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Fragmentation: Why the US was so not ready for a pandemic

We should have been ready. This country has what it needs to fight an outbreak. When world experts created the Global Health Security Index to assess 195 countries and their capability of preventing and mitigating epidemics and pandemics, the United States ranked No. 1. “Out of all the countries that were assessed, the United States has the highest score – 83.5, a solid B. But if you look at how the country has actually reacted to the pandemic, I think we probably get something like an F,” science writer Ed Yong told Terry Gross on Fresh Air this month.

So what went wrong?

Many scientists point to our fragmented healthcare system. “We have no way to centralize things in this country, short of declaring martial law,” Harvard epidemiologist Michael Mina said last week in a forum on problems in the US medical supply chain. “There’s little ability for a central sort of command unit to pool all of the resources from around the country,” he said. “Just getting the hospitals within given cities to coordinate has been a tremendous feat.” We’ve been short on tests, as well as swabs for taking nasal samples. And we have no hub for lab supplies and testing equipment, Mina said. “Every lab that has tried to get this test up and running has kind of had to start from scratch… and sort of do it on their own.”

There isn’t even a comprehensive list of who needs what, where. “State by state, county by county, these databases are being constructed,” Mina said. It’s a piecemeal effort. “We’re very fragmented.” And a lot of it’s happening through grassroots campaigns, donation pages, and individuals stepping up to say, hey, my family has connections to a factory in China that can produce swabs or masks – “I can put you in touch with them; how many do you need?”

That’s generous, and helpful, but far short of what a nation needs at the height of crisis.

Contrast that with Taiwan, which established a National Health Command Center in the wake of SARS in 2003. Today, the NHCC implements exactly the sort of central coordination Mina talked about. Similarly, Singapore created a national task force to manage outbreak response, which it used during H1N1, Zika, and now COVID-19 (plus, coronavirus testing and care are covered by the government).

Or Iceland, whose government is testing anyone who wants to be tested – some 19,500 people as of early this week – and paying up to 75% of salaries so workers can take cuts in hours without losing their jobs.

But things haven’t worked that way in the United States. Here, we have always prided ourselves on being individual, independent, exceptional. We don’t like big government. We don’t like conformity, either.

But we do need leadership, coordination, and collective vision when we face a common enemy. (Instead, for better or worse, we have Gavin Newsom declaring California a “nation-state.”)

Much of the chaos and calamity we’re seeing comes down to “a failure of mankind to find collaborative and cooperative ways of living and working together,” our friend Mike Boddington wrote to us this week. (We first met Mike a decade ago, while he was working on UXO issues in Laos. He’s one of those genius high-achievers with a resume that runs to the moon. When I asked Mike how he wanted me to identify him, he said call him “friend.” But I feel compelled to tell you he is in fact Mike Boddington, a Member of the Most Excellent Order of the British Empire!)

Mike’s been trying to weigh the potential economic fallout of this crisis globally. He’s been looking at the history of capitalism and communism from his home in the heart of Lao PDR, a one-party socialist republic that underwent New Economic Mechanism reforms back in the 1980s. Laos has had its taste of communism and capitalism, and when Mike asked colleagues what their country could offer as a message in the time of COVID-19, he received this succinct and poignant reply: tolerance.

“The one thing that Lao folk have always been admired for is their good-natured, easy-going tolerance towards all and everyone,” Mike said. “I don’t know whether COVID-19 will harden Laos and the Lao people on the anvil of its passage, or whether they will turn more fully to tolerance as a way of getting through these tough times, but I would appreciate it so much if some contribution to the international order – something that incorporates tolerance and compassion – could come out of this country.

Tolerance and compassion.

That brings me back to the Q&A with Harvard’s Michael Mina. When he talked about shortcomings in US medical supplies, he talked about two kinds of responses: federal efforts to “cajole” manufacturers into ramping up production, and grassroots efforts of goodwill. The success of the former relies on economic stimuli, a.k.a., money. But the success of the latter relies on compassion.

In our system, we need money to survive. But as a society, we need compassion to thrive.

One reply on “Fragmentation: Why the US was so not ready for a pandemic”

Calmly stated truth for examination with choices of how to best move forward after this.

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