There were two major press conferences yesterday on the state of play of US preparations for what the World Health Organization (WHO) is now referring to as the “very real threat” of a pandemic.
In his appearance alongside Vice President Mike Pence and his largely silent coronavirus task force, Donald Trump spent a perfunctory two and a half minutes describing how “tremendous” his response has been, and offered a promise of financial assistance for the cruise ship, hotel, and airline industries, as well as payroll tax cuts and loans for small businesses, before quickly ducking out to avoid reporters’ questions about whether he had been tested for the virus himself given that he has potentially been exposed to the disease via one degree of separation. Wall Street executives including the heads of the nation’s seven largest banks — world-renowned for their considerable epidemiological expertise — have also been invited to the White House to discuss how to respond to the outbreak.
At one point, after the director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, answered a reporter’s question about the elderly and those with underlying conditions by saying: “I recommend strongly that they should not go on a cruise ship,” Pence quickly slid over to the podium to reassure that the “cruise line leadership all stepped up” with a proposal on new safety protocols and processes for evacuating those with the coronavirus, expected in the coming days. The move is of a piece with how the White House overruled the Centers for Disease Control and Prevention (CDC), excising a recommendation that the elderly be advised not to fly so as to avoid exposure to the virus.
The problem here is not so much with support for the tourism industries that have been hit first and so far hardest by the disease — airline, hotel, and cruise ship workers need to be protected in the face of this crisis as much as any fossil fuel sector workers need a just transition in the face of the climate crisis — but that Trump’s recently discovered urgent focus seems more prompted by a plunging stock market than by the coronavirus, with little attention paid to policies specific to arresting its threat.
Bernie’s Expert Panel vs. Trump’s Press Conference
Meanwhile in Detroit, in counterpoint to the evidence-phobic leader of the free world, Vermont senator Bernie Sanders calmly detailed the multiple, overlapping, and ultimately systemic failures of the country’s pandemic preparedness, flanked by an Obama administration Department of Defense special assistant on nuclear, chemical, and biological defense, the director of the Yale Center for Infectious Disease Modeling and Analysis, and a prominent family physician. Also speaking were the head of the largest union of registered nurses and former Michigan gubernatorial candidate and Bernie supporter Abdul El-Sayed, who also happens to be an epidemiologist and former director of the Detroit Health Department.
Unlike Pence’s wall of tight-lipped task forces, this expert panel went into detail for over an hour and a half, addressing the different aspects of the COVID-19 debacle, from the stunningly inadequate and restrictive rollout of testing for the illness, to the insufficiency of ventilator and intensive care unit (ICU) bed capacity, the epidemiological threat posed by lack of mandatory sick pay, and the vital need for accurate, evidence-based information grounded in science that people can trust — including what to expect in the coming weeks and months.
This latter demand, for an evidence-based approach, stands in clear contrast to what Sanders correctly described as reckless statements from Trump, who, while declaring himself to have a “natural ability” to understand COVID-19, also tweeted that the disease is less of a threat than the flu, encouraged those with the disease to continue to go to work, and suggested that it will all be over by April.
Alarmism can indeed provoke overreactions that produce economic and social outcomes worse than the disease might, but complacency is no less a danger. It may be true that most people and young people in particular will only experience a mild illness, but those over sixty-five and those with compromised immune systems or other underlying conditions are at much greater risk. A cynical sneering at the lower risk facing younger people places our elders in danger. And there are still young people who are dying. We do not yet have a good grasp on the mortality rate, and unlike the flu, we have no vaccine or treatment yet.
Instead of both alarmism and complacency, what is required is a sufficiently appropriate, sober, vigilant level of concern to encourage measures such as rigorous and regular handwashing and social distancing that can slow down the spread, in turn reducing the likelihood of health systems being overwhelmed as may currently be occurring in Italy, and to rally the necessary resources to combat the disease.
And as the pair of epidemiologists on Sanders’s panel, Abdul El-Sayed and Yale’s Alison Galvani, were keen to stress, the United States definitely has not committed those necessary resources.
A majority of the suite of epidemiological simulations across a range of scenarios performed by Galvani’s team project that the United States does not currently have the ventilator or ICU capacity required to handle the likely domestic growth of the pandemic, and that it will likely be only a couple of weeks before critically ill cases exceed the number of existing ICU beds.
El-Sayed argued that the situation has been exacerbated by this administration’s cuts to CDC funding and, perhaps more importantly, by cuts to state and local public health funding. Containment has been brutally handicapped. In Washington State, so far the worst hit by the outbreak, this has meant that public health officials have moved from attempting to contain it to now attempting to mitigate its effects. “We didn’t have to be here. We used to be able to do this but under this administration that all has failed.”
Perhaps worst of all, at least so far, according to El-Sayed, is the lack of testing kits. In an impressive piece of data journalism, the Atlantic reporters Robinson Meyer and Alexis Madrigal in concert with data scientist Jeffrey Hammerbacher parsing health data published by all fifty states and the District of Columbia, reported that barely more than four thousand people had been tested as of Monday afternoon. For comparison, they noted that in South Korea at the same point after the pivotal discovery of community transmission (meaning a case where the individual did not travel to a region known to have the virus), the south Asian nation was testing some fifteen thousand people per day and had tested more than a hundred thousand people.
At Trump’s press conference, the Health and Human Services secretary said that more than one million tests are due to be shipped by the end of this week, subsequently ramping up to four million a week. Let’s hope they are finally getting their act together, but, as family physician Victoria Dooley speaking at Sanders’s event worried, frontline health workers have been shackled by overly restrictive rules requiring that only those who know themselves to have been exposed to the coronavirus be tested. This has knock-on effects, with greater unnecessary exposure of health workers.
Deborah Burger, president of National Nurses United, gave an example of how this overlaps with insufficient stocking of protective equipment, supplies, and training. At the UC Davis medical center in Sacramento, the appearance of a single coronavirus patient resulted in the quarantine of 124 hospital workers, including thirty-six registered nurses. The burden of care of all the other non-COVID-19 patients was then placed on the remaining nurses and doctors. As Dooley added of health workers: “What happens when we all get sick?”
“An Injury to One Is an Injury to All”
Greg Whitten, the Obama administration Department of Defense special assistant for nuclear, chemical, and biological defense programs, lamented how the administration had effectively isolated itself from much of the rest of the world with respect to the sharing of data, arguing that when facing down a pandemic, it is just as important to share data with those countries that are not allies as with allies. Relatedly, in February, an annual intelligence report that warned that the United States was unprepared for a global pandemic and had been indefinitely postponed without explanation was leaked to the press. El-Sayed echoed these complaints with respect to disease surveillance, noting that in the wake of the West African Ebola outbreak, the United States had participated in support for the creation of monitoring bases in forty-nine countries. In the past few years, however, funding has been cut by 80 percent, slashing the number of countries with such bases down to ten.
But it would be a mistake to place all the blame for the coronavirus debacle on the Trump administration. There is a deeper, systemic malaise.
“In the middle of a potential pandemic, no one should be stopping themselves from going to a doctor simply because they are afraid that they cannot afford it,” said Sanders. He’s right. Those who are insured are at greater risk because there are people who are uninsured or underinsured. But Trump didn’t keep the United States from having a single-payer health system free at the point of use. That was the Democrat establishment, including presidential front-runner Joe Biden, who have consistently opposed a Canadian-style health system as too radical. And it wasn’t Trump that allowed America to become one of the only developed countries without some form of nationally guaranteed paid sick leave and paid family leave. Those people will continue to work all through being sick. “That is absurd in a general sense. But it is particularly dangerous at the moment.”
Sanders noted that Trump has suggested that a COVID-19 vaccine, once developed, may be too costly for some people to afford. “How vulgar, obscene is that idea?” Sanders said. “You’re rich, you get the vaccine. You’re poor, you can’t get the vaccine.” Limiting vaccination to only those who can afford it undermines herd immunity, where a sufficiently large percentage of a population that has been vaccinated provides protection against disease for members of that population that cannot be vaccinated because they are too young, too ill, or have immune system problems. That is, unequal access to health infrastructure is a threat to us all, not just those at the bottom. And again, Trump didn’t cause grotesque inequality. He is the symptom of it.
Trump in his press conference did at least mention that there could also be help for hourly wage earners fearful of missing a paycheck, an essential part of any adequate response. The details will be released later this week. We’ll see. Republicans have consistently been allergic to paid leave policies due to fears of the costs imposed on business. Some twelve states across the southeast, including purple state Florida, have passed legislation preventing sick leave requirements.
But so have many Democrats for much the same reason. Even in more liberal-tending states where such laws have passed, firms bypass them by recasting their workers as contractors, with little in the way of sanction.
Last year Senator Patty Murray of Washington State and Representative Rosa DeLauro of Connecticut introduced legislation that would have required companies with more than fifteen workers to provide seven days of paid sick leave per year. It largely went nowhere.
On Friday, however, they reintroduced their bills, this time with the provision that an additional fourteen days be immediately available during public health emergencies. The sick leave could also be used during such emergencies to take care of children in the event of school closure or if they or a family member is quarantined. And this time there appears to be traction. Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer said on Monday that they are set to unveil their own proposals for economic relief. Their packages’ key elements include free testing for those showing coronavirus symptoms, paid sick leave for quarantined workers or parents of children whose schools are closed, expansion of food stamps to ensure they don’t go hungry in the event of such closures, and expansion of unemployment insurance for those laid off by the economic effects of the virus.
This is all a good start. Unlike Trump’s proposals, they are focused on those most likely to be hit hardest, working families, and also make the most economic sense as a stimulus, as workers are more likely to spend such funds immediately than are cruise ship executives. The free testing in particular is essential.
But the devil is in the details. What happens if a worker is sick or quarantined longer than fourteen days? Beyond any question of social justice for those involved, are the quarantined supposed to just go back to work after this fortnight, quarantine be damned? Instead, it needs to be open-ended, as appears to be the case with Iceland’s quarantine pay. And what are the provisions for gig economy “independent contractors”? If they don’t work, they don’t get paid.
And there appear so far to be no provisions for free health care for those with COVID-19. The lack of this provision runs up against the same epidemiological problem as a lack of free testing. And for the same reason again, there must be a guarantee, as per Sanders’s demand, that the vaccine, once developed, must be freely available to all, indeed all around the world. And there must be sufficient funding for ventilators and ICU beds. Galvani projected that three hundred thousand will be needed in the next few months, up from today’s ninety thousand (excluding the 60 percent currently occupied). There also needs to be logistical preparation covering the spatial distribution of such beds. Need may not be spread geographically evenly and there needs to be plans and funding for how to get patients to where beds are open. All of this is important, to be stressed one last time, not just for those immediately affected, but for all of us. “An injury to one is an injury to all” might as well be an epidemiological slogan as much as it was a trade-unionist one at the turn of the last century.
What the Science Demands
Regardless of how the race for the Democratic nomination plays out, Sanders and his movement would do well to keep up the pressure to ensure that whatever Trump, or Pelosi and Schumer, have in mind for workers gets closer to what the epidemiological experts are saying is required.
In addition, a weekly panel of experts similar to what Sanders provided on Monday independent of the Trumpian censors, giving dispassionate, trustworthy updates while also being sufficiently muzzle-free to expose the public health infrastructure gaps where they exist, would provide a world of reassurance, and also offer everyone a policy lodestar to focus attention. This is especially important given all the reports suggesting the administration is micromanaging communications relating to COVID-19 and limiting appearances of infectious disease specialists who might be off-message. By performing this crucial service, Bernie has demonstrated, whether officially or not, he is, as one would term it in the UK, the leader of the opposition.
Above all, the pandemic appears to be, late in the Democratic nomination game, something of an I-told-you-so vindication for Sanders that Medicare for All and worker protection is not radical in the way that Biden, Buttigieg, Bloomberg, Harris, and the rest have cast it. It is actually what, as is also often said with respect to climate change, simply what the science demands. This is why it is no coincidence that so many public health experts and frontline workers, from epidemiologists to RNs, back Bernie: the incentives of the market are antithetical to the requirements of public health.
Staring down this potential pandemic, the democratic-socialist response just also happens to be the most evidence-based one.