First, America lacks the tests to understand the scale, scope or severity of the outbreak. The incubation period is up to 14 days which means it has spread widely in America. News reports indicate that 35 states have infected residents. Beyond the spread of the disease, America still does not know its severity or its scope so that even if the testing starts this week, it will be months before enough people get tested to understand whether the outbreak has stabilized.
Second, most adult Americans have underlying health conditions that make them vulnerable to Covid-19. Many Americans are obese[i]. Many suffer from high blood pressure.[ii] A large percentage have some sort of cardiovascular disease.[iii] Beyond those conditions, we find that many Americans have diabetes or have a combination of all the above and more. We can see this medical vulnerability in the fact that 66% of adult Americans take some sort of prescription medicine for a chronic condition[iv]. The consequences are that nearly all adult Americans are at a higher risk of mortality from Covid-19 based on available evidence regarding mortality.[v]
Third, Americans have poor diets.[vi] Despite having some of the best farmland in the world and some of the most advanced agriculture, Americans eat a poor diet of highly processed food that is high in salt, saturated fats and a variety of chemical and pharmaceutical additives. Americans eat a lot of meat that is fed steroids[vii] and antibiotics.[viii] Although the steroids and antibiotics used in animal feed are not considered a threat to human health, only China and the United States use them to such a large degree.[ix]
Fourth, it appears that the American healthcare system, at a bureaucratic level, is not well designed for pandemics or epidemics. The early stages show that the CDC limited the testing and where testing was to be done it had to be approved by a doctor. The testing system meant that there was a bottleneck as people had to go to a doctor to get tested and the tests were not available. Even with the roll out of more tests, it will be weeks before enough people can be tested to know the outbreak’s scale, scope and severity. By that time, it will have spread farther and deeper into communities.
A related issue is how Americans use their healthcare system which really means how they use health insurance. Many people will not seek treatment for two main reasons. First, they fear that they cannot take time off for work as many do not have paid sick leave or fear that taking medical leave will put their job at risk.[x] If they must self-isolate, they will worry they may not have a job when they come back or that they cannot afford to go that long without paid work especially if they work in the “gig economy”. Americans who do get symptoms may not go for treatment for fear that they cannot afford it. People will have seen the stories that a private Covid-19 test cost $3000 so they will balk at the possible expense. Even if they have health insurance, they know that they will have to pay the “co-pay” and that may vary depending on the plan and the coverage.[xi] this will influence their premiums and eligibility. By contrast, people in other countries with national health care systems can seek treatment or have treatment come to them without fear of the costs so they are less likely to hide their illness or avoid being tested.
A final problem for Americans is the misinformation that is promoted within social media. Many Americans believe that it is no worse than regular flu. Others believe that a vaccine will soon arrive. For some, they believe that it is a disease that only affects the elderly and the infirm. What America needs are leaders who will face reality, describe that reality, and respond to that reality no matter the effect on their ego, their election chances, or the financial markets. Such leaders will provide a consistent and clear message from all levels of the government. They would also demonstrate and explain why the country needs to listen to and follow expert advice. Yet, those are two areas where Americans are least prepared. They have become habituated to the discordant messages from Washington DC and they have been encouraged to distrust experts.
America is reaping what it has sown.
The grim reality is that America is not ready for Covid-19. The scale of what is already present suggests that it will soon surpass Italy and Iran for the most cases and deaths. If we consider that the disease is already in 35 states before any meaningful testing has occurred, it is likely that once America starts to test it will find it has over 10,000 cases and 1000 deaths. I would not be surprised to see those numbers before the end of March.
America could have been ready for this outbreak, but it lacked the leader with the vision to act decisively. Instead, it had a leader and a government focused on appearances and symbolic acts. America does not need a better medical system; it needs better leaders who will put the public interest before their personal interests and put the common good before the financial good. If you survive Covid-19 you can vote to change who leads this country.
[vii] https://www.fda.gov/animal-veterinary/product-safety-information/steroid-hormone-implants-used-growth-food-producing-animals It is worth considering that many countries ban American foods for steroids and other additives. https://www.huffpost.com/entry/these-american-meat-produ_b_5153275?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAMZqtEFa6-FJPBJ_sxLM5l2RtzYDZ6EuC05namwa5kZCziLQb9ySGoMVSMAZAuf4WFk7KRsNf8YjGTCNV4J7TwnGw3QLvKrIOkp99HQYtq09KGoZG29Hf2L7tlM249r0MBLW8pFrduZL3iO85VFh34nbUNao4cxtOIXbJROt7vBA