The final two sections of the article written by Ed Yong of the Atlantic Magazine titled "Pandemic Year Two" sum up many of the concerns about the continuing problems we will have even as the vaccination campaign proceeds in the United States. In my opinion, the inequalities in our social fabric served as the fuel to convert this virus into a public health disaster. We are not a cohesive nation, and the divisions have grown much, much worse with the current president (who will be leaving office soon, but drew far too many votes despite his abject failures).
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V. The Widened Gaps
after world war ii, women who entered the workforce in Western Europe mostly stayed there to help rebuild their battered nations. To support them, governments provided better child care, longer school hours, and extended maternity leaves. But the U.S., which was less severely affected, did the opposite, encouraging women to relinquish their wartime jobs to returning men and resume their supposed place at home. “That set the stage for the inequalities we have today,” said Jess Calarco, a sociologist at Indiana University, “where women disproportionately do the work a welfare state should be doing.”
When COVID-19 closed schools and child-care centers, American women shouldered the extra burdens of household work, parenting, and remote learning. Without governmental support for affordable child care, many of these burdens became untenable. “In interviews I’ve done, women felt like they were failing as mothers, workers, and teachers,” Calarco said. “Many had to choose between sending their kids to school and maybe getting them sick, or keeping them at home and dropping out of the workforce.” Many women in heterosexual couples picked the latter. In September alone, four times as many women left the workforce as men—865,000 in total. “That will have lifelong effects,” said Loyce Pace, of the Global Health Council. “You can barely have a baby in this country and have a job again, and that’s not even a two- or three-month leave.”
The closure of schools has widened inequalities among children too. “For a lot of people, school is a place where they get food and safety,” said Seema Mohapatra, who studies health equity at Indiana University. Many students with disabilities have struggled without individual attention from trained professionals. Children in 4.4 million households, especially in Black, Latino, and Indigenous communities, lack access to personal computers. Overseeing remote learning is hard enough for parents with flexible, well-paying jobs; those who work hourly, low-wage jobs have been put in an even harder position. These disparities will have generational consequences, because early inequalities can “set kids up for a lifetime of success or catching up,” Mohapatra said.
For some families, educational struggles are compounded by grief. Black, Latino, and Indigenous people are roughly three times more likely to be killed by COVID-19 than white people. People in these communities die not only at higher rates, but at younger ages: While just 10 percent of white Americans who have died of COVID-19 were younger than 65, 28 percent of Black Americans and 45 percent of Indigenous Americans were. The pandemic has wiped out the past 14 years of progress in narrowing the life-expectancy gap between Black and white people. That gap was 3.6 years; it is now more than five.
These inequities stem from centuries of racist policies that segregated people of color into neglected neighborhoods, deprived them of medical care, and concentrated them in low-paying jobs that have made social distancing impossible. And because Black, Latino, and Indigenous people have been more likely to lose their jobs, homes, and access to health care during the pandemic, they will be even more vulnerable to the inevitable epidemics of the future.
Biden has appointed Marcella Nunez-Smith of Yale to lead a federal task force focused on racial inequities during the pandemic. “There’s a strong commitment to equity, and there’s not a single conversation that doesn’t involve talking about how we reduce disparities,” Luciana Borio, who is part of that group and who was formerly on the National Security Council, told me. “That was never a consideration” for the outgoing administration. But Pace, who is Black, worries that the broader societal will to recognize and reduce health inequities will fade as the U.S. begins edging back toward normalcy. “People are accustomed to us dying,” she said. “It’s always been acceptable for us to not do well, to be locked up, to die. It’s a habit, and habits are hard to break.”
VI. The Lessons Learned
in the coming years, the full toll of the pandemic will become clearer, as researchers calculate more accurate estimates of how many lives were affected and lost. A blizzard of investigations by independent commissions will assess how governments and agencies fared against the virus. (Some have already begun.) Helpfully, the coronavirus pandemic has been documented extensively, providing an unparalleled trove of real-time accounts.
But many tragedies are still hidden. Some of the most overworked people, including health-care workers and caregivers, have had little time to record their experiences. Many long-haulers have suffered in silence, lacking the energy to share their stories. Many patients have died in hospital beds, alone. The need for medical privacy has meant that most people have never learned what the virus can truly do to a body. And from America’s gaping political fissure, warring versions of reality have emerged. With conspiracy theories now mainstream, “we can’t analyze disasters anymore without [asking if] we can even achieve a shared description of the events that are happening,” Knowles, the disaster historian, told me. How does a country learn from its mistakes if it cannot even agree on whether it made any?
COVID-19 will neither be the last pandemic nor the worst. Its lessons will dictate how well the U.S. prepares for the next one—and the country should start with its understanding of what preparedness actually means. In 2019, the Global Health Security Index used 85 indicators to assess how ready every country was for a pandemic. The U.S. had the highest score of all 195 nations, a verdict that seems laughable just one year later. Indeed, six months into this pandemic, the index’s scores had almost no correlation with countries’ actual death rates. If anything, it seems to have indexed hubris more than preparedness.
The idea that “America and the West are more advanced than Eastern and African countries is not true, but is seeded in the way global health operates,” said Abraar Karan of Brigham and Women’s Hospital and Harvard Medical School. “But when the tires hit the ground, the car didn’t start.” In retrospect, many Western health experts were too focused on capacities, such as equipment and resources, and not enough on capabilities, “which is how you apply those in times of crisis,” said Sylvie Briand of the World Health Organization. Many rich nations had little experience in deploying their enormous capacities, because “most of them never had outbreaks,” she added. By contrast, East Asian and sub-Saharan countries that regularly stare down epidemics had both an understanding that they weren’t untouchable and a cultural muscle memory of what to do.
Vietnam, the first country to contain SARS in 2003, “immediately understood that a few cases without an emergency-level response will be thousands of cases in a short period,” said Lincoln, the San Francisco State medical anthropologist, who has worked in Vietnam extensively. “Their public-health response was just impeccable and relentless, and the public supports health agencies.” At the time of my writing, Vietnam had recorded just 1,451 cases of COVID-19 all year, fewer than each of the 32 hardest-hit U.S. prisons.
Rwanda also took the pandemic seriously from the start. It instituted a strict lockdown after its first case, in March; mandated masks a month later; offered tests frequently and freely; and provided food and space to people who had to quarantine. Though ranked 117th in preparedness, and with only 1 percent of America’s per capita GDP, Rwanda has recorded just 8,021 cases of COVID-19 and 75 deaths in total. For comparison, the disease has killed more Americans, on average, every hour of December.
Crucially, while U.S. health care is skewed toward treating sick people in hospitals, Rwandan health care is skewed toward preventing sickness in communities. The U.S. devotes just 5 percent of its gargantuan health budget to primary care; Rwanda spends 38 percent. The U.S. was forced to hire and train thousands of contact tracers; Rwanda already had plenty of community health workers who knew their neighbors and had their trust. “Community health workers know where the most vulnerable people are and what they need,” said Sheila Davis, the chief executive of the nonprofit Partners in Health. A living safety net, these workers can intervene early if people need food, medications, or prenatal care. “We [in the U.S.] wait for someone to completely crash and burn before we provide those things,” Davis said. “We are too focused on high-tech and expensive health care. We’re set up to fail in a pandemic like this.”
After the post-9/11 anthrax attacks in 2001, fears of bioterrorism encroached on American attitudes toward naturally emerging diseases. Preparedness was framed with the rhetoric of national security. Health experts developed surveillance systems for disease, simulated epidemics in war games, and focused on fighting outbreaks in other countries. “This came at the expense of investment in public health, equity, and housing—boringly crucial sectors that actually support human wellness,” Lincoln said. “One cannot prevent a pandemic by preparing for a war, but that is exactly what the U.S. has been doing.”
To truly prepare itself against the next pandemic, the U.S. has to reimagine what preparedness looks like. Every epidemic is different, as new pathogens with unique characteristics emerge from different regions. But those pathogens eventually test the same health systems and expose the same historical inequities. Think of epidemics as a million rivers that must all flow through the same lake. The U.S. has been trying to dam the rivers. It has to focus on the lake.
It must reverse the decades-long underfunding of public health. It should invest in policies such as paid sick leave, affordable child care, and reparations that would narrow the old inequities that make some Americans more susceptible than others to new diseases. “Epidemics are always social phenomena with historical roots,” said Mary Bassett, who studies health equity at Harvard. “Viewing them purely as a matter of an individual confronting a virus leaves out all the things that affect that person’s vulnerability. I worry that as vaccines come online, that part of the equation will be forgotten.”
There is a likely future in which America’s immune system learns lessons from COVID-19 but its collective consciousness does not. Indeed, the U.S. has a long history of plastering over social problems with technological fixes. It and other wealthy countries have already monopolized global vaccine supplies, and, despite having the worst outbreaks, are likely to reach the pandemic’s endgame first. They might deduce that magic bullets won the day, forgetting the costs of idly waiting for those solutions and leaving vulnerable people to die.
In The Past Is a Foreign Country, the historian David Lowenthal wrote, “The art of forgetting is a high and delicate enterprise … It can be a process of social catharsis and healing or one that sanitises and eschews the past.” The choice between those options is now before us, as the coronavirus pandemic enters its second full year. As Americans get vaccinated, they must decide whether to remember the people who sacrificed to keep stores open and hospitals afloat, the president who lied to them throughout 2020 and consigned them to disaster, the families still grieving, the long-haulers still suffering, the weaknesses of the old normal, and the costs of reaching the new one. They must decide whether to resist the decay of memory and the elision of history—whether to forget, or to join the many who will never be able to.
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