How America Bungled the Pandemic
The sun rises over "In America: Remember," an art installation of white flags at the National Mall memorializing hundreds of thousands of Americans who have died as a result of the COVID-19 pandemic, in Washington, D.C. on September 30, 2021. (Photo by Matthew Rodier/Sipa USA)(Sipa via AP Images)
Why did the world’s richest nation, with some of the most advanced health care, respond so poorly to COVID-19?
By every objective measure, the U.S. mounted one of the world’s worst responses to the COVID-19 pandemic. Its 1.1 million deaths left it with a mortality rate that exceeded all other advanced industrial nations except the United Kingdom. Official explanations for this catastrophe are in as short supply as ventilators, masks, and hospital gowns were during the pandemic’s first wave. Neither Congress nor the White House has appointed an independent commission to document what went wrong. Federal and state public health officials have offered few recommendations on how the nation could be better prepared for the next pandemic when it strikes, as it certainly will in this crowded and warming world. Even the usually hyperactive network of think tanks and academicians engaged in public health have been relatively silent about the need for changes in U.S. policy to correct the gaps in pandemic preparedness revealed by COVID-19.
Why did a country with the most expensive health care system in the world, an enviable scientific capacity, and a deep bench of public health expertise perform so miserably when confronted by this unique and dangerous pathogen? The short answer, according to a new book by the award-winning journalists Joe Nocera and Bethany McLean, is that it was inevitable given the decades-long trends in every sector of society that must be mobilized to successfully combat a new threat to public health.
Their review of the actions of elected leaders, the government’s health-related bureaucracies, corporate America, health care institutions, and a substantial fraction of the general public claims that each responded in a self-interested manner. A collective response, which requires a commitment by individuals, corporations, and institutions to preserve life (as necessary in combating a public health threat as it is in wartime), never took hold in the U.S. A few countries succeeded in mobilizing their societies around a joint response. Ours did not, in spectacular fashion.
In The Big Fail, the authors provide a comprehensive catalog of the institutional and leadership failures that led to America’s bungled response. Each failure they document reflected organizational and individual behaviors that had been decades in the making. “A central tenet of this book is that we could not have done better, and pretending differently is a dangerous fiction, one that prevents us from taking a much-needed look in the mirror,” the authors write.
hey begin by documenting the missteps of Donald Trump’s administration and the president’s antiscientific pronouncements. Trump’s early embrace of unproven and dangerous cures was contagious. In the midst of his reelection campaign, he shoved Health and Human Services Secretary Alex Azar to the sidelines. His replacement as head of the government task force, Vice President Mike Pence, promptly took to the pages of The Wall Street Journal to confidently predict that there would be no second wave—which broke with ferocity just after the election.
The Big Fail: What the Pandemic Revealed About Who America Protects and Who It Leaves Behind, by Joe Nocera and Bethany McLean
The authors only briefly mention the prior decade’s defunding of the nation’s pandemic preparedness infrastructure. But those cuts, demanded by the Republican-run Congress in its dealings with Barack Obama’s administration, contributed to the chaos at the outset of the pandemic. Corporations that supplied personal protective equipment had been outsourcing their manufacturing capacity, largely to China, for decades. Their hospital customers helped drive the trend by demanding ever lower prices for PPE in the name of maximizing their own profits. The result? The government’s stockpile—hoarded by the Trump administration—was inadequate. And supply closets were thinly stocked everywhere. The field was ripe for profiteering and fraud when demand exploded at the outset of the pandemic.
Nocera and McLean provide an important history of the growth of antivaccine sentiment over the previous two decades. When the vaccine finally arrived—a joint government–private sector endeavor that receives generous praise in the book—once-niche antivaxxer sentiment grew to one in seven Americans, one reason why nearly a third of the population remains less than fully vaccinated. The country that helped invent the mRNA vaccine failed to take full advantage of its medical benefits. (Two scientists from the University of Pennsylvania just won this year’s Nobel Prize in Medicine for their work on the vaccine.)
Private equity’s incursion into the health care industry comes in for repeated criticism in the book. More than a fifth of all deaths took place among residents and staff in nursing homes, which private equity firms had purchased in large numbers early in the 2000s but largely abandoned after extracting short-term profits. Those Medicaid-dependent institutions have never been properly funded by Congress, nor have regulators adopted standards for operators that might have protected patients. “Once the pandemic arrived, it was too late,” Nocera and McLean write.
The hospital industry’s inadequate response to COVID was similarly skewed by inadequate funding—for some hospitals, not all. People who are poor or low-income are more likely to suffer from one or more chronic medical conditions and therefore were the ones most vulnerable to serious consequences when stricken with COVID. They were more likely to wind up in one of the nation’s safety net hospitals, which get most of their funding from Medicare and Medicaid, which pay less than private insurance. Hospitals in well-off neighborhoods, meanwhile, took care of fewer COVID patients, yet they received a disproportionate share of hospital emergency funds, which were distributed based on pre-COVID revenue. As a result, hospitals with the least resources bore the brunt of the fight against the disease.
The authors aim their fire for this sorry situation at privately owned chains like HCA Healthcare; at private equity’s incursion into the hospital sector (still a very small share of hospitals); and at the outsized salaries of top hospital officials. It’s important to note that major nonprofit chains, often religiously affiliated, benefited just as much during COVID from the government’s failure to channel most of its emergency aid to frontline institutions.