A coronavirus is so tiny that 1,000 of them could be stacked in the thickness of a sheet of paper. It is an invisible threat, and it is making vivid the shortcomings of our health care systems.

The world is a “a playground” for viruses like the novel coronavirus that causes Covid-19, infectious disease experts wrote last week in the New England Journal of Medicine. “We must realize that in our crowded world of 7.8 billion people, a combination of altered human behaviors, environmental changes, and inadequate global public health mechanisms now easily turn obscure animal viruses into existential human threats.”  

There is still a chance that the outbreak, which has now spread to six continents, will stall out. China’s willingness to impose draconian, unprecedented quarantines has bought everyone time.

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But the outbreak should be a wake-up call — one ignored with the less widespread outbreak of SARS in 2003 and the not-so-deadly flu pandemic of 2009 — about infectious threats that we face together and that exploit vulnerabilities associated with income inequality, health disparities, and our slowness to recognize threats.

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We don’t ignore all threats. We tend to overreact to problems that are facing us right now but underreact to long-term threats that build slowly. We’re willing to take heroic measures to treat a heart attack, but slower to prevent heart attacks from happening. So, too, we’ve been derelict in spending the money needed to prepare for pandemics. We panic, but we don’t prepare. Take the current run on face masks. They won’t protect you from your neighbor’s coronavirus, but a shortage of masks to protect health care professionals who need to treat sick people means we could all suffer.

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The Trump administration’s mistakes have been symptomatic of this larger problem. Officials eliminated  White House-level positions aimed at preventing pandemics two years ago, and sought to scale back work to deal with disease outbreaks elsewhere from 49 countries to 10. The administration bungled the roll-out of diagnostic tests. And the Centers for Disease Control and Prevention and the Food and Drug Administration were too slow to adopt a suggestion made by former FDA Commissioner Scott Gottlieb: loop in major academic medical centers so more tests can be run. Only now is testing capacity for coronavirus starting to ramp up.

There is still a chance that cases that have been missed can be identified and controlled with measures like isolation or quarantine. Yet even if that can be done, the question is what happens next when the novel coronavirus comes into widespread contact with our health care system.

To contain the virus, people will need to call health care providers as soon as they develop any flu-like symptoms. But will they do so if it means losing money? Not only do 26 million Americans lack health insurance, but nearly half of those with private insurance — another 60 million people — have high-deductible plans in which they can be on the hook for thousands of dollars. Already, the Miami Herald has reported on a man who was charged $3,270 for getting checked out at a hospital, and the New York Times profiled a man who is facing nearly $4,000 in bills after he and his daughter were quarantined following their return from China.

Later on in the epidemic, when we have a better sense for the prevalence and severity of the disease, it may be better for patients with Covid-19 to stay home and use telemedicine services to see the doctor. But telemedicine, though on the rise, is still hamstrung by state licensing rules and the fact that all insurers don’t pay for it the same way.

When patients arrive at a hospital or doctor’s office, they may face shortages of nurses and physicians, particularly in rural areas. There are concerns about whether there are enough ventilators in the country to care for all the people who could get pneumonia in a worst-case scenario.

Bill Gates, the Microsoft billionaire and co-chair of The Bill & Melinda Gates Foundation, fretted in an editorial in the New England Journal of Medicine that this might be “a once-in-a-century pandemic.” Gates, who has been warning of the dangers of disease outbreaks for decades, prescribed a set of steps to help deal with the current outbreak, including his own donation of as much as $100 million to help efforts in lower- and middle-income countries.

To prevent future pandemics, Gates called for a data surveillance system that would instantly give relevant organizations the information they need about potential outbreaks. The U.S. has seemed to move in the opposite direction: The largest maker of electronic medical records in the U.S., Epic Systems, has been pushing back against rules aimed at allowing different record systems to communicate with each other. 

Gates also argued that the government should spend billions of dollars to build manufacturing plants for vaccines that would normally provide routine vaccinations (drug companies now handle this, for profit) but could be refitted during a pandemic.

The idea seems like folly in part because of the scope of the idea. Billions of dollars? The Trump administration’s entire funding request for this emergency is only $2.5 billion, although members of Congress have complained it is too low.

But it’s worth considering one area where Gates’ dreams don’t fall short: the development of drugs and therapeutics. His idea of a plug-and-play vaccine that can immediately be deployed against any new pathogen is, well, far out. But new treatments and vaccines are being tested at a speed that would have until now been unfathomable. Early studies of the first vaccine candidate by Moderna Therapeutics are already beginning. An antiviral drug that was already invented by Gilead is being tested. Regeneron Pharmaceuticals and Vir Biotechnology are working on antibody drugs.

“Our savior here is going to be our technology,” Gottlieb, the former FDA commissioner, said on CBS’s “Face The Nation.” “And we need to make a really robust effort to try to develop a therapeutic.”

Given the low success rate for new drugs, it is possible that all these approaches could hit roadblocks or fail outright. But they exist because the development of drugs can be lucrative and Wall Street is willing to give biotech companies millions of dollars to try out new science. 

The facile argument here is that this justifies the high prices of new medicines. That’s not necessarily true. But it’s true that this is a role that has been played better by industry than government in part because government is too cheap, too penny wise, and pound foolish to take the risk.

So take this lesson instead: If we were willing to see investments in health care infrastructure as a defense against terrifying new pathogens, those investments might very well pay off. They’d make the next pandemic a lot less scary, and benefit us in non-pandemic years, too.

  • Enough BS it’s time for medical for all. One central data base. Eliminate the duplications a associated costs of endless insurance plans and providers.
    It starts with education and we need to invest a significant amount in our schools starting with a wage for teachers that represents their importance in the community.
    I’m a small “c” conservative having had a good education and can think for myself and not get wrapped up in the political BS

    • I worked in health care for 45+ years. Seen many versions of health care “reform”. Watched employers cut health care coverage as premiums rise. When we retired we continued our health care coverage from our employers. Lucky to have that option. However, it cost us $15,000 a year. How many families can afford that for two people…? Fortunately we could but it was hand to mouth until we cleared the mortgage and got eligible for Medicare.

      One conclusion: The biggest mistake that our country has made in our health care system was to privatize it. You put money, capitalism, and greed in the formula you are guaranteed to have fraud, over utilization of services, increasing costs. Basically, do you want that bypass or not….

      The right rants about how ‘the government’ can’t run health care efficiently.
      That mantra is a MYTH as the government currently does not administer Medicare. It is contracted out to major insurance companies like United Health Care, Blue Cross Blue Shield, Travelers, etc. The government’s role is regulation. They decide what is covered and what is not. The criteria for exceptions based on medical necessity. They establish best practices for management of a given diagnosis. Pay for only cost efficient treatment.
      For example, cataract surgery. They have standards for how severe a cataract must be before they qualify for reimbursement. Otherwise, there would be /was a lot of cataract surgery performed by doctors at the first sign of a cataract. After all cataract surgery is their bread and butter. Mine are a nuisance for night driving but otherwise fully functional. I do not yet qualify and I am far from visually impaired.

      Medicare does not pay for cataract laser surgery. Simply, it is more expensive and provides no better clinical outcomes that typical surgery. The word “Laser” sounds good to the consumer. High Tech. It must be better. Well, it isn’t better. Why Medicare doesn’t pay for it.

      Since the rules are the same for all the different insurance companies the patient care provided is consistent in all 50 states. It is a well respected health care insurance program for the over 65s. It should be available for every American.

      Medicare spends a great deal time and effort to identify, curb, prosecute, and recover monies from entities and individual practitioners that commit fraud. Yes there is millions of dollars of fraud per year. A consequence of a privatized, capitalistic system. My only complaint is they spend their efforts to recover money. Admirable, but FEW executives, physicians, administrators who direct the fraud are sent to jail. Fewer still for any length of time.
      I believe if people went to jail routinely, there would be a lot of people working in these companies thinking they aren’t being paid enough to participate in fraud. There would be a lot more whistle blowers covering their backsides… But prosecution is expensive to gather the information to result in a conviction. Still, that costs should be incurred by federal law enforcement.

      No private insurance company does that. Go ahead and call your insurance company and ask for the phone number of the fraud department. If they have one ask how many people work in their department. That is simply the cost of doing business and they pass those costs on to you and me in premiums.

  • First things first, the chances that you or one of your loved ones becomes infected is very small. The covid-19 (Coronavirus) disease is NOT a pre-existing condition of any current policy. https://bit.ly/2vVx6Lt In the unlikely event of you or any of your dependents covered by your policy requires hospitalization the cost will be met by your plan.

  • Tuesday, The Admin announced they have done wonders for Americans in negotiating a Great Deal with our Insurance Carriers.. Testing will be free. (It already was free) and all private insurance companies, Medicare, Medicaid will cover treatment for the virus. “America is covered.” (There is no treatment for the virus. Complications from the virus such as pneumonia, cardiac conditions, etc. were already covered) Not a word was spoken about treatment costs for the people without any insurance. So Not ALL of America is covered. “For the second year in a row, the number of uninsured increased. In 2018, 27.9 million nonelderly individuals”

    The only new news was that the insurance companies will waive the co pays for treatment. That was the only real news.

    CNBC Goldman Sach executive stated that “not only has the public lost confidence in the Administration. Major Fund managers have as well’.

    It is not political. Just a fact that the Democrats will repeat over and over that is political.

  • Didn’t the federal government asked/appropriate over 8 billion dollars? Is Obamacare not working if so many people are not covered, and there are such high deductables??

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