The coronavirus (COVID-19) is in its very early stages in the United States so it is too early to predict its full impacts. The World Health Organization reports that COVID-19 has stricken more than 86,000 people around the world, killing nearly 3,000 and has spread to at least 60 countries. The global march of COVID-19 looks unstoppable.
On Friday, three new patients in California, Oregon and Washington State who had not traveled outside of the U.S. were diagnosed with COVID-19, suggesting community transmission in the U.S. has begun. The first death in the US happened this weekend in Washington State. The Times reports that “flawed test kits distributed to states by the CDC and strict criteria initially used for identifying potential cases may have slowed detection of the virus spreading within communities across the country.” The virus is likely to spread to every corner of the nation.
The economic impact of the COVID-19 virus, which has already wiped out $6 trillion in global wealth, $4 trillion in the U.S., is beginning to take effect. On Wall Street, the Dow Jones index closed down nearly 360 points on Friday. The index has dropped more than 14% from a recent high, making this the market’s worst week since the 2008 global financial crisis. Europe’s economy is already teetering on the edge of recession. If COVID-19 becomes a global pandemic, economists expect the impact could be much worse, with the U.S. and other global economies falling into recession. The White House is considering tax cuts and pressure on the Federal Reserve in response, but these are not likely to provide relief.
The real issue is health. COVID-19 will be a challenge for the fragmented U.S. health system where tens of millions of people do not have adequate access to healthcare. The U.S. is poorly prepared for an epidemic. The Center for Disease Control (CDC) estimates the flu has resulted in between 9 million to 45 million illnesses, between 140,000 to 810,000 hospitalizations and between 12,000 and 61,000 deaths annually since 2010. And, that is not an epidemic like COVID-19 could become. COVID-19 has a 2 percent death rate, 20 times higher than the influenza virus.
If the virus spreads, it will highlight the danger of healthcare inequality in the U.S. as millions of people without insurance will delay seeking care and spread the disease to family, neighbors, and co-workers. The profit-driven system will make access to medicine expensive and out-of-reach-for many. And the lack of paid sick leave will make it impossible for workers, particularly in the service sector, to stay home and avoid infecting others. The demand for National Improved Medicare for all and other necessities must be stronger.
The US is not well prepared for a viral epidemic
A 2019 report by CSIS Commission on Strengthening America’s Health Security found “the United States remains woefully ill-prepared to respond to global health security threats.” The report predicted what is occurring now in our globalized world: ” Outbreaks proliferate that can spread swiftly across the globe and become pandemics, disrupting supply chains, trade, transport, and ultimately entire societies and economies.”
The report recommended building the response to global health pandemics at the National Security Council and other agencies, increasing investment in preparedness, producing vaccines and other measures. Rather than heeding these recommendations, the Trump administration has done the opposite. In May 2018, Rear Adm. Tim Ziemer, the head of global health security on the White House’s National Security Council, left the Trump administration, one day after an Ebola outbreak was declared in the Democratic Republic of the Congo. This was part of the entire pandemic response chain of command being removed. Also in 2018, Trump fired Tom Bossert, homeland security adviser responsible for coordinating the response to global pandemics. His job has remained vacant.
While Trump has made serious errors, the 2019 report points to successive administrations writing, “Over several successive administrations, the White House has seldom exercised sufficiently authoritative, high-level leadership, creating acute threats to U.S. national interests when dangerous outbreaks occur at home and abroad. U.S. programs on global health security are fragmented, scattered across diverse executive agencies, and not clearly prioritized.”
The Global Preparedness Monitoring Board of the World Health Organization and World Bank found the threat from pandemics “is growing, and the world is not prepared.” In October 2019, the Global Health Security Index concluded that “collectively, international preparedness is weak.”
This week, National Nurses United sounded the alarm that the U.S. is not prepared for the spread of the COVID-19 virus. They point to many problems including the lack of health care workers. In one case at the UC Davis Medical Center, a “patient admitted to the facility on Feb. 19 has now led to the self-quarantine at home of at least 36 RNs and 88 other health care workers.” One case resulted in 124 health professionals being unavailable.
National Nurses United is conducting a survey of registered nurses across the country on hospital preparedness and will be releasing those results next week. Preliminary results from more than 1,000 nurses in California are worrisome:
- Only 27 percent report that there is a plan in place to isolate a patient with a possible novel coronavirus infection. 47 percent report they don’t know if there is a plan.
- Only 73 percent report that they have access to N95 respirators on their units; 47 percent report access to powered air-purifying respirators (PAPRs) on their units.
- Only 27 percent report that their employer has sufficient personal protective equipment (PPE) stock on hand to protect staff if there is a rapid surge in patients with possible coronavirus infections; 44 percent don’t know.
Inadequate training and equipment are already a serious problem. A whistleblower reported that a dozen workers were “improperly deployed” to two California military bases receiving Americans evacuated from coronavirus-impacted areas. They were given neither training nor protective gear for handling the possibly high-risk patients. The whistleblower alleged that HHS officials shot down her concerns and on Feb. 15 threatened to fire her if she did not accept a reassignment. The workers who may have been exposed to the coronavirus were able to travel freely among the public, the complaint reportedly said.
The New York Times did an in-depth analysis of how prepared the U.S. is for a coronavirus outbreak and found many areas of vulnerability including critical shortages of respirators and masks. They note that a 2005 CDC report estimated that a severe influenza pandemic would require mechanical ventilators for 740,000 critically ill people. The U.S. only has 62,000 full-featured ventilators available in hospitals across the country. They also report there could be acute shortages of health workers to operate ventilators and care for patients, hospital beds, masks, and other protective equipment.
Because of shortfalls, some hospitals are making provisions for rationing including removing some patients from ventilators to make way for others presumed to have a better chance of survival. Further, plans would limit access of some patients “from critical care or even hospitalization during a peak pandemic based on criteria such as their age or an underlying chronic disease.” Of course, rural and poor communities will be impacted the most by lack of resources.
The U.S. has a total of 6,146 hospitals with 924,107 beds. There are 36,353,946 admissions annually. In rural towns across the U.S., communities are in crisis due to hospital closings. There have also been hospital closings in urban areas. The Times reports Gary Cox, the Oklahoma health commissioner, said reopening rural hospitals that had closed in recent years was an option under consideration and the state was also exploring the idea of using recreational vehicles to house people who have tested positive for the virus but do not need hospital care. The DoDand CDC have approved at least 15 U.S. military bases as quarantine camps.
Another major problem area is the accurate communication of information. The CDC has a 65-page manual on how the agency should communicate during a health crisis, which includes sharing scientific information “in an open, timely, and appropriate way.” But, the White House has taken over communication around COVID-19. The Washington Post reported that a government employee faced retaliation for raising concerns about unsafe assessment of potentially-infected individuals. The New York Times reports that public communications about the virus from CDC scientists will need “clearance.” Anthony Fauci, a senior NIH official and physician-scientist, had to cancel several television appearances after the vice president gave him a gag order.
COVID-19 demonstrates the need for improved Medicare for All
Universal access to healthcare through National Improved Medicare for All (NIMA) would make a tremendous difference in both controlling the spread of the virus as well as making sure people receive the treatment they need. Today, more than 27 million people in the US do not have insurance. Tens of millions more are underinsured—45 percent of working-age adults, or 87 million people, were either underinsured or had no coverage for at least part of the last year.
People with inadequate insurance have financial barriers to healthcare. The Kaiser Family Foundation reports the average deductible among covered workers is $1,500 for an individual and $3,000 for a family. Twenty percent have high deductible plans that cost $3000 for an individual or $5000 for a family. Half of U.S. adults say they or a family member put off or skipped some sort of health care in the last year. Even for people who obtain insurance through the Affordable Care Act, the average deductible is $4,000.
As a result, even if you are among the small percentage of the population that has very robust health insurance, you are at risk for getting COVID-19 because people with symptoms will not go to the doctor to be tested and treated because they fear the risk of bankruptcy. Healthcare costs are the major cause of bankruptcy in the United States with 530,000 bankruptcies annually linked to medical illness.
The signs of COVID-19 are highly non-specific and include fever, cough, shortness of breath, and viral pneumonia. A diagnostic test is a key tool in determining whether someone has the virus along with clinical observation, the patient’s medical and travel history, and contacts. At the low end, the cost of the test is $250, and at the high end, it’s $1,500 or more.
The case of a Miami man shows why underinsured people will not seek healthcare. He had viral symptoms and went to be tested. He tested negative but received a bill from his insurance company for $3,270. He would be responsible for $1,400 of that bill, but the insurer required additional documentation: three years of medical records to prove the flu he got didn’t relate to a preexisting condition. This individual is typical of many people in the U.S. He earns about $55,000 a year working for a medical device company that does not offer health insurance. He purchased an inexpensive policy that cost $180 per month for a limited plan.
NIMA would ensure that every person had access to necessary tests, care, and medications including a coronavirus vaccine when one is developed. The government is going to invest at least $1 billion in the development of a vaccine but Health and Human Services Secretary, Alex Azar, said they could not ensure it would be affordable saying, “we can’t control that price because we need the private sector to invest.” Azar served as the top lobbyist for Eli Lilly before becoming president of the drug company’s US operations in 2012. Azar earned nearly $2 million during his last year at Lilly at a time when the cost of its drugs went up significantly, e.g. insulin sold by the company more than doubled in price The actions of Lilly during his tenure resulted in a lawsuit filed in 2017.
Azar is emblematic of the pharmaceutical industry, one of the most profitable sectors of the economy. He is one of many people on President Trump’s coronavirus task force who has conflicts of interest due to ties to for-profit healthcare. Another task force member is Joseph Grogan, a lobbyist for the pharmaceutical giant Gilead Sciences before he joined the Trump administration as director of the Domestic Policy Council. Gilead announced last week that it would be starting two clinical trials of an antiviral drug that could be used to treat the virus and the company’s stock price surged. Of the task force’s 16 members—17, if you include Vice President Mike Pence, only four have any training in science or medicine.
Another member of the task force, Commerce Secretary Wilbur Ross, said the coronavirus virus created business opportunities as it “will help to accelerate the return of jobs to North America.” The first action of Pence, who leads the task force, was to go on the Rush Limbaugh show to praise the actions of President Trump and to reassure the financial markets. It is evident from Pence’s actions and the make-up of the commission that the response to COVID-19 is more about politics than health.
When a public health system like NIMA is put in place, then other policies change. Employment policies would make a tremendous difference in stopping the spread of the virus. A study of 22 countries by the Center for Economic and Policy Research found all countries offered at least nine sick days with full pay, the U.S. does not require any paid sick time for workers. On average, Americans who do have paid sick days are entitled to up to seven days per year, according to the Bureau of Labor Statistics. However, nearly four in 10 workers—43.5 million people—don’t have any paid sick leave.
Research shows that flu rates fell by about 40 percent in U.S. cities that mandated sick pay. People who cannot stay home when they have symptoms spread illness to co-workers, customers, and others they come into contact with. People in the U.S. want paid sick leave and family leave, but corporate America blocks it. With the potential of COVID-19, the country will pay a heavy price for that greed. The U.S. and other nations have implemented mandatory 14-day quarantine measures for returning travelers and residents who may have been exposed to the virus in China. Without sick leave, how will workers tolerate being quarantined?
The fate of COVID-19 in the United States is in our hands
COVID-19 is expected to be widespread in the United States by mid-March. Without competent leadership and a universal healthcare system, it is up to us to take action in our communities. One of the simplest things to do is to make sure people are aware of how the virus spreads and how to protect themselves. It is spread by droplets that land on surfaces when an infected person coughs or sneezes. The virus can stay alive for several days on surfaces. If someone touches a contaminated surface and then touches their mouth, nose or eyes, they can become infected.
We should all avoid coughing or sneezing openly. Use a tissue or your clothing if that’s all you have. Wash your hands frequently. Avoid touching your mouth, nose, and eyes. Stay in if you have symptoms of a cold and avoid people who have cold symptoms. Contact your doctor if your symptoms worsen. While most people who contract COVID-19 will recover from it, the death rate is much higher than the flu virus, which has already killed 14,000 people in the US this season, and so we must do what we can to limit its spread. People who are older and have compromised health are the most vulnerable. Check the CDC for up to date information.
We must also be prepared for a possible recession. It is time now to reach out to others in your community to make plans for mutual aid to reduce the suffering that will occur. This time, it may be much worse because we have high debt and a weaker economic foundation. But together, we can get through this and use it as an opportunity to demand more such as National Improved Medicare for All, public banks, a stronger social safety net and diversion of military spending to transition to a green energy economy.
NOTE: The article was edited on March 2, 2020 to reflect that while President Trump has consistently proposed major cuts in funding to the CDC, Congress has not approved those cuts. However, prior to President Trump, plans were put in place to cut grants to states and local areas for disease management.