Things Fall Apart

Stay-at-Home orders are now expiring in many US states. In some places where orders remain in force, compliance is weakening. The US has not used the time in lockdown to establish effective testing and contact tracing plans. The vulnerable populations in nursing homes, factories, and prisons remain unprotected. These lapses will cause more COVID-19 deaths than would have occurred if the time had been used well. But if we aren’t using the lockdown to prepare an offensive against COVID-19, then continuing it is pointless. 

So if the lockdown is ending, where are we? The US is in a threefold crisis. 

  1. Population health is declining. Despite being wealthier than any nation in history and despite spending 1 in every 5 dollars on health care, US life expectancy at birth was lower in 2019 than it was in 2014. And that is before the pandemic hit. To the morbidity and mortality that rose in this decade, COIVD-19 adds more than 2000 excess deaths per day, and this may persist for months.
  2. Economic production and employment are collapsing. We are seeing job loss and the destruction of financial and human capital reminiscent of the Great Depression. The steepness of these declines is unprecedented, and we haven’t hit bottom yet. As poverty and despair grow, these calamities will further undermine population health. Release from lockdown will have economic benefits. But it is difficult to see how the economy can recover until the pandemic is extinguished.
  3. American political institutions are failing. One of the virtues of democracy — a government of the people — is that a democracy can mobilize the population in a crisis. But despite being the world leader in biomedical science, the US has failed to mount a coherent response to the pandemic. If Clinton were president, she would have tried to implement public health measures appropriate to the crisis. That is what previous American presidents from both parties did when facing epidemics. Yet it is not clear that Clinton would have succeeded. Fighting a pandemic requires social solidarity. US citizens are highly polarized, scientists are not trusted, and conflict entrepreneurs would have exploited our fear and suffering. Many Americans would have resisted lockdown, testing, contract tracing, selective quarantine, and — when we have them — vaccinations. 

American is hemorrhaging life, wealth, and social cohesion. Now we face what will be a vicious election in the context of a pandemic and depression. Things will fall apart faster.

This is where I am supposed to reveal what we need to do to solve the problem. But I don’t have a solution. Even if I did, I’d present it another time. Right now, it is essential to see that the United States is broken. 


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