We Weren’t Ready: Why the U.S. is Especially Vulnerable to COVID-19

By Chiara Rosenbaum

During this shelter in place, I’ve been consuming news articles as if they were a bag full of spicy chips I can’t put down. While I’m trying to keep up with the unprecedented events that unfold each day, the volume of opinions and facts exceeds the time available to process the information. It seems almost impossible to arrive at any meaning when policies and infection rates change by the hour; and perhaps there is no clear-cut lesson to be learned. Regardless, this article attempts to delineate how seemingly inherent disparities, such as safe housing, food security, and economic stability, have been exacerbated by our nation’s disregard for public health, ultimately allowing COVID-19 to devastate the United States.

Public health is dedicated to improving quality of life for communities and individuals through organized efforts of prevention, education, and preparedness. It is a system that is dedicated to preventing illness and committed to tracking outbreaks. Before the COVID-19 pandemic, only 3 cents of every dollar spent in the United States went to public health. 1 And according to a 2019 report from the non-profit organization Trust for America’s Health, health care spending increased by 52 percent in the past decade, while the budget of local health departments shrank by 24 percent. 1 As a result, the number of epidemiologists, laboratory technicians, and public information specialists has been vastly reduced – with 23 percent of their total workforce eliminated over the past ten years. 2 This reduction has left our country scrambling in the wake of the pandemic, with not enough personnel to properly respond to and track the spreading virus.

The Trump administration further undermined public health efforts when they disbanded the White House pandemic response team in 2018. Although Trump denied responsibility for the dissolution of this seemingly crucial committee, his administration’s policies and repeated requests to cut the CDC’s budget speak louder than his baseless remarks alleging our country’s preparedness. 3 It’s apparent that Trump will disparage anyone to avoid admitting to his errors, including the World Health Organization.

Given that our president cares more about his reputation than about leading the country through a global crisis, his efforts inevitably fall short of promoting an effective public health system. It’s no wonder the United States is severely lacking in proper test kits and testing centers. These testing efforts have been stunted by the dearth of local health officials, who would, in theory, be able to coordinate the development and distribution of tests in endemic areas. And while contact tracing, which traces and monitors individuals who may have come in contact with an infected individual, has helped many Asian countries curb the spread of COVID-19, much of the United States is unable to implement such measures. With limited digital tools and an inadequate number of staffed agents, our country’s longstanding budget cuts have detrimentally constrained our ability to test, track, and prevent clusters of infection. 4

Massachusetts just recently invested $44 million into a contact tracing program, which entails hiring and training 1,000 public health workers. 5 And while these new jobs are welcomed (when the unemployment rate is at an all-time high), these positions should have already existed.

Our country’s response to the virus may not have been so delayed or ineffective if we had invested in substantial public health infrastructure and valued the work of public health officials. Our weak public health system has proven unstable under the weight of a destructive virus, and it is undeniable that the government enabled its decline. By neglecting to bolster public health initiatives, the Trump administration’s oversights are manifesting in overwhelmed hospital systems and directly contributing to the growing death toll. If we are to learn anything from these missteps, it is that public health should be apolitical.

Some are claiming that the pandemic has been an equalizer and that this crisis is a democratizing experience. But what is becoming increasingly clear is that our country can only be as strong as its most vulnerable citizens; and COVID’s uncontrollable spread through the United States is in large part due to our country’s neglect of vulnerable populations.

Structural inequalities are on full display as individuals with poor career mobility work frontline jobs with inadequate personal protective equipment. Social inequity is hindering the health of many Americans as dense neighborhoods are unable to practice social distancing and access to affordable health care is a distant dream. The spread of COVID-19 has shined an unrelenting light on how socioeconomic status, race, immigration, and housing are determinant of one’s health.

The connection between structural vulnerability and health is more visible than ever, as incarcerated individuals are one of the largest threats to the spread of COVID. 6 The overcrowded conditions in prisons are a pathogen’s ideal breeding ground; and since medical services are often understaffed and infrequently offered, inmates are especially susceptible to falling ill. There are larger socioeconomic and political forces fueling mass incarceration in the United States, and it is these upstream systems that are putting the health of individuals at risk. The structural arrangement of prisons, as well as immigration facilities, leave its occupants considerably vulnerable to negative health outcomes. While many activists have dedicated their life’s work to improving these inhumane conditions, the rest of the nation seems to only take notice when the effects of such inequalities directly threaten their well-being.

The virus doesn’t discriminate – it will infect anyone it can sink its spikes into. And yet, the limited data on race and socioeconomic status in infected individuals demonstrates a disproportionate amount of cases amongst racial minorities. In New York, the virus has extensively plagued neighborhoods with lower median incomes, many of which are Hispanic and Black. 7 And states like Louisiana and Michigan, whose black populations make up less than one third of the entire state, are recording that the majority of COVID-related deaths have occurred among black persons. Yes, comorbidities like hypertension, diabetes, and heart disease increase one’s susceptibility to the virus; but many of the communities where black people reside “are in poor areas characterized by high housing density, high crime rates, and poor access to healthy foods. Low socioeconomic status alone is a risk factor for total mortality independent of any other risk factors.” 8 And with emerging data linking COVID-19 death rates with long-term pollution exposure, it is a cruel irony that the Trump administration would roll back additional regulations on air pollutants. 9 This correlation cannot be a coincidence when black people are 75 percent more likely to live near industrial facilities than the average American. 10

This disregard for public health is the government’s way of promoting social structures that hinder the health of millions of Americans. They are weakening our democracy by preventing any amelioration of the deep-rooted disparities that undermine our country’s health. And in the face of a deadly virus, these indelible inequalities have proven harmful to not only individuals, but also to our nation as a whole.

If we are to heal from this pandemic, we are going to need more than a vaccine. It’s going to take a robust public health system to combat the structural and social disparities that negatively impact so many Americans. And in order for this to occur, public health cannot be dictated by capricious politicians with alternative agendas; it has proven integral enough to be immune from partisan sway.

I hope we come out of this crisis as a stronger, healthier nation. But until we address longstanding inequalities and reform the systems that perpetuate discrepancies in wealth and opportunity, we will be just as vulnerable to the next pandemic.

References:
1. McKillop, Matt. Trust for America’s Health. Trust for America’s Health,
www.tfah.org/wp-content/uploads/2020/03/TFAH_2019_PublicHealthFunding_07.pdf.
2. Interlandi, Jeneen. “The U.S. Approach to Public Health: Neglect, Panic, Repeat.” New York Times, 6 Apr. 2020, www.nytimes.com/2020/04/09/opinion/coronavirus-public-
health-system-us.html?action=click&module=Opinion&pgtype=Homepage.
3. Lopez, German. “The Trump Administration’s Botched Coronavirus Response,
Explained.” Vox, 2 Apr. 2020, www.vox.com/policy-and-
politics/2020/3/14/21177509/coronavirus-trump-covid-19-pandemic-response.
4. Simmons-Duffin, Selena. “How Contact Tracing Works And How It Can Help Reopen The Country.” NPR, 2020, www.npr.org/sections/health-
shots/2020/04/14/833726999/how-contact-tracing-can-help-fight-coronavirus.
5. Barry, Ellen. “An Army of Coronavirus Tracers Take Shape in Massachusetts.” New York Times, 16 Apr. 2020, www.nytimes.com/2020/04/16/us/coronavirus-massachusetts- contact-tracing.html.
6. “Workbook: NYS-COVID19-Tracker.” New York State Department of Health,
covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-
19Tracker-Fatalities?%3Aembed=yes&%3Atoolbar=no&%3Atabs=n.
7. Akiyama, Matthew J., et al. “Flattening the Curve for Incarcerated Populations — Covid- 19 in Jails and Prisons.” New England Journal of Medicine, 2020, doi:10.1056/nejmp2005687.
8. Yancy CW. COVID-19 and African Americans. JAMA. Published online April 15,
2020. doi:10.1001/jama.2020.6548
9. Friedman, Lisa. “New Research Links Air Pollution to Higher Coronavirus Death Rates.” New York Times, 7 Apr. 2020, www.nytimes.com/2020/04/07/climate/air-pollution-coronavirus-covid.html.
10. Gunn-Wright, Rhiana. “Think This Pandemic Is Bad? We Have Another Crisis Coming.” New York Times, 15 Apr. 2020, www.nytimes.com/2020/04/15/opinion/sunday/climate-change-covid-economy.html.

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