Indefinite Lockout

In a sense, we are living in an indefinite lockout, facing an administration that sets a higher priority on destroying the US Postal Service than it does on organizing a crash program to produce the tests, safety equipment, and antivirals that will allow the United States to return to work.

Trump’s accomplices are monsters like Amazon, which in two weeks made Jeff Bezos $25 billion richer, and UnitedHealth Group, the world’s largest health insurance company, whose profits increased by $4.1 billion in the first three months of the pandemic. Medical insurers have experienced a windfall, since most of their enrollees are now unable to book operations or obtain vital treatments.

A volcanic rage is rapidly rising to the surface in this country and we need to harness it to defend and build unions, ensure Medicare for all, and knock the bastards off their gilded thrones.

How We Got Here

Last New Year’s Eve, while we were lifting our glasses, hugging our mates, and singing a few verses of a song written several centuries ago by a Scots revolutionary, Chinese doctors were notifying colleagues around the world that a rapidly increasing number of acute pneumonia cases, clustered around the city of Wuhan, was the result of infections caused by a previously unknown virus.

Within a week it had been gene-sequenced and unmasked as a “coronavirus.” Until 2003, research on this family of viruses had principally responded to the serious diseases they cause in a variety of animals, including livestock and poultry. Only two were known to infect humans, and since they produced only mild colds, researchers at the time considered them insignificant.

Then in 2003 a new viral epidemic started with a traveler in a Chinese airport hotel who passed his infection on to everyone with whom he had contact. Within twenty-four hours the virus had flown to five other countries. Severe Acute Respiratory Syndrome (SARS) killed one out of every ten victims.

The SARS pathogen was identified as another coronavirus, passed from bats to small lithe carnivores known as civets, long valued in southern Chinese cuisine. SARS reached thirty countries and caused a full-scale international panic. But it had an Achilles’ heel: it was only contagious at the stage when infected people displayed symptoms like dry coughing, fever, and muscle aches. Because it was so easily recognized, the SARS virus was finally contained.

A similar virus, a kind of mummy’s curse spread by tomb bats to camels, emerged in 2012 and has killed 1,000 people, mainly in the Arabian Peninsula. But it’s mostly spread by direct contact with camels and thus has not been considered a candidate for starting a pandemic.

The Stealth Virus

Researchers hoped that the current killer, a virus known as SARS-C0V-2 and sharing most of its genes with the original SARS, would likewise be simple to identify through correlation with patients’ symptoms. They were disastrously mistaken.

After four months of circulation in the human world, we now know that the virus, unlike its predecessors, flies on the same wings as influenza: spread easily by people without visible signs of illness. The current pathogen has turned out to be a “stealth virus” on a scale far exceeding influenzas and perhaps unprecedented in the annals of microbiology. The Navy has tested almost the entire crew of the stricken aircraft carrier Theodore Roosevelt and discovered that 60 percent of those infected never displayed visible symptoms.

A large universe of undetected cases might be considered good news if infections produced durable immunity, but that doesn’t seem to be the case. The dozens of antibody-detecting blood tests that are now in use, all uncertified by the FDA, are producing confusing and contradictory results, making the idea of a back-to-work antibody ID card impossible at the moment.

But most recent research (which can be reviewed at the National Institutes of Health pandemic website, LitCovid) suggests that conferred immunity is very limited and coronavirus could become as entrenched as influenza. Barring dramatic mutations, second and third infections will likely be less dangerous to survivors, but there is as of yet no evidence that they will be any less dangerous to uninfected people in high-risk groups. So COVID-19 will be the monster in our attic for a long time.

They Knew This Was Coming

But the disease is not an eruption of the totally unknown, a biological asteroid. Although its transmissibility was unexpected in a coronavirus, the pandemic otherwise corresponds closely to the scenario long described for an avian flu outbreak.

For nearly a generation the World Health Organization (WHO) and all major governments have been planning how to detect and respond to such a pandemic. There has always been a very clear international understanding of the need for early detection, large stockpiles of emergency medical supplies, and surge capacity in ICU beds. Most important has the been the agreement of WHO members to coordinate their response along guidelines they all had voted to accept. Early containment was crucial: comprehensive testing, contact tracing, and the isolation of suspected cases. Large-scale quarantines, sealing off cities, shutting large sectors of the economy — these should be only last-ditch measures, made unnecessary by extensive planning.

Along these lines, after the arrival of avian flu in 2005 the US government published an ambitious “National Strategy for Pandemic Influenza” based on the finding that all levels of the American public health system were totally unprepared for a large-scale outbreak. After the swine flu scare in 2009, the strategy was updated, and, in 2017, a week before Trump’s inauguration, outgoing Obama officials and incoming Trump administrators jointly carried out a large-scale simulation that tested the response of federal agencies and hospitals to a pandemic arising in three different scenarios: swine flu, Ebola, and Zika virus.

In the simulation the system, of course, failed to prevent the outbreaks or, for that matter, flatten the curves in time. Part of the problem was detection and coordination. Another was inadequate stockpiles and supply chains with obvious bottlenecks, such as depending on a few overseas factories to produce vital protective equipment. And behind all this lay the failure to aggressively take advantage of revolutionary advances in biological design over the last decade in order to stockpile an arsenal of new antivirals and vaccines.

In other words, the United States was not ready, and the government knew it was not ready.

Dominoes of Disaster

By the end of January 2020 three things had happened. First, the WHO quickly distributed hundreds of thousands of test kits designed by German scientists but otherwise was pushed to the sidelines while each nation bolted its doors and ignored previous commitments to mutual aid.

Second, three East Asian nations with well-prepared medical arsenals and single-payer health systems — South Korea, Singapore, and Taiwan — successfully contained outbreaks with minimal mortality and moderate periods of social isolation. After early disasters that allowed the virus to escape on air flights and forced the lockdown of Wuhan, China mobilized on an unprecedented scale and quickly extinguished all COVID-19 hotspots outside Wuhan.

Third, our Centers for Disease Control and Prevention (CDC) decided to create its own diagnostic kit rather than use the one distributed by the WHO. The CDC’s production lines were contaminated with viruses, however, and the test kits were useless. The entire month of February, when it was still possible to prevent the exponential increase of infection through testing and contact tracing, was squandered.

This was the first disaster. The second was in March, when severe and critical cases began to crowd hospitals. As institutions began to run out of respirators, N-95 masks, and ventilators, they turned to their states and then to the federal government’s National Strategic Stockpile, which had been designed specifically for use during an outbreak like COVID-19.

But the cupboard was almost bare. It had been largely depleted during the national panic over swine flu in 2009 and several subsequent emergencies. The Trump administration had been repeatedly warned of its statutory duty to restock it, but had other priorities such as slashing the budget of the CDC and killing the Affordable Care Act.

As a result, millions of American workers have been going into battle in hospitals, nursing homes, public transit, and Amazon warehouses without essential protection that costs only pennies to manufacture. Nothing is as emblematic of the Trump administration’s total dereliction of duty than the fact that on the same day that the president was bragging of the United States’ “unmatched scientific and technological superiority,” the New York Times was devoting a page to “How to Sew a Mask at Home.”