It's a Social Problem

Ed Yong wrote this excellent analysis of why the US seems to be particularly bad in dealing with COVID-19. Initially, people thought it all due to Trump’s actions and inactions, but as subsequent events have shown:

“The weaknesses were in the rootstock, not high up in the trees.”

Around March-April, Biden had declared “victory”. As case counts fell:

“Abbott Laboratories, which makes a rapid COVID-19 test, discarded inventory, canceled contracts, and laid off workers.”

The Americans had seen what the highly infectious Delta variant did in India. And yet they were totally unprepared when it landed in the US:

“Models failed to predict Delta’s early arrival. The variant then ripped through the U.S.’s half-vaccinated populace.”

Leading to the question:

“Delta was an audition for the next pandemic, and one that America flubbed. How can a country hope to stay 10 steps ahead of tomorrow’s viruses when it can’t stay one step ahead of today’s?”

 

At the heart of it, the problem seems to be an attitudinal one, as Alexandra Phelan put it:

“We’re so focused on these high-tech solutions because they appear to be what a high-income country would do.”

New tech mRNA vaccines. As Yong says:

“The promise of biomedical panaceas is deeply ingrained in the U.S. psyche.”

But as far back as 1849, Rudolf Virchow had pointed out that “epidemics were tied to poverty, overcrowding, squalor, and hazardous working conditions”. Or to put it under a generalized heading: social conditions matter a lot. And in a country as unequal as the US, “(hi-tech) magic bullets lose their power”:

“Diseases exploit society’s cracks, and so “medicine is a social science,” Virchow famously said.”

An elaboration of the social aspect of diseases:

“Low-income and minority groups would be more exposed to airborne viruses because they’re more likely to live in crowded housing, use public transportation, and hold low-wage jobs that don’t allow them to work from home or take time off when sick.”

 

Ironically, throughout the West, the discovery of germs as agents of disease led to “an extraordinarily powerful vision of the pathogen as an entity that could be vanquished”. Overnight, diseases became a technical problem. Nothing wrong with that, except that it led to the belief that one could ignore the “pesky details of the social world” in the fight against diseases and epidemics. It’s easy to understand why this happened:

“Ignoring them (social side causes) was noble; it made medicine and science more apolitical and objective. Ignoring them was also easier; instead of staring into the abyss of society’s intractable ills, physicians could simply stare at a bug under a microscope and devise ways of killing it.”

 

But of course, the technical-only approach, which works great when dealing with individuals, doesn’t scale up to society wide diseases:

“This worldview accelerated a growing rift between the fields of medicine (which cares for sick individuals) and public health (which prevents sickness in communities).”

Even worse, it led to perverse incentives:

“It also tied them to a profit-driven system that saw the preventive work of public health as a financial threat. “Some suggested that if prevention could eliminate all disease, there would be no need for medicine in the future,” Brandt and Gardner wrote.”

 

In America in particular, there’s the added social problem of the attitude towards vaccines:

“(Vaccines don’t help) if people can’t or won’t get vaccinated, and especially if they equate faster development (of vaccines) with nefarious corner-cutting, as many Americans did this year.”

In super-polarized America, 26 states have passed laws that “curtail the possibility of quarantines and mask mandates”.

 

All of which explains why the US, despite developing new vaccines with new technology at break-neck speed, plateaued in its vaccination rates so fast, leaving huge chunks of concentrated populations unvaccinated, and let Delta have a field day when it landed.