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.
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.
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.
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Thanks for the great article and thought ful research
The total absolute failure of the US health care system (read: chaos) will be in the spotlight as the world deals with Covid-19. Lots of ineffective jobs and power-squabbling will cost many lives. This despicable scenario needs a huge overhaul, from top to bottom, but mostly at the top. Sincere appreciation for the front-line, directly exposed health care workers. They too deserve better.
Washington state just recently diagnosed 27 cases, of which 9 have already died (Snohomish and King counties, one a teenager). An airport in northern Washington sent staff with flu symptoms home – without testing for the coronavirus. The state is short test kits. The whole US is short, delinquent. And yet everyone still flies or boats in and out. Despicable, how the big USA can not deal with an outbreak. Watch this go totally off the rails, killing thousands. Incompetent health ministers, governments and organizations basically cause second degree murder. And they call this a “wealthy, top-of-the-world powerhouse country”? Hahahahahaha. So DIY : Do-It-Yourself : avoid crowds and travel, and do all possible to boost your immune system.
There is some indication that a depleted immune system is better than a hyped up immune system. For example pregnant women seem to survive.
The CDC is FUBAR but were hobbled by an FDA decision made by the Obama Administration.
We may be too centralized.
Washington State certainly should have responded faster. My experience is that the state Departments of Health are incompetent.
That is what happens when the main function of government is to create jobs. It can do that but that does not mean those in the jobs do anything.
The people on the West Coast think they are superior. It does not look like it.
Matthew. I would be interested to see who has a better healthcare system? Where do you think the vaccine will be coming from? The WHO sounded the alarm on 1/20/2020 and the US took action on 1/31/2020. Trust me, if I had the virus, I would rather be taken care off in the US rather than any other country. This was an outbreak that the Chinese kept as a secret as long as possible.
Michael, if you believe the US has the best healthcare in the world, please do some research. We’re not even in the top 25 of most lists for any given year.
” who has a better healthcare system?”
We have the best health care system in the world. My doctor is the best in town
Simply wishful thinking.
Depending on how you measure health care OUTCOMES for a given illness. Cost efficiency. Overall health parameters of the population. Life expectancy, infant mortality, etc. etc. The US is lagging in many categories.
There are HUGE disparities in health care if you look at different demographics, uninsured, Medicaid, Private Insurance, Under Insured, and Medicare. Money in our system drives practice.
Its doesn’t matter. Our health insurance generally stops at the border so few have a choice to go elsewhere and pay full cost out of pocket.
Many people assume their insurance will cover them on vacation in Cancun. It doesn’t.
Why we buy trip insurance that covers Medical and will fly air ambulance back to the USA if you can’t travel commercially.
The response has thus far been bungled but our market dominated health system will severely limit our ability to respond appropriately to this epidemic. Out of pocket costs impede and delay people from getting evaluated, diagnosed and treated. The uninsured will have the most limited access to care. The undocumented fear deportation if they show up at clinics or hospitals. The solution is single-payer, Expanded and Improved Medicare for All. A not- for- profit, national health program will be free at the point of service, no medical billing (savings many billions) and will be funded through progressive taxation. We must end deportations and provide Americans with guaranteed paid sick leave, just like every other wealthy, and many not so wealthy countries.
The debate over these common sense solutions will in large part be decided tomorrow by the Super Tuesday primary results. Too bad we didn’t do this before this pandemic struck.
I don’t think you’ve thought through the ramifications of free health care for illegals and just letting all the illegals in with no deportation. We would quickly cripple the economy, much as Sweden has gone through, and is now rolling back from. We need to make legal immigration easier, and get immigrants working and paying taxes for your other goals to be sustainable.
As they say never let a good crisis go to waste. So why not make some political hay out of this crisis? I truly dislike people who do this.
This is an emergency and testing and treatment should be free. Pandemics are not a routine event. In general, people should pay for their own healthcare and government should stay out of the insurance business.
But in an emergency it is not about a transaction between a willing seller and a willing buyer. It becomes a matter of the commons. So you do what is necessary for the commons and everyone benefits.
Heard on the news of people being charged $3,000 to be tested for the coronavirus . Also reported that the under insured, uninsured, homeless, illegals, etc. would not be able to access diagnosis due to cost.
That would certainly distort reporting data with unreported cases and provide a large population to be an incubator for passing on the virus.
So I looked it up to verify. Quips from various articles below shed some light on these issues.
” but felt he had a responsibility to get tested amid fears of a coronavirus outbreak in the U.S. Azcue tested positive for the flu and went home with a bill for $3,270, which cost him $1,400 after insurance.”
“New York Gov. Andrew Cuomo (D) announced Monday evening that he would direct state health insurers to waive fees related to coronavirus testing in the state amid fears of an outbreak in the U.S.”
Presumably that would include ER charges, Office visits, the virus test, etc. Depends what “related” means. Means the insurance company has to pay the charges or the provider has to absorb the charges. Can a hospital or doctor refuse to test if they aren’t getting paid?
“Testing for COVID-19 (the disease caused by coronavirus) is free, according to a new report.
But Americans could be stuck paying for other medical-related costs for suspected coronavirus treatment, like a $1,000 hospital stay.
FAIR Health provided Business Insider with average costs for ER and urgent care visits, as well as flu and blood tests.
How much you can expect to pay depends on your insurance plan, if you have one.”
The virus test is for tracking the outbreak. It is a national public health emergency. There should be no cost to any person to be tested if they are not treated medically. The test is to assist the public health officials to contain the outbreak.
Since this is an emergency there is no reason why anyone needs to be charged for testing or treatment.
The cost of not dealing with this will be a lot more than the cost of dealing with it so another $50B of National Debt will not make any difference.
One does not need to change things to deal with an emergency. I dislike the use of misery to advance political agendae. It slows down any response. It takes time to change things but it does not take time to respond to an emergency. You just do it.
Because seniors who contact covid 2019 are at increased risk of serious illness necessitating critical care in hospital, an increased effort to prevent their exposure would be a wise move. Our senior centers are still bringing that susceptible population together 5 days a week for congregational dining. Several hundred seniors get together for lunch in our area some of whom have contact with school aged grandchildren who are likely to be exposed and not show symptoms (thank goodness.) Our healthcare system during an outbreak would have a vastly reduced burden (need fewer beds) if valuable programs like this were suspended and a substitute lunch at a service window or home delivered was provided. Fewer ill seniors is good for the senior as well as for society as a whole. I’m a senior who has stopped going for lunch.
Silly to propose closing senior centers, schools, events, etc. etc. at this time.
Your fear factor is way out of reality. Educate yourself about your real risk and how to minimize it.
CDC says to go on about your lives. Right now the odds of contracting the virus is like winning the lottery in reverse. Extremely remote.
Population of the US is 331,002,650 .
One chronovirus death out of every 160,000,000 so far.
300 cases in the US make the odds 1 in a million. We are near that. Yet.
In the last 10 years (2009-2018), the U.S. has averaged only 27 lightning strike fatalities; Your risk of dying from chronovirus is less that getting stuck by lighting.
Now, things could change for the worse. or the better. But is it FEAR that is causing more harm than the disease.
DaisyGirl – you have a very valid point, chosing to avoid contamination in close quarters. Very much like school closures. And the opposite of the cruise ship lock-down disaster.
Dale – it is CORONAVIRUS. Correct notion however that (Covid-19) seems to be only 2.5% fatal = same as other / common flu diseases.
China with its cover-up of the spread of a new virus has wasted precious time and is endangering many people that are older or have challenged immune systems – globally. China is not a poor country, it ought to be billed for the cost of global spread, and it should (be forced to) keep its students / people from traveling to other countries. Dangerous wanton tampering that jeopardizes the rest of the worl deserves hard and long-term consequences.
Dale please note the advice from CDC this morning. “The goal of social distancing is to limit exposure by reducing face-to-face contact and preventing spread among people in community settings.” Increasing social distancing in a senior population will decrease transmission is this vulnerable group.
Your targeted use of the words and “silly”, “fear”, “educate” and once again “fear” in all caps show that you are not listening to the message just targeting the messenger in an attempt to devalue the message.
Communal dining continues in our area. Transmission of the virus to the senior population has been reduced by increasing exposure during lunchtime dining (300 people at communal tables a day) by lengthening the time in which lunch is served as well as reducing the number of chairs at each table to increase social distancing. The lunchtime meal also allows correct information about the virus risk to be conveyed to the senior public.
There are solutions and those solutions will evolve as needed.
There is no benefit in being political about this unless the authors have an agenda which they clearly do.
There has probably never been an emergency for which any nation has been fully prepared. I spent a year working on Y2K plans and Emergency Action Plans are ALWAYS a lousy assignment for someone and generally useless.
It is not human nature to prepare. That needs to change. Being political is not useful. I do agree with the criticisms however.
We will not be able to rely on rich people to come to the rescue as our society wants to eliminate rich people. But they can act quickly.
For those who survive it will be a learning experience that they will probably remember for five years.
Preparedness is a matter of degree, planning, and funding. Oh, and denial.
In the hospital every year we drill a community wide Disaster Plan. Simulates a plain crash, terrorist attack, etc. with hundreds of casualties. The joke is they named it right because the drill is usually a Disaster pointing out how we should improve our preparedness, communications, coordination, and contingency planning.
I am not aware of a community disaster drill scenario involving a pandemic. Maybe we should. The plan would not be the least bit similar.
This new virus shows the failures of our current For Profit healthcare system. Technology is not going to save us, until there are clear ethical guidelines and profiteering is outlawed. It is becoming very clear that this virus has already killed people in the US, but that fact based data was not collected and likely suppressed.
Even a viral pandemic was no reason to stop marketing, peddle snake oil, and mislead the general public. There used to be laws about physician marketing, and peddling medical misinformation, because people could die. These laws are no longer enforced.
Clever people at this site, never wrote about misleading death statistics, and how various industries are free to profit from fear and death. They also did not inform the public about the evisceration of our federal agencies, that were supposed to protect us.
A physician marketing her practice as an Influncer, openly recommended an herbal remedy for Corona Virus, even though her recommendation could lead to death, or confusion.
Only Bernie Sanders can save us from the horror of the For Profit System. The pharma marketers on this site would not want this kind of information, discussed here.
https://theintercept.com/2020/03/02/coronavirus-vaccine-price-gouging-senate/
Oh yea, it’s not like a communist country started this pandemic. We really need to elect a communist to make us safe. Bernie Sanders has no idea how to make any of his plans even remotely feasible, and, even if elected, he would fortunately fail to destroy our economy as he intends. His tax plans would force half the country into bankruptcy. There really isn’t an endless amount of money out there like you far leftists seem to think.
“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.”
“But we are totally prepared to manage this.” – Donald Trump
Forgot to add “badly”.
CNN: There are about 100,000 respiratory ventilators in the country. Approximately two thirds of them are in use at any time. Should 40,000 chronovirus patients need respirators, who decides? Your rural hospital with 50 beds might have two. Then what? Send that third patient to where? How do they know where. Phone calls? Will they admit chronovirus patients at all? They have a bulding full of sick people. Vulnerable people.
I have heard nothing about contingency planning at the federal level. I’m sure it is happening. Each hospital is assessing their strengths and weakness.
Who’s in charge of the Big Picture? A guy with no experience or training in health care.
Nah, it’s obvious Fauci is the one really in charge. I trust him.
And excellent scope of article, with legitimate depth in every facet.
All of these points need to be addressed before the next pandemic.