A Medical Katrina

If there’s one voice we need to hear from on COVID-19, it is that of Mike Davis, the great writer about disasters and inequality. His take is bracing.

A year from now we may look back in admiration at China’s success in containing the pandemic but in horror at the USA’s failure.  (I’m making the heroic assumption that China’s declaration of rapidly declining transmission is more or less accurate.)  The inability of our institutions to keep Pandora’s Box closed, of course, is hardly a surprise.  Since 2000 we’ve repeatedly seen breakdowns in frontline healthcare. 

The 2018 flu season, for instance, overwhelmed hospitals across the country, exposing the shocking shortage of hospital beds after twenty years of profit-driven cutbacks of in-patient capacity (the industry’s version of just-in-time inventory management).   Private and charity hospital closures and nursing shortages, likewise enforced by market logic, have devastated health services in poorer communities and rural areas, transferring the burden to underfunded public hospitals and VA facilities.  ER conditions in such institutions are already unable to cope with seasonal infections, so how will they cope with an imminent overload of critical cases?

We are in the early stages of a medical Katrina. Despite years of warnings about avian flu and other pandemics, inventories of basic emergency equipment such as respirators aren’t sufficient to deal with the expected flood of critical cases.  Militant nurses unions in California and other states are making sure that we all understand the grave dangers created by inadequate stockpiles of essential protective supplies like N95 face masks.  Even more vulnerable because invisible are the hundreds of thousands of low-wage and overworked homecare workers and nursing home staff. 

The nursing home and assisted care industry which warehouses 2.5 million elderly Americans – most of them on Medicare – has long been a national scandal. According to the New York Times, an incredible 380,000nursing home patients die every year from facilities’ neglect of basic infection control procedures.   Many homes – particularly in Southern states – find it cheaper to pay fines for sanitary violations than to hire additional staff and provide them with proper training.  Now, as the Seattle example warns, dozens, perhaps hundreds more nursing homes will become corona virus hotspots and their minimum-wage employees will rationally choose to protect their own families by staying home.  In such a case the system could collapse and we shouldn’t expect the National Guard to empty bedpans.

The outbreak has instantly exposed the stark class divide in healthcare: those with good health plans who can also work or teach from home are comfortably isolated provided they follow prudent safeguards.  Public employees and other groups of unionized workers with decent coverage will have to make difficult choices between income and protection.  Meanwhile millions of low wage service workers, farm employees, uncovered contingent workers, the unemployed and the homeless will be thrown to the wolves.  Even if the Washington ultimately resolves the testing fiasco and provides adequate numbers of kits, the uninsured will still have to pay doctors or hospitals for administrating the tests.  Overall family medical bills will soar at the same time that millions of workers are losing their jobs and their employer-provided insurance.  Could there possibly be a stronger, more urgent case in favor of Medicare for All?

Davis also explores the potential devastating impact on the global South and notes, and he knows this better than anyone, how natural disasters routinely and brutally exacerbate inequality.