American Catastrophes, Part 1
The United States of America has never been a perfect union. Today, however, it feels as far from perfect as it ever has in my lifetime.
Tougher times and greater hardships tested previous generations of Americans. The period between 1776 and 1865 when chattel slavery remained the legal economic engine of the republic will always stand as the hypocritical low point in attempts to live up to our ideals. The Civil War that brought an end to that system will hopefully always stand as the closest we came to the complete abandonment of our Union. The lynch mobs of Jim Crow and the bread lines of the Depression are the archetypal images of the racism, violence, hunger, and suffering that too many Americans knew in the first half of the 20th century.
No moment in American history since the end of the Cold War, however, has felt as fraught and unpredictable as the present.
For three primary reasons, 2020 will forever mark a pivotal moment in our history. How we as a people respond to the pandemic, the protests, and the presidency will determine the course of the United States in the 21st century.
The Pandemic
According to the Johns Hopkins Coronavirus Resource Center, the United States has seen roughly 7,105,604 confirmed cases of COVID-19 as of September 27. This week we crossed the ghastly milestone of 200,000 American deaths, 204,738 as of this writing. That gives the coronavirus in the U.S. an observed 2.88% case-fatality ratio, though it’s difficult to know the true counts given our across-the-board failings in testing. By comparison, the Center for Disease Control and Prevention estimates that the 2017-2018 flu had a case-fatality ratio of around 0.14%, representing a particularly deadly season. The coronavirus is not “just the flu,” and it will not disappear like magic.
While COVID-19 remains a global pandemic, the U.S. distinguished itself with a particularly poor response to the virus. Rather than leading the world and marshaling our public health expertise and scientific resources, we are in the company of the worst hit countries like Brazil and India. According to The Economist, our death toll is higher than that of all of western Europe combined, and their analysis shows that the true number of deaths could be closer to 300,000.
Our leading governmental scientific and infectious disease organizations have been denuded of critical staff and resources. The upper ranks of formerly impeccable agencies like the CDC and the Department of Health and Human Services are infected with politicized leadership. The Trump administration has prioritized PR over public health almost every step of the way.
To be fair, though, Americans have not proven to be particularly good patients. Anti-science and anti-expertise bias has asserted itself at the worst possible moment. Whole segments of our society can’t even agree there’s a crisis to worry about in the first place. The science fiction writer Isaac Asimov penned an essay in 1980 entitled “A Cult of Ignorance” that I’ve found particularly relevant this year. In it he writes:
There is a cult of ignorance in the United States, and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that ‘my ignorance is just as good as your knowledge.’
This cult has found plenty of willing new members in 21st century America. Our shunning of science has led to demonstrably worse outcomes in our fight against the pandemic.
The Brookings Institution compared our virus numbers to an average of 25 other high-income countries in the Organization for Economic Co-operation and Development (OECD). According to their research, the U.S. now has four times the number of virus cases per capita and twice as many deaths per capita. In September alone, the number of new cases per capita in the U.S. were 60% higher and the number of new deaths five times higher than those in an average OECD country.
The number of Americans deaths due to COVID-19, from March through September, is more than the number of American soldiers killed in the the Revolutionary War (4,435), the War of 1812 (2,260), the Mexican-American War (13,283), the Spanish-American War (385), World War One (53,402), the Korean War (36,574), the Vietnam War (58,220), and the first Gulf War (148) combined. It is almost two-thirds the number of Union soldiers killed in the Civil War (360,000). It is almost exactly half the number of Americans killed in World War Two (416,800).
Yet the fall and winter are widely predicted to be worse.
A Numbers Game
Sickness and death are not the only considerations at play in this public health disaster. As a result of the pandemic, we also witnessed the biggest economic collapse since the Great Depression. The official unemployment rate rocketed from around 3.5 percent in February to 14.7 percent in April. While that number reportedly decreased to 8.4 percent in August as many states and businesses reopened, it remains tenuous. According to Brookings, the United States had the largest unemployment rate increase of any high-income OECD country.
At the beginning of September, Forbes reported that multiple corporations announced as many as 200,000 additional layoffs. The airline industry alone is set to lay off 35,000 employees this week, even after accepting billions of dollars in federal aid from the Cares Act earlier this year. For other workers, temporary furloughs are rapidly becoming permanent firings. According to Bloomberg, Goldman Sachs Inc. estimates roughly a quarter of the employees temporarily laid off earlier in the pandemic won’t have a job to return to. Many Americans now face the prospect of long-term unemployment, part-time employment, reduced hours and economic instability for the foreseeable future.
What happened?
Many conservative voices, including the president, presented us with a false dichotomy. Either we could reopen from lock downs as quickly as possible and save the economy (while accepting worse health outcomes), or we could continue to lock down our country to halt the spread of the virus (while tanking the economy). In reality, we have miraculously managed to do neither. “Both employment and health outcomes for the U.S. during the pandemic have been worse than in almost any other high-income country in the world,” says Harry J. Holzer of Brookings. “The U.S. has experienced the worst of both worlds,” he claims, pointing to “very high unemployment and very high caseloads and deaths” during the pandemic.
The two remain inextricably linked. As long as Americans don’t feel safe returning to their full lives outside the home, for fear of the virus, the economy that their spending and travel sustains will not fully recover. We tried to force an answer on the second half of that equation without ever solving for the first. Thanks to the wasted opportunities of April, May, and June, both the pandemic and the slow economic recovery will be with us well into 2021.
Unhealthy Habits
Much like a personal health scare may lead you to reassess your own habits and wellness, a societal health scare can force us to examine existing systems and policies to identify those that leave us vulnerable.
New York Times columnist Nicholas Kristoff reports that the Social Progress Index, a report measuring 50 different metrics of well-being and quality of life for 163 countries, finds the United States is going backwards. In fact, we dropped over the last decade from 19th in 2011 to 28th this year. The only other two countries not to see advances in these measures: Brazil and Hungary, which saw smaller decreases. “The Social Progress Index,” Kristoff writes, “finds that Americans have health statistics similar to those of people in Chile, Jordan and Albania, while kids in the United States get an education roughly on par with what children get in Uzbekistan and Mongolia.”
In his book Trumpocalypse: Restoring American Democracy, writer David Frum examines health care spending vs. health care outcomes in the United States. He finds that while “Americans spend vastly more than anybody on health care,” an average of $20,000 or more per year for a family of four, “life expectancy dropped in the United States” over 2016, 2017, and 2018. (pp. 131-132) If things stay the same, “life expectancy in the United States will have tumbled to sixty-fourth place among the nations” by 2040. Similarly, “life expectancies in China will overtake those in the United States by 2027,” Frum states.
Financial columnist Eduardo Porter, in his book American Poison: How Racial Hostility Destroyed Our Promise, offers many of the same dour points. “Take a pick of virtually any measure of social progress over the last four decades,” Porter writes, and you will find the U.S. “lags the rest of the industrialized world.” (p. 40) Here are some of the most shocking numbers he cites:
The U.S. ranks fifty-first in infant mortality rates, near Croatia.
One-fifth of American children live in poor homes.
Life expectancy for girls born in the U.S. fell from thirteenth place in 1980 to thirtieth by 2017.
Americans aged fifty-five to sixty-four have the third-highest college graduation rate in OECD countries; Americans aged twenty-five to thirty-four have the twelfth-highest college graduation rate.
Already, the coronavirus has exposed some glaring weaknesses in the American approach to public health. The advocacy group Families USA found that 5.4 million Americans lost their employer-sponsored health insurance between February and May due coronavirus-related layoffs. This dwarfs the number who lost their insurance during the Great Recession. Additionally, the American Medical Association estimates that a total of 27 million Americans could lose their employer-sponsored health insurance due to the coronavirus pandemic. That employment status can decide a person’s access to health care during a global pandemic and economic catastrophe seems, to me, illogical and inhumane.
Hunger was already a largely invisible problem in America before the pandemic. NPR reports that nearly 13.7 million American households, or around 10.5% of all U.S. homes, experienced “food insecurity at some point in 2019.” Food insecurity is defined as “a lack of consistent access to enough food for an active, healthy life.” This included a population of five million children. COVID-19 and the economic collapse supercharged that number. Now, nearly one in four American homes have experienced food insecurity this year.
Leaving aside the short-term responses of Congress and state governments, the fact is we’ve known our health care system is designed to serve the wealthy. Access to doctors and treatments is viewed as a generous benefit bestowed by employers upon the economically worthy, leaving too many to forgo all but emergency care. Maybe the strain of the coronavirus will finally force us to see health care as a human right that should be guaranteed to all in some form, and a prerequisite to “life, liberty and the pursuit of happiness.” A system designed only to work when things are going well is bound to collapse when faced with adversity.
The Essentials
As has been widely reported, both the virus and the economic effects of the virus disproportionately impact racial and ethnic minorities. Data from the CDC shows that the American Indian and Alaska Native (AIAN) population suffers a hospitalization rate 5.3 times that of Whites. Black and Hispanic Americans are nearly 4.7 times more likely to be hospitalized by the virus than Whites. State-by-state breakdowns from early in the pandemic show the disparity in striking terms. According to the Kaiser Family Foundation, Black citizens made up a staggeringly high percentage of the coronavirus cases in a number of states.
In North Carolina, 21% of the total population is Black; they made up 37% of the total number of cases through April 6.
In Louisiana, 32% of the population is Black, but they represented 70% of the state’s COVID-19 deaths through April 6.
In Michigan, 14% of the total population is Black, but they made up 31% of confirmed cases and 41% of deaths in the state through April 6.
These outcomes have less to do with biology than sociology. Black and Hispanic citizens are more likely to work in the service industry and in essential roles that prevent them from isolating at home. Nearly a quarter of all Black and Hispanic employees work in the service industry, and Black Americans make up 30% of all licensed nurses. Many of these workers also depend on public transportation, exposing them to further daily risk.
Cruelly, those Americans more likely to be infected by the virus are less likely to have health insurance. Black Amerians, according to 2018 data, have an uninsured rate of 11%, Hispanics a rate of 19%, and the AIAN population a rate of 22%, compared to an 8% uninsured rate for Whites. Lack of insurance coverage, inevitably, leads to higher rates of pre-existing conditions. As populations more likely to fall under the poverty line forgo preventative care and avoid expensive doctor visits for anything but life-threatening conditions, they develop chronic conditions that make them more susceptible to deadly infections, like the coronavirus.
Additionally, NPR found that Black families were nearly twice as likely to experience food insecurity as White families. They cite USDA data from 2019, before the pandemic, that shows 19.1% of Black families and 15.6% of Hispanic families experienced food insecurity, while the number was 7.9% for White families. All of these numbers have only gotten worse in 2020.
While many Americans, myself included, are fortunate enough to work from home for jobs that provide employer-based health insurance, a disproportionate amount of the pandemic’s burden falls on those who cannot.
A Catalogue of Plagues
The novel coronavirus pandemic may be new to us, but it’s not unique in history. We are not the first generation of humans humbled by disease. Plagues and pandemics are a near constant part of history. In fact, once you start looking for examples of microbes altering the course of civilizations, it becomes hard to avoid them. Here is a brief list of some of the most infamous infections in world history: the 10 plagues of Egypt (13th century BCE); the Plague of Athens (430 - 428 BCE); the Antonine Plague (165 - 180 CE); the Plague of Justinian (541 - 542 CE); the Black Death (1348 - 1352 CE); Cocoliztli Epidemics (1545 - 1548); The Great Plague of London (1665 - 1666 CE); the Spanish Flu pandemic (1918 - 1920 CE).
In the 20th century alone there were three major influenza pandemics, in 1918, 1957 and 1968, plus the HIV/AIDS pandemic, not to mention numerous epidemics that fell just short of full-blown pandemics. The SARS epidemic of 2002 - 2004, H1N1 Swine Flu pandemic of 2009, West African Ebola epidemic of 2014 - 2016, and the Zika virus epidemic of 2015 - 2016 all captured global attention in the 21st century. None of these recent outbreaks, however, come anywhere close to the coronavirus pandemic’s effects on our world.
In all of these cases, it is not just the disease that changes history; it is also the human reaction to disease. The Black Death of Europe in the 14th century killed up to half of Europe’s population in five years. It also altered the way people thought about, well, everything. The experience of the plague brought radical changes to the way people thought about politics, religion, art, sanitation, medicine, and themselves. These ultimately combined to break down feudalism and move Europe out of the Middle Ages and into the Renaissance. These new ideas also kindled the Protestant Reformation.
As frightening and exhausting as the global coronavirus pandemic has proven, it also brings the possibility for much needed change. To echo Ed Yong of The Atlantic, who has masterfully chronicled the pandemic and America’s response from the beginning, COVID-19 has exposed our country’s pre-existing conditions and glaring shortcomings with regards to public health and economic inequality. “A virus a thousand times smaller than a dust mote has humbled and humiliated the planet’s most powerful nation,” Yong writes, adding that “America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader.” Ultimately, he finds that there is a way forward, but it emphatically must not include a mere return to “normal.” From Yong again:
COVID‑19 is an assault on America’s body, and a referendum on the ideas that animate its culture. Recovery is possible, but it demands radical introspection. America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies. It should strive to prevent sickness instead of profiting from it. It should build a health-care system that prizes resilience over brittle efficiency, and an information system that favors light over heat. It should rebuild its international alliances, its social safety net, and its trust in empiricism. It should address the health inequities that flow from its history. Not least, it should elect leaders with sound judgment, high character, and respect for science, logic, and reason.
After any society-shaking event, there is a clear line of distinction added in histories to indicate life before and life after the event. This shows how the experience altered daily life for human beings, and even how it changed the way they saw the world and each other. I hope that someday the pandemic will mark the moment we changed life for the better in this country. I hope we will look back and say “There, that’s when we made things right.”
As our nation grappled with this once-in-a-century crisis, however, we were suddenly engulfed by a second.
