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National guard troops put together sandwiches for coronavirus-affected residents in New Rochelle, New York. (Photo: John Moore/Getty Images)

National guard troops put together sandwiches for coronavirus-affected residents in New Rochelle, New York. (Photo: John Moore/Getty Images)

Coronavirus Is Exploiting an Underlying Condition: Our Epidemic of Insecurity

As hosts to the pathogen, we Americans are uniquely susceptible because of lack of health coverage, precarious jobs and skewed economics.

Abdul El-Sayed

 by The Guardian

As the global Covid-19 pandemic bears down on cities and towns across the country and the world, municipal and state leaders are scrambling to mitigate the spread and “flatten the curve”. To be sure, these social distancing interventions, including closing schools, eliminating mass gatherings – even shuttering small businesses – are necessary right now. Yet policymakers have been reticent to fully enact them because of the sweeping economic and social consequences they’ll have for so many in our society.

Our lack of healthcare access means that we are less likely to seek healthcare, more likely to unknowingly spread coronavirus.

Yet the very position in which we find ourselves – caught between slowing the outbreak to save lives and slow-walking our interventions to save livelihoods – suggests a deeper truth about our society right now. Indeed, Covid-19 isn’t the only epidemic we are suffering. The other is slower and more difficult to identify, though it has laid the groundwork for the coronavirus. It is an epidemic of insecurity.

As an epidemiologist, considering the spread of a disease, I know to consider not just the pathogen that causes a specific disease – the novel coronavirus pathogen that caused the Covid-19 syndrome, for example – but also characteristics of the host and the environment that make the spread possible.

This is where insecurity comes in. Because of it, we, as hosts, are uniquely susceptible. Nearly 10% of Americans are uninsured. And for those who have insurance, the average deductible is over $5,000. Because it renews annually, a March pandemic means that fewer people will visit the doctor for the constellation of symptoms for Covid-19 – a fever and cough – so commonly experienced and necessarily ignored by people who can’t afford to pay for healthcare. Our lack of healthcare access means that we are less likely to seek healthcare, more likely to unknowingly spread coronavirus.

Too many Americans work gigs – like waiting tables or driving Uber or Lyft – that leave them uniquely vulnerable to the economic interruptions we’ll experience trying to slow Covid-19. With $1.5tn in collective student debt, losing a gig may mean defaulting on a loan. And soaring rents may leave millions at risk of eviction and homelessness. Living on the ragged fringe of economic viability leaves Americans insecure – afraid for our future because of the instability of our present. And our insecurity leaves us uniquely vulnerable to the social and economic consequences of this pandemic – and less likely to adhere to mitigation efforts to slow the spread of Covid-19. Insecurity makes us sick.

But the epidemic of insecurity itself is a function of the environment in which we live – interlocking systems of government and economics that have frozen us out. Gig work is a necessary consequence of a financialized economy that guarantees more rights to corporations than it does to people. Homelessness is a consequence of federal policies that subsidize homeownership among the wealthy rather than housing for the poor. And the capacity for unlimited corporate spending in our elections coupled with direct and indirect voter suppression tactics disenfranchise us at the polls. These have led to failures of basic government infrastructure that Americans have long been able to rely upon. For example, extending work requirements on Snap food benefits will leave more than a million American families food insecure. Indeed, proposed cuts to the CDC and the elimination of the national security council’s pandemic response team may even have facilitated coronavirus’s spread into the US.

We cannot tackle the biological epidemic of Covid-19 without tackling the political epidemic of insecurity.

We cannot tackle the biological epidemic of Covid-19 without tackling the political epidemic of insecurity lest people have their lives saved by our interventions, only to have their livelihoods ruined by them. That means we have to tackle the epidemic of Covid-19 and the epidemic of insecurity at the same time.

Taking on the epidemic of coronavirus will require bold action to mitigate spread – this means eliminating congregation in restaurants, bars and clubs, as well as potentially locking down communities with major outbreaks. It means mandating work from home for non-essential personnel. It means contemplating a parallel Covid-19-specific health system under the control of the national guard to vastly increase our health system’s capacity.

Taking on the epidemic of insecurity will require bold action, too. Congress’s bipartisan Covid-19 response bill is a good first step, though like our social safety net more generally, it has far too many holes. First, in the absence of Medicare for All, we must guarantee healthcare coverage for confirmed or suspected Covid-19 cases to remove the paywall for testing and treatment. It should cover all out-of-pocket costs for insured and uninsured people, alike. Second, we need a universal paid sick leave policy that covers all workers, as well as a guaranteed basic income as our economy sags. Third, rather than just focus on major corporations as it has in the past in times of economic downturn, the government ought to focus its financial might on supporting small businesses that are particularly vulnerable during this time.

Though the Covid-19 pandemic threatens our physical wellbeing, the epidemic of insecurity underneath it threatens our social, economic and political wellbeing. We must act to protect Americans suffering from both.

© 2020 The Guardian

Abdul El-Sayed

Abdul El-Sayed is a physician, epidemiologist, public health expert and progressive activist

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