Austerity Could Make the U.S. Coronavirus Outbreak So Much Worse

Michigan has much to teach the rest of the country when it comes to containing the coronavirus outbreak. (Photo by Jeenah Moon/Getty Images)

The lack of investment in public health, a robust social safety net or universal healthcare system all make the U.S. especially vulnerable to the fast-spreading disease.

As Com­mis­sion­er of Pub­lic Health in the City of Detroit, Abdul El-Sayed helmed response efforts to an epi­dem­ic that stark­ly illus­trat­ed just how unhealthy both inequal­i­ty and gov­ern­ment aus­ter­i­ty can be. In 2016, the city saw the begin­nings of a Hepati­tis A out­break less than five years after Detroit declared bank­rupt­cy and shut­tered its pub­lic health depart­ment. Two ear­ly cas­es were sus­pect­ed to be linked to patients hav­ing cleaned out base­ments that had flood­ed dur­ing a storm (with water poten­tial­ly con­tain­ing raw sewage, a trans­mit­ter of the pathogen) before falling ill.

El-Sayed’s team scram­bled to set up mobile vac­ci­na­tion hotspots and coor­di­nat­ed with com­mu­ni­ty part­ners to cull the spread, part of a response that like­ly pre­vent­ed infec­tions. Still, the expe­ri­ence illus­trat­ed the impor­tance of pub­lic invest­ment in pub­lic health to stop such an out­break, which ulti­mate­ly last­ed for two years and spread across Michigan.

Neglect­ed pub­lic infra­struc­ture like­ly con­tributed to the over­loaded sewage sys­tems that flood­ed vic­tims’ homes, just as inad­e­quate hous­ing is more sus­cep­ti­ble to such impact. We were able to put togeth­er a few vac­ci­na­tion clin­ics in that set­ting,” El-Sayed recalled of the response efforts. But the very rea­son those peo­ple were exposed in the first place was Michigan’s inabil­i­ty to invest in its own infra­struc­ture. It allowed this flood­ing to hap­pen, which is what got peo­ple sick in the first place. It all comes down to gov­ern­ment aus­ter­i­ty, and the inabil­i­ty or lack of fore­sight to invest in pub­lic goods, which then allows infec­tious dis­ease to spread.”

It’s a dynam­ic, accord­ing to El-Sayed, that will undoubt­ed­ly influ­ence how the coro­n­avirus out­break plays out. After the Trump admin­is­tra­tion cut the glob­al bud­get of the Cen­ters for Dis­ease Con­trol in 2018 and lack­ing a robust safe­ty net or uni­ver­sal health­care sys­tem, we are left with­out crit­i­cal resources for fight­ing nov­el pathogens. As El-Sayed put it, when we invest in pub­lic goods, we’re keep­ing peo­ple safe in real time. When we let up on those invest­ments, bad things happen.”

One such bad thing” is the lack of an effi­cient diag­nos­tic test, accord­ing to Ranu Dhillon, an epi­dem­ic advi­sor with the Har­vard Med­ical School. Because test­ing sup­plies have yet to be ade­quate­ly dis­trib­uted across the Unit­ed States, and coro­n­avirus symp­toms are indis­tin­guish­able from com­mon ail­ments, it’s dif­fi­cult to iden­ti­fy, trace and treat the cas­es already in our com­mu­ni­ties. This, Dhillon said, was a mat­ter of failed strat­e­gy and under­fund­ing, which is now being addressed in Con­gress. If you’re in World War II, and you need to devel­op a cer­tain sort of mis­sile to win the war, you spare no effort to try and devel­op that as soon as pos­si­ble,” he said. You con­tract with the com­pa­nies who are going to do it, you get it done.”

And yet, get­ting it done” will be made infi­nite­ly more chal­leng­ing in a con­text where broad swaths of the pop­u­la­tion lack access to the health­care sys­tem. Famil­iar sta­tis­tics about Amer­i­cans’ access to care — near­ly 30 mil­lion unin­sured, and anoth­er 44 mil­lion under­in­sured — take on a new urgency in the face of a poten­tial pan­dem­ic. A Medicare for All sys­tem, where care is guar­an­teed for free to every­one, fills in these gaps, which oth­er­wise dri­ve peo­ple away from the health­care sys­tem and make it more dif­fi­cult to man­age a crisis.

Fun­da­men­tal­ly, you need uni­ver­sal health­care to mit­i­gate an out­break,” Dhillon said. Apart from financ­ing care, uni­ver­sal sys­tems cul­ti­vate a stronger rela­tion­ship between providers and patients, who are con­di­tioned to seek care with­out hes­i­ta­tion when they need it. But in the Unit­ed States, Dhillon said, you have the oppo­site. You have peo­ple who are averse to com­ing for­ward unless they absolute­ly have to. That’s going to be a seri­ous issue mov­ing forward.”

Avail­able evi­dence backs up this point: research shows that more than half of Amer­i­cans have skipped need­ed care due to cost. Ever-ris­ing deductibles mean they’re on the hook to pay out more and more. And when it comes to con­tain­ing the coro­n­avirus, there are sig­nif­i­cant finan­cial penal­ties to be wor­ried about. In one wide­ly report­ed case, an insur­er refused to cov­er a Mia­mi patient’s test­ing and quar­an­tine, sad­dling him with a $3,200 bill.

In the con­text of an infec­tious dis­ease out­break, these prob­lems com­pound them­selves as peo­ple who don’t seek treat­ment or fol­low con­tain­ment pro­to­col are like­ly to infect oth­ers, par­tic­u­lar­ly if they live in areas of high­ly-con­cen­trat­ed unin­sured pop­u­la­tions. While sev­er­al states includ­ing New York and Cal­i­for­nia have stepped in to direct insur­ers to waive cost-shar­ing for coro­n­avirus-relat­ed care, the scope is lim­it­ed. Not all insur­ance plans are reg­u­lat­ed at the state lev­el, and it’s unclear what ser­vices specif­i­cal­ly will be included.

Those bear­ing the brunt of inequal­i­ty are often the most severe­ly impact­ed by infec­tious dis­ease. Peo­ple liv­ing with chron­ic stress and ill­ness are more sus­cep­ti­ble to emerg­ing pathogens, and those with­out access to health­care are less like­ly to have their con­di­tions prop­er­ly man­aged. Peo­ple in sub­stan­dard hous­ing are like­ly to live in more crowd­ed con­di­tions that fuel trans­mis­sion, or wors­en base­line health in the same way the flood­ed homes in Detroit did.

For Dr. Steven Thrash­er, an HIV-AIDS schol­ar, it all adds up to one thing: If cor­po­ra­tions want to pay low­er tax­es and the state doesn’t want to spend mon­ey on test­ing or broad treat­ment, then the peo­ple who con­tract coro­n­avirus — who get sick, and pos­si­bly die — are going to pay that price.”

Heav­ier invest­ment in pre­pared­ness, pub­lic health infra­struc­ture and a func­tion­al health­care financ­ing sys­tem could shift those costs off of patients. But, as El-Sayed learned in Detroit, that demands a deep polit­i­cal com­mit­ment. My fear is that we come out of this and a lot of effort is put into mak­ing sure we build the infra­struc­ture to make sure this does­n’t hap­pen again,” he said. Then five or ten years down the road, we look at a bud­get doc­u­ment and say, why are we fund­ing this?’ and then we’re back at square one. The Right has a field day cut­ting peo­ples’ tax­es and gov­ern­ment red tape. They cut these things that are crit­i­cal­ly impor­tant to keep­ing us safe, and I’d hate to see that again.”

Natal­ie Shure is a Los Ange­les-based writer and researcher whose work focus­es on his­to­ry, health, and politics.
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