepare for the next pandemic. This conversation has been edited and condensed for clarity.
Mike Pesca: You make an analogy of a rock with many different cracks in it, and a pandemic is like water—it will find its way to each of the cracks, and the rock of America certainly has a lot of cracks and deficiencies in terms of its health care. But how big is the biggest crack: the failure of leadership of a president?
Ed Yong: We have now done the experiment where, assuming everything else about America is the same, what happens when you have incompetent leadership at the top? And we’ve seen the results, and the results are catastrophic. Donald Trump does not bear sole responsibility for what is happening right now—far from it. But he plays a central role in it. So he cannot be absolved of responsibility, nor should his many failures be used as an excuse to ignore all the rest of the cracks in that rock. By repeatedly misleading the American public by spreading misinformation and falsehoods about the virus and how America is faring, Trump has certainly eroded the sense of purpose and added to the confusion around the pandemic. By filling his administration with sycophants and people who are not experts, and then not listening to actual experts when the time came, Trump really hampered America’s ability to understand what was going on and to prepare for it adequately. By sidelining the [Centers for Disease Control and Prevention], arguably the greatest public health agency in the world, Trump has effectively neutralized one of America’s most potent defenses against a pandemic.
All of this is true, but it doesn’t remove the need to talk about the brittle health care system, the long-standing inequalities that flow from the country’s history of racism and colonialism, of overstuffed prisons and the understaffed nursing homes, of all of these things that people in different sectors have been talking about as problems for a very long time and that are now manifesting in the pandemic. We need to deal with all of it, Trump included.
So often in the past the reason that a president would act swiftly, decisively, and maybe not perfectly, but at least with purpose, against such a pandemic was altruism. It seems to me that that is a fundamental aspect of the Trump administration that has been lacking.
The fact that the virus has disproportionately hit Black and brown and poor people across the U.S. is inextricable from the political response to it. We cannot dissociate the fact that Trump and Trumpism is about neglecting these marginalized communities from the fact that those same communities have been hardest hit by the virus and are now still suffering the greatest fallout from federal inaction.
The U.S. spends 2.5 percent of its gigantic health care budget on public health—very low. If that number were 4 percent or 5 percent, how might things be different?
Ideally you’d want it to be a little higher, but every little bit counts. I think public health has long struggled with this problem—that it is devalued. Public health is about preventing communities from getting sick in the first place, rather than just treating the symptoms of individual patients. It is the world of sanitation and vaccination. And it has done its job admirably, it has led to all the wondrous health benefits that many of us enjoy: the longer life span, the freedom from many infectious diseases. But because of that, we take all of that for granted. We relish in the miracle of a normal, healthy day without thinking about the work that went into that. And if we had a stronger public health system, we might have been able to spot the spread of the virus earlier. We might be able to marshal more resources to testing people who were sick, to tracing their contacts, to helping the people who were infected to isolate in a more humane way.
All of that might have been possible, but instead the U.S. threw its resources to it in the only way it knew how: at hospitals, at this profit-driven health care system that focuses on treating sick patients rather than stopping people from becoming sick in the first place. This is not the only option available to us. I spoke to a woman named Sheila Davis who heads Partners in Health, a nonprofit that works on public health around the world. She talked regularly to colleagues who work in places like Rwanda and Peru who are frankly shocked at the way the U.S. runs its health care. This idea that it’s all focused on hospitals rather than having health being a thing that is threaded throughout communities is just such an anathema to much of the world. And if you could fuse that ethic with the magnitude of wealth that the U.S. has and that it spends on health care, often wastefully, we might see a very different outcome when the next pandemic hits.
What about the fact that we have a just-in-time supply chain, which is to say we don’t stockpile masks and PPE, but we know how to get it in time, except when we don’t? Is that something that we should rethink?
Yes, to an extent. Obviously you can’t just have massive warehouses of stuff sitting idle all the time, right? That stuff will expire. It will run out. You need resources in the moment to deal with the problems you’re currently facing. So to an extent that problem of having a long supply chain for things like masks and drugs is an inevitable consequence of this globalized world. That being said, it is clear that the system is nowhere near as resilient as people would like it to be.
I also wrote a piece about the immune system and how it reacts to COVID. The immune system is weirdly a good analogy here and a metaphor for a better system, because it has a ton of redundancies. If one bit of the immune system messes up and goes down, there are other branches that can take up the slack. And that’s what we don’t have with supply chains around the world. There is a certain amount of resilience, but as we’ve seen in this pandemic, if China goes down early and China is the hub for making things like masks and protective equipment, that’s really going to cascade around the world. And it turns out there’s sort of a plan B, but it doesn’t really work. There needs to be a more resilient system with more redundancies, more backups.
One of the points I make in the piece is that a lot of the countries that did well with the pandemic—places like New Zealand and Japan and Germany—it’s not that they got everything right. But they did enough things right. And so by corollary the U.S. has failed because we did a lot of things wrong. We just made mistakes across the board.
I’m thinking of three future events. One is a vaccine, some stages of which seem to be going well, but the time lag between injecting it into someone’s arm and where we are now is still rather large. Second, what about the supply chain and having enough syringes? And then the third thing is, what about the messaging? The public health communication has been so bad. Why would we expect that to be better for a vaccine?
Yeah, very much agree. My colleague, Sarah Zhang, has written an incredible piece on exactly this. Throughout this pandemic—and I think just in general—Americans have this tendency to focus on the biomedical solution. We want the drug or the technological fix that is going to solve all our problems. But I think one thing the pandemic should make clear to everyone, I hope, is that that’s only part of the picture. There are so many sociological dimensions to the problems that we face, and there must therefore be sociological solutions. So let’s say a vaccine is approved. That is just step one. How do you then distribute it across the country? And especially how do you distribute it to adults and the elderly, who are not the typical groups of people who get vaccinated? That’s mostly children. Can a country that has so inefficiently failed to provide protective equipment to its essential workers successfully distribute a vaccine? I’m not sure.
Then there’s the misinformation problem. Will people distrust a vaccine, especially when the project they created has a title as ostentatious as Operation Warp Speed? Will people reasonably wonder if a vaccine has been rushed before safety and efficiency have been adequately proven? And then the third thing is the inequality piece. If all the communities we’ve talked about—Black, Latino, Indigenous, elderly, disabled, poor—have been so neglected thus far in the pandemic, are they going to be first in line for the vaccine? I am skeptical. Or will they just be lost again? Will they continue to be underserved? We need to think about all these things now. And I think we can also look to interventions that can reduce health inequalities without needing to wait for a vaccine.
We can think about things like broadening health care, offering adequate sick or hazard pay. We can think about all these measures that have a strong evidence base behind them that will help people take care of themselves, help prevent infections, help essential workers to do their jobs without risking their lives for their livelihoods. We can do all of that without waiting for the magic bullet from the world of biomedicine. And if we actually do that, we’re going to improve people’s health in general, for other infectious diseases, for other chronic diseases, and against the infections of the future. A vaccine against SARS-CoV-2 is only going to protect against this coronavirus, whereas other ways of improving public health and reducing inequalities are going to protect against the coronavirus and everything else, which sounds better to me.
You made reference to SARS-CoV-2. What about SARS-CoV-3?
Will there be another coronavirus that hits us? I don’t know. Will there be another pandemic? Absolutely. For those of us who are lucky to get through this one, we will probably live through the next flu pandemic, maybe the next pandemic of a new coronavirus, or something else that takes us by surprise. This is an era of emergent infections. That is a consequence of this world we have built, which has been riddled by climate change, which is facing increasing agricultural use, where humans have intruded into the spaces that were once the domain of animals and the viruses that they carry. So we should absolutely expect more pandemics, and we should realize that they could be worse.
I know this is a galling thing for people to hear, given how much our lives have been uprooted by this current one, but SARS-CoV-2 is not the worst virus we could expect. It is not as transmissible as other known ones like measles, for example. It is not as lethal as other coronaviruses of the past. So unfortunately it could be worse, and we need to prepare ourselves for that.
Normal led to this, so we can’t just return to it. And being prepared for the next pandemic is not just a case of making sure vaccine technology is ready or that diagnostic tests can be quickly rolled out, although that is important. It is also a matter of fixing the broken foundations across the country, the health inequalities, the carceral state, the way we look after elderly and disabled people, all of those things. If we shore up the foundational problems, then I think we do have a chance of really kicking the next virus that threatens us. But if not, and I worry that we won’t learn the lesson from this, then we’re just going to repeat history again.