United States President Donald Trumpwas convinced that the coronavirus was just a common flu. On March 4, he told the television host Sean Hannity that the coronavirus was not even as lethal as the flu, which could kill between 27,000 and 77,000 people a year. A week later, Dr Anthony Fauci of the National Institutes of Health told the U.S. Congress that “the mortality of COVID-19 is multiple times what the seasonal flu is”. The death rate for the flu is 0.1 per cent, while the World Health Organisation (WHO) says that the estimated death rate for coronavirus is at 3.4 per cent. This small incident reveals how callous Trump was from the very first about the coronavirus and the threat it posed to the people of the world, and to the people of the U.S.
Not only was Trump publicly callous about the threat from this coronavirus, but his administration had cut funding for the Infectious Diseases Rapid Response Reserve Fund and for the Centres for Disease Control and Prevention (CDC). The CDC lost 15 per cent of its budget, which amounts to $1.2 billion, while the Reserve Fund lost $35 million. The federal Public Health Emergency Preparedness programme lost a third of its budget between 2002 and 2019, now down to $617 million; this has meant a loss of trained workers who can manage a pandemic at the community level. These cuts come after a decade of austerity for public health services in the U.S. and the haemorrhaging of workers in the social services and public health sectors. The infrastructure that would deal with a pandemic had been sliced down to the bone, or indeed, even into the bone.
The cuts to the sections of the U.S. government that are meant to prepare for pandemics came alongside the attrition of U.S. health care in general. In 2019, 30 major U.S. hospitals filed for bankruptcy, with others barely alive as health care costs have soared and as government assistance has been reduced. The Polsinelli TrBK Health Care Services Distress Index shows the spike in bankruptcies over the past few years. Health care policy experts consider this process the “gentrification” of hospitals—meaning that hospitals and health care centres that used to serve the urban and rural poor have been “consolidated”, which means they have closed down, with care now turned over to mega-hospitals in wealthier areas that are hard to access (they are physically distant from the urban and rural poor, and they have higher barriers for medical insurance, with many of them not wanting to accept government assistance programmes).
With rising costs in the health care system and declining government support, there has been a consolidation of hospitals in the hands of a few private equity consortiums led by Bain Capital, KKR, and Joel Freedman. Their interest is money, not health care. The “efficiencies” that they have brought to U.S. health care have included cutting the surge capacity of hospitals: everything is managed for maximum usage, maximum beds used, maximum machines used; when an emergency breaks out, these hospitals are just not equipped with enough beds or staff to tackle the surge.
Beneath Trump’s cavalier attitude lies a much more dangerous reality: a health system that does not have the capacity to deal with a pandemic.
The Harvard Global Health Institute has compiled important data on the coronavirus and what it might do. If the trends from Italy are matched in the U.S., then there will be between 10 and 34 million hospital visits in the U.S. There are insufficient beds for people, particularly for the estimated 200,000 people—at a minimum—who would need to be in intensive care units; there are only about 45,000 intensive care beds in the U.S., which would be quickly overrun. The U.S. has 2.8 hospital beds per 1,000 people, which is far fewer than China (4.3 beds per 1,000) and South Korea (12.3 beds per 1,000). In Wuhan, the Chinese government built two hospitals in 10 days; there is no such activity at present in the U.S. Hope vests in the U.S. military saving the day.
People will struggle to pay bills
Trump has begun to throw money at the problem: $8.3 billion in the first instalment and then $50 billion. This is important, but the U.S. will not be able to hastily construct capacity; if hospitals can be built, that is one thing, but staff cannot be trained in such a short time. The austerity policy allowed private equity firms to make money on hospitals, but it was not able to retain trained workers who are most needed in the time of an emergency. Trump’s money will go towards buying equipment, but even here there are limitations as the global supply chain has seized up and production is not going to be restarted easily. But none of this money will go to the people who, without work, will struggle to pay their bills.
Last year, a Federal Reserve survey pointed out that 40 per cent of people in the U.S. do not have more than $400 in their bank accounts; this means that they might run out of money during the period of social isolation at home. Senator Mitt Romney suggested that the Trump administration send everyone a cheque for $1,000; this would go far towards allaying the potential bankruptcy and starvation of a considerable section of the population. The Trump administration has proposed giving every U.S. citizen $1,000 to tide over in this time of uncertainty; the proposal was not met with a favourable response, although as the enforced coronavirus unemployment increases, there will be political pressure for some kind of emergency payment.
First cities began to urge people not to gather in large numbers, and then States went into full-blown quarantine. Within a few days in mid March, the entire country waited for the storm to come. What happened in Italy was a cruel shock. No longer was it possible to think of the coronavirus as a “Chinese” episode, nor was it possible to simply blame China; this was, as the WHO put it, a global pandemic, and as the Chinese Foreign Ministry suggested, it was hard to know exactly where the pandemic began. Doubt and shock prevailed as people rushed to shops to buy supplies, including hand sanitisers and toilet paper (both of these ran out first).
Schools had to close, but this came at a cost; 70 per cent of New York City’s public-school students rely upon the meals served at school to help them stave off hunger, which meant that when the schools stopped, they would not get three meals a day. Shops closed, at another cost: despite a reasonable Bill passed by the U.S. legislature, most workers neither had paid sick leave nor were they being given paid coronavirus leave. Unlike Spain, the U.S. government did not quickly nationalise hospitals temporarily; unlike France and Italy, the U.S. did not halt mortgage and rent payments. The self-isolation comes at great personal cost to the U.S. working class.
Trump made a series of appearances after he had been in close proximity to people who had contracted the coronavirus, and each time he made comments that were not true. He said that anyone who wanted a test for COVID-19 could get one, which is not true; he said that the tests would be free, which is also not true. These slips, each one trying to show the government as humane, occasioned a lack of faith in the state and therefore great panic in society. One of the outcomes of this long-term austerity project in the West, which has included an ideology of belittling the state, has been that the institutions that are necessary to battle a pandemic are insufficient; it has also meant, in this period, that the achievements of the Chinese and South Korean states have been mocked as being somehow the work of an authoritarian government. There is simply no room to understand that in those societies, the state has not been whittled down and retains the capacity to act decisively in a time of crisis. This is not the case in the U.S. Trump’s buffoonery is not, therefore, an individual failing; it is a symptom of a country where the state has been emptied out.
Little wonder that people rushed to stores to buy what they could, including guns and ammunition. No effective government official informed the public about what was going on, what to expect and how the social isolation would be managed by the state. People were told to fend for themselves: wash your hands and hide in your homes. There was no credible preparation, no credible statements. As I write these lines, most people are under a lockdown that might last at least two weeks. Classes are being taught online, workers bite their nails as their jobs vanish and the elderly fear the flutter of the angel of death.