The United States' Pre-Existing Conditions

Updated: 2020-08-27 16:16:04
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Even now, all these months into our "new way of doing things," there is still so much we don't know about COVID-19. We're still adding to the long list of known symptoms and trying to figure out a testing protocol when so many of the people spreading the virus don't have any symptoms. And just this Monday, researchers in Hong Kong confirmed that someone was reinfected with the coronavirus, months after they first contracted it.

Leaving aside the science, we still don't know how the pandemic is going to affect our country long term. Airports are still mostly empty. Parents around the country weigh whether it's safe enough to send their children back to school. Joblessness is at the highest rates since the Great Depression. Millions of people are in danger of losing their homes. More than 175 thousand people in the U.S. have died from the virus.

So how is it that the richest nation in the world has been laid low by a virus only a few dozen nanometers in size?

To answer this question, we talked to Ed Yong, a science writer for the Atlantic who has spent the past seven months covering COVID-19. In his September cover story for the magazine, titled "How the Pandemic Defeated America," he says it's the inequities that have been with us for generations that made the U.S. so vulnerable to the virus. Below is an excerpt from our conversation, which has been edited and condensed for clarity.


In your piece, you wrote: "Water running along a pavement will readily seep into every crack. So, too, did the unchecked coronavirus seep into every fault line in the modern world." Walk us through some of the fault lines that you're talking about.

I mean everything from America's chronic under-funding of public health, which left it vulnerable when this virus started spreading through the country. I'm talking about it's understaffed nursing homes and its overstuffed prisons. I'm talking about its health care system, which receives a huge amount of money, but struggles with a lack of capacity to surge in a crisis. It struggles with access to health care, which uniquely in the world is predicated on this weird system of employer-tied insurance. And I'm talking about long-standing inequalities in race and other dimensions that have clearly been a problem for the health of Americans for decades and centuries, but that have manifested in horrible, tragic ways in this pandemic.

The overarching thesis of this piece is that SARS-CoV-2 is a new virus. But all the problems that have emerged during the pandemic are not new. They were predictable and preventable. They had been discussed beforehand, and just ignored and left to fester. And we are now paying the price for that.

You write that the virus spread most quickly in America's,"sick buildings": our prisons, our nursing homes. Tell us what you mean by sick buildings.

A lot of the indoor spaces have standards of ventilation that have been set more for engineering than for human health. And there are many scholars who have argued that we have moved away from practices like better ventilation—using open windows, encouraging fresh air and better circulation—that have left us more vulnerable to pathogens and pollutants which can build up in indoor spaces. It's obviously hard to say exactly to what extent this has contributed to the spread of the pandemic. But I don't think it is a coincidence that you're much more likely to contract the virus from an infected person in indoor spaces than outdoor spaces, that most of the outbreaks that we've seen have taken place indoors. But I think when we think about epidemics and the spread of disease, we think about the virus and the people. And we sort of forget that broader environment in which they exist.

So, prisons and nursing homes in particular are cauldrons of the sort of structural sickness.

Totally. That's not just to do with their architecture. It also has to do with how we think about people in those spaces: who we ignore, who we marginalize, and whose lives we truly care about. In prisons, there's this very densely packed population that is under-served in terms of its health, that was obviously going to be incredibly vulnerable when a fast-spreading virus like this hit the country. It should be no surprise that prisons became hot spots.

And the same could be said for nursing homes. The fact that nursing homes account for more than 40 percent of deaths from COVID-19 in America is truly shameful. I think it reflects our attitudes to the oldest among us— people who we should be giving respect and care to, but instead who we often neglect. And this isn't to say that like all nursing homes are bad, but it is to say that they are underfunded and understaffed, and that they were not the recipient of extra disproportionate support and attention when this pandemic started spreading. And they should have been. The people who work and live in those nursing homes and other long term care facilities paid the price for that neglect.

Black people have been more than twice as likely as white Americans to die of coronavirus. You argue that the reasons for that have everything to do with inequality, and with the massive rollback in public-health spending over the last four to five decades. Can you walk us through how that rollback of public-health spending happened, and why that's been so disastrous to Black communities around the country?

The problem with public health is that the better it does its job, the more people ignore it. Public health is about preventing people from getting sick in the first place, rather than treating people who show up at the hospital who are already sick. And it means that if you do that well—if you vaccinate your way out of infectious diseases, if you have better sanitation, if you have better nutrition in your neighborhoods—people just have good health. And we take that for granted. We forget what it was like to be roiling in infectious diseases all the time. So public health has been underfunded for decades now because of that principle: The better it does its job, the more it's neglected.

But I think it's also because Americans have this idea of health as being a matter of personal responsibility rather than a collective good. There's this very pernicious idea that if you are sick, it's because of the bad decisions that you've made, rather than all the other systemic factors that affect those choices in the first place. In this pandemic, we can see that people from poor communities who do these so-called essential jobs find it harder to protect themselves and their families. How do you socially isolate yourselves? How do you stay at home if you work a low-paid hourly wage job that doesn't give you any kind of paid sick leave? People from Black and Brown communities are disproportionately represented in those jobs. They are fielding risks for the sake of their lives and livelihoods that people from more privileged backgrounds don't have to deal with.

And because of the long-standing push of health care access away from Black neighborhoods, they already have worse access to insurance, to good care. All of these things mean that Black folks entered the pandemic with a poorer baseline of health. Again, a lot of people have tried to portray this as a matter of individual responsibility. Much has been said about how Black communities have higher rates of obesity and diabetes, which makes you predisposed to COVID-19. But why do they have higher rates of chronic disease in the first place? Could it possibly be because of, you know, decades of social disinvestment and poor access to health care? So I think if you just keep on digging down into the actual root causes of it, you see the effects of these long-standing health problems which are fundamentally to do with racism.

I imagine that some of the same things you're talking about—a sort of divestment from public health spending and generational negligence—is part of why we've seen the Navajo Nation devastated by COVID.

Yeah, absolutely. At the end of spring, the Navajo Nation had a higher rate of COVID-19 infection than any state. That, again, is a totally predictable result of decades and centuries of disinvestment. People were pushed out of their own lands and denied access to the water that is rightfully theirs. That means that a lot of Indigenous communities live without regular access to water, and don't have the option of, like, washing their hands regularly. Sometimes that water is contaminated by uranium mining that took place on their lands. Many of them live far away from hospitals in cramped, multi-generational homes through which the virus can more easily spread. You have, again, higher rates of chronic disease because of poorer access to health care and worse public health infrastructure. There are many cases throughout the country where these historical sins have once again jeopardized the lives of marginalized folks.

You mentioned that this has been a moment for people to really think about the deep inequities in our society that have been with us from the beginning of this country. And you write that tackling these problems requires radical introspection. I'm curious: What does radical introspection look like to you?

Throughout much of the year, people have asked themselves, how can we get back to normal? We want some semblance of our previous lives back. And I think radical introspection begins with understanding that "normal" wasn't so great for everyone. You know, that normal included a swath of inequalities, of long standing problems that we had come to tolerate. We had almost come to accept what should have been unacceptable. And I think we need to recognize all the ways in which "normal" failed: in the carceral state, the health care system, the legacy of racism and colonialism. If we can't even look all of those problems in the face, we're just going to be weak again the next time round.

That's hard. It takes a lot of work. It's like staring at the sun; you can't just look straight at it, but you kind of have to, because I think the pandemic has shown us that we don't have a choice. We should now be able to very clearly see what happens when we allow historical negligence to accumulate. If we are to move forward and be better prepared next time round, we really need to look at the past in a comprehensive and unflinching way.


To hear more, listen to this week's Code Switch episode wherever you get your podcasts, including NPR One, Apple Podcasts, Spotify, Pocket Casts, Stitcher, Google Podcasts and RSS.

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