Is the United States prepared to deal with a public health emergency? At this point such an emergency seems likely, but, even if it were not, the consequence of inaction are catastrophic and must be planned for. Preparation for a national health emergency depends on two variables, the medical resources available to provide acute and preventive care and the demands made of these resources. Unfortunately a generation- long war on democratic government and a never very generous welfare state has inflicted severe harm on both the supply and demand sides of the emergency preparedness equation.
There is good reason to believe the medical infrastructure for acute care has been as neglected as our roads and bridges in the current neoliberal order A survey of California hospitals conducted by the National Nurses Union revealed: “ 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.
What about the administrative capacity to assess these shortages—along with the tenuous supply chins for crucial drugs? An administration that is determined to downsize and denigrate government itself seems unlikely to rise to the challenge. Indeed as NNU Executive Director put it,” nurses and health care workers need optimal staffing, equipment, and supplies … This is not the time for hospital chains to cut corners or prioritize their profits. This is the time to go the extra mile and make sure health care workers, patients, and the public are protected at the highest standards.”
University of Hawaii political theorist Jairus Grove has a suggestion attuned to the inadequacies of current administrative efforts: “This is not an ad-hoc FEMA job this is the job for local social work and health infrastructures with large federal infusions of resources and money. Hoarding needs to be addressed and rationing needs to be equitable. Otherwise wealth will determine the odds of survival.”
As Grove’s remarks about rationing and survival odds imply, a successful response to the crisis must address the demand side. Citizens are much more likely to make sacrifices if they believe we are all in this together. Fostering this feeling, let alone establishing it will be an inordinate challenge. The CDC can in a matter of fact tone ask workers who are sick to stay home, but many states do not require businesses to provide paid sick days for their employees. The Economic Policy Institute reports, “access to paid sick days is vastly unequal. The highest wage workers are more than three times as likely to have access to paid sick leave as the lowest paid workers. Whereas 93% of the highest wage workers had access to paid sick days, only 30% of the lowest paid workers were able to earn sick days.”
Equally significant the many holes in our health insurance system combined with the extreme inequalities in our political economy are a perfect storm for aggravating the crisis. Surveys have shown that nearly half of the population could not come up with $500 to meet an unexpected expense. In addition if they are insured they likely face so many co- pays and deductibles that visiting the doctor is a nonstarter. Going to work rather than to the doctor not only spreads the disease but also deprives public health experts of the data needed to construct the most effective strategies. Since many of the workers who fit this description are service sector and in more contact with others the adverse consequences are greater. (Even in a more dangerous environment are the 2.1 million citizens in prison, a veritable petri dish. Has anyone considered their fate in this crisis?)
There are policy responses far short of a social revolution that would address these strains. Paid sick leave more work at home four day workweek, universal healthcare, and job guarantees would be a good start. These are portrayed as radical, but they are essential to the health of the body politic and the air that we all breathe.
Bonus video added by Informed Comment: