Welcome back to The Long Version, a newsletter by Jonathan Myerson Katz.
For most Americans, for most of our lives, the United States has been a comfortable place to live. There are glaring exceptions, and if you are one, then know that I am not talking about you. But it is safe to say that American national life and policy have long been based on the assumption that the worst possible thing that can happen is for a generation to grow up slightly less rich and healthy than its parents.
That sunny outlook, built on a bed of endless consumption and constant expansion, lends itself to meta-narratives and an addiction to entertainment. It is the best explanation I can come up with for why, today, the 24th day of the third month of the Year of Our Lord 2020, some people are actually entertaining Donald Trump’s argument that—after little over a week of meager and belated efforts—it might be time to end attempts at mitigation and “go back to work.”
That is murderous, naïve insanity. I hate to be the bearer of bad news, but everything we here in North America have gone through so far—the sitting at home, the anxiety, the toilet paper memes—is just preparation. For us, the disaster has not happened yet.
Wait for it
I’ve covered and survived a lot of disasters—earthquakes, hurricanes, and multiple epidemics among them. I’ve learned from experts that disasters are not momentary events, as it sometimes seem, but series of stages. The Federal Emergency Management Agency describes them in a cycle like this—the idea being that all communities are in at least one of the stages at any given time:
“Preparedness” is the stage where Trump screwed us all of us for the last three years— dissolving the National Security Council’s pandemic response unit and eroding staffs and budgets at the CDC and National Institutes of Health. (Only congressional action, mostly by Democrats, kept Trump’s slashing of our health safeguards from being even worse.)
Steps to “reduce vulnerability to future disasters”—such as implementing a national healthcare plan such as Medicare for All, which over the long term would improve monitoring and allowing everyone to get medical attention without fear of bankruptcy—belongs in “Recovery” or “Mitigation.”
Right now, we are at the point in the cycle where the arrow hits “Response.” That is the event—what most of us mean when we say “the disaster”:
The debate we’re having right now is like arguing about whether people should leave their homes and run around in the streets, just as the hurricane is coming onshore.
Italy tried a similar move about a month ago. In February, with a small number of cases but a worrying trend line, some Italian authorities slowly ramped up measures aimed at social distancing: stopping professional soccer matches, canceling the last two days of the Carnival of Venice, and so on.
Many Italians, perhaps displaying their own imperial outlook, resisted the attempts. On February 27, Nicola Zingaretti, leader of the ruling center-left Partito Democratico, went to Milan, at the center of the country’s outbreak, to performatively enjoy an aperitivo with a group of students. He shared the moment on Instagram with the caption: “We can’t stop Milan and Italy. Our economy is stronger than fear.”
As Zingaretti sipped his drink, there were 650 confirmed cases of COVID-19 in Italy and 17 deaths. There are now 69,176 confirmed cases. (Zingaretti is one of them.) The official Italian death toll now stands at 6,820, and is rising by hundreds of new deaths per day. It is already more than twice the death toll in China, where the first wave’s spread was kept to Hubei Province—whose population is roughly the same as Italy’s, or to put it in American terms, a little less than California and Texas combined.
Too late, Italy has now been forced into a nationwide lockdown—in hopes of saving some, but too late for too many. Hospitals do not have enough respirators to go around. Doctors are being forced into the agonizing position of deciding who lives and who dies.
“Older patients are not being resuscitated and die alone,” doctors at a regional hospital in Bergamo, in northern Lombardy, warned three days ago in the New England Journal of Medicine. Nurses cannot administer palliative care to ease these people’s suffering in their last moments of life. Relatives have to wait for days by their phones to find out whether their loved ones have died.
Trump’s surgeon general told Fox News last week that the United States was following Italy’s pattern of COVID-19 spread, roughly two weeks behind its schedule. That now looks too optimistic:
If those trends hold—and there is little reason to think they won’t—the U.S. chapter of the COVID-19 epidemic will be worse than any other in the world. Sheri Fink reported nearly two weeks ago that the U.S. Centers for Disease Control and Prevention estimates that, without assertive measures, 160 million to 214 million people in the United States could be infected. A team of epidemiologists at Imperial College London has estimated that as many as 2.2 million Americans could die.
To that number in perspective, that toll would be more than the military casualties of every U.S. war in history, and the 1918 influenza epidemic combined.
No one knows what that will be like. Few in this country have seen anything like it before. I survived the deadliest earthquake ever recorded in the Western Hemisphere, in which an estimated 100,000 to 316,000 people died—almost one in ten people in and around Haiti’s capital, Port-au-Prince. It scarred all of us for life. Yet that event was constrained to one small part of one small country. These COVID-19 estimates describe an unimaginable catastrophe across one of the biggest countries in the world in the next few weeks.
Anyone who tells you we will simply shrug off even a fraction as many deaths as a “sacrifice,” as Texas lieutenant governor Dan Patrick and Glenn Beck have said, has no idea what they’re talking about, is a sociopath, or both. Anyone who thinks that coercing millions of people to hasten their own and their loved ones’ deaths will do anything but further destroy the economy is either stupid or has a plan to get rich on the side.
The estimates above are worst-case scenarios. But avoiding them requires continued immediate action. Unfortunately, just today, Trump promised to “have the country opened up and just rarin’ to go by Easter”—April 12, just nineteen days from now. That is a very short time in confronting a disease that can take fourteen days to incubate. If Trump’s followers take him seriously, the worst-case scenarios become more likely:
Even if we limit ourselves to home isolation of suspect cases and some social distancing—perhaps broadly what ABC News political editor Matthew Dowd referred to in a brief Twitter conversation this morning as a “targeted approach”—the Imperial College authors warn that would still leave us with hundreds of thousands of deaths and a medical system too overwhelmed to do much else.
Only active suppression—“isolating people with symptoms, reducing everyone’s social contact by 75 percent, quarantining households and closing schools and universities for five months,” as the FT summarized—might keep the outbreak to levels that U.S. hospitals can cope.
Better luck next time
It is a crime that any of this is necessary. If the CDC and National Security Council had been kept intact in the preparation stage—if they had reacted quickly scaling up testing and contact-tracing from what should have been the first moments of the response, back in early January—maybe all of this would be limited to one or two cities, or even neighborhoods.
With competent leadership, more people could have been persuaded to start self-isolating sooner. Paid leave could already be in place, already encouraging millions to shelter at home. Respirators and protective equipment for doctors, nurses, and other essential responders (including, it seems, supermarket cashiers and delivery people) might be ready.
Trump’s failed efforts to cover up the scale of the epidemic in the United States is why a complete economic shutdown was necessary in the first place. His impatience will only make it worse.
Anyone worried about the long-term stability of the economy, institutions, and the country itself should be entirely focused on keeping the number of deaths as low as possible, the president’s wishes be damned. Even if suppression measures work—if they keep hospitals functional while buying time for researchers to produce a vaccine or cure—is impossible to say how a society this large will respond to months of isolation on a national scale. We can have a long, productive conversation about it after the disaster. But we have to get there first.
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Jonathan Myerson Katz is a journalist and the author of The Big Truck That Went By: How the World Came to Save Haiti and Left Behind a Disaster. His next book, Gangsters of Capitalism, will trace the origins and contradictions of America’s empire. Follow him on Twitter @KatzOnEarth.
Photo: Alessandra Tarantino/AP
Correction 5/14/20: Due to an editing error this post incorrectly said that the upper-bound Imperial College estimate would be double the total number of US war deaths and American flu deaths in 1918. It would be more than both combined, not exactly double.