Disasters Like The Coronavirus Don’t Happen In a Vacuum
The pandemic is the result of many bad choices.
It’s tempting to think of catastrophes as existing in their own special bubbles, ellipses separated from our normal, real lives. They resonate with the feeling of unreality that comes when what seemed solid and indisputable a week ago—bridges, the earth beneath your feet, open schools, and full shelves in the supermarket—is shaken or destroyed overnight.
But thinking about disasters as special cases obscures the ways broader policies have contributed to these crises. It may be comforting to think that, at some point, this uncomfortable and intense interlude will end and everything will go back to the way it was. But disasters do not occur in a vacuum, and to properly prepare for them—and deal with the aftermath—requires tackling the ways they are rooted in societies.
Disaster exceptionalism—this idea that crises are extra-ordinary and demand extra-ordinary answers and laws—is already being applied to the accelerating outbreak of COVID-19 in the United States. In his Oval Office speech on Wednesday night, Trump said of the pandemic, “This is just a temporary moment of time,” and continued to frame the virus as both foreign and likely to disappear on its own.
Other Republican politicians have also been singling out the crisis as an unusual moment in health policy. The Huffington Post, in a story about members of the GOP who “seem open to reimbursing hospitals for treating the uninsured,” quotes Republican Rep. Mike Johnson as saying, “I think a pandemic is a distinct issue from the overall health care proposals that have been on the table for a while.” The pandemic, however, isn’t a magical change from the noncrisis health care situation in the United States but a continuation of it. It’s dangerous—and, consciously or otherwise, deceptive—to claim that disasters are special “moments in time,” completely separate from our day-to-day lives.
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Imagine, for example, that the U.S. government had taken immediate action to address the “distinct issue” of the pandemic and made all treatment related to COVID-19 free. As welcome as that move would have been, the crisis would still be tied to its context. It would take time for information about the shift in policy to filter through the population. Even once people knew about it, those like me, who have been burned in the past by health insurance duplicity, might still be cautious: Would they be charged if they took the test and it came back negative? Would all the extras that U.S. hospitals delight in throwing into bills be taken care of?
Hospitals would need time to work out new procedures and processes for intake to deal with the unusual case of something that won’t be billed for. The damage of inaccessible medical care—untreated or undertreated chronic diseases—would still make large segments of the population more susceptible to the effects of the virus, as would poverty, substandard housing, and poor nutrition. According to a report from the Commonwealth Fund, the United States has the highest chronic disease burden, among the highest number of hospitalizations from preventable causes, and the highest rate of avoidable deaths when compared to its peer nations in the Organization for Economic Co-operation and Development. Even if we could imagine a perfect response from the instant a crisis hits, an underlying substandard health care system and high percentage of people made vulnerable by poverty would still worsen outcomes.
None of this is meant to suggest that we shouldn’t be pushing for the best response we can manage right now. Rather, we should be holding our governments accountable for the choices they made before the disaster as well as during it. Disasters may feel like alternate universes—consider the eerie photos of empty highways, airports, and subway cars—but they are deeply rooted in their context. “Catastrophes do not occur in historical vacuums,” writes Steve Kroll-Smith in his book Recovering Inequality, on the 1906 San Francisco earthquake and 2005’s Hurricane Katrina. “Rather they take shape and form in part through the social, political, and economic forces in play at the moment of impact.”
In the practice of disaster risk-reduction, experts distinguish the disaster (the damage, deaths, injuries, chaos) from the hazard (hurricane, earthquake, drought, highly contagious virus). An earthquake that occurs in a place with well-constructed buildings (or no buildings at all) may be only an incident, while the same earthquake in a place with poor construction triggers a catastrophe. Compare, for example, the 2010 earthquakes in Haiti and Chile. Although the Chilean tremor was far stronger, it caused around 500 deaths, while the numbers in Haiti were more than 300,000. As Hurricane Katrina showed us in 2005, early-warning communications, the accessibility of public transport, the quality of drainage, and the robustness of the electrical grid, among other factors, can be the difference between an annoying weather pattern and people dying.
The same is true for epidemics and pandemics. Even if the government is creating new task forces and unleashing special response teams, they are limited by existing infrastructure, physical and human. If hospitals are lacking in medical technology and bed space before the epidemic, it’s going to be that much harder to ramp up. Doctors and nurses can only be trained so fast. The impacts of the disease will depend on the baseline health profile of the population; dissemination of critical information will depend on existing communications networks, and adoption of that information will depend on education and social norms. This is playing out now in real time: Low media literacy and a history of deliberate misinformation campaigns are hampering crisis communications.
Changing mindsets also takes time. Disaster protocol may state that bureaucratic strictures should be loosened, but if people have worked for their entire careers with certain attitudes, it’s not going to be easy to adjust. My research on the Fukushima Dai-ichi crisis found that despite manuals emphasizing that those closest to the disaster should be in charge, those farther away—and higher up the hierarchy—consistently attempted to take over, sometimes successfully. Initial approaches to the disaster are likely to reflect noncrisis tendencies: If a government is increasingly using digital surveillance, for example, that will be one of the first tools its bureaucrats think of when it comes to managing the epidemic. If a health care system is profit-driven, it’s going to take decisionmakers some extra effort—or extra outcry from users—to realize that may not be practical during a pandemic.
Once the effort to downplay COVID-19 is absolutely irredeemable, you are likely to hear the government playing it up instead. If past disasters are any indication, the epidemic will be described as “unprecedented” and “unimaginable”—in other words, exceptional—despite the historical record of previous epidemics and the existence of an entire field of study based on them. Emphasizing the cataclysmic nature of the hazard is most obviously an excuse for shortfalls in the response but also another way to untether it from its causes in long-term policy. Disasters, and their responses, provide a powerful lens for critiquing the societies in which they occur. We should not let the focus on the hazard, which we can do nothing about, distract us from the underlying conditions that turned it into a disaster. Those, at least, we can change before the next crisis hits.