One of the late summer, early autumn rituals in Florida is hurricane preparedness. You might be thinking, “ah….isn’t that the middle of the peak of hurricane season?” Yes, it is. And to be clear there also has to be a projection of a hurricane possibly heading to your home area for any meaningful preparedness activities to be undertaken in earnest.. And then, even at that, the level of preparedness is related to the projected storm strength. “Only Cat 1? No problem, we’re good.” The fact that, especially in Gulf of Mexico waters, storms can rapidly increase to Cat 3 and 4 is acknowledged, “but that stuff hits Texas or Louisiana – maybe the Florida Panhandle, but that’s almost Alabama anyway.” Every year in late May the newspapers print a special insert on preparing for hurricane season; not sure how well it is read. I am not sure we Floridians are the most prepared for hurricane season and we know it’s coming. We’ll chat about it, we’ll tell stories about particular hurricanes, “that was a big one; blew roofs clean off homes. The whole neighborhood had the blue tarp covers on roofs for months. Yup, that was a big one.” But as the seasons change, Floridian’s conversations shift from hurricanes to the changing colors of … auto license plates during the annual snowbird invasion, congesting roads but filling state tax coffers with the tourist tax. We’re prepared for that.
I am sure every geographical locale has its own unique events for which the general public does not take heed, warning, or preparation advice – driving public safety officials somewhat flummoxed. America’s frustrating inability to learn from the recent past shouldn’t be surprising to anyone familiar with the history of public health. We don’t seem to have a sustained capacity to address infectious diseases. There is a long history of cholera outbreaks in every century of American life, the so-called Spanish flu epidemic of 1918, the 1980s raised up HIV, the early 2000s brought us the SARS infections, and 2019 brought out its cousin Covid-19. Every outbreak lets us rediscover the weaknesses in the country’s health system, briefly attempt to address the problem, and then when we think we have it under control, our interest and focus passes with the immediate crisis. This has been described as a Sisyphean cycle of panic and neglect in which progress is undone; promise, unfulfilled.
More Americans have been killed by the new coronavirus than the influenza pandemic of 1918, despite a century of intervening medical advancement. The U.S. was ranked first among nations in pandemic preparedness but has among the highest death rates in the industrialized world. It invests more in medical care than any comparable country, but it’s hospitals have been overwhelmed. It helped develop COVID-19 vaccines at near-miraculous and record-breaking speed, but its vaccination rates plateaued so quickly that it is now 38th in the world. COVID-19 revealed that the U.S., despite many superficial strengths, is alarmingly vulnerable to new diseases—and such diseases are inevitable. As the global population grows, as the climate changes, and as humans push into spaces occupied by wild animals, future pandemics become more likely. We are not guaranteed the luxury of facing just one a century, or even one at a time.
And it is not a question of experience. Katrina didn’t happen because Louisiana never had a hurricane before; it happened because of policy choices that led to catastrophe and the people/state were not prepared. The arc of history does not automatically bend toward preparedness. It must be bent.
America failed to test sufficiently throughout the pandemic even though rigorous tests have long been available. Antiviral drugs played a small part because they typically provide incremental benefits over basic medical care, and can be overly expensive even when they work. And vaccines were already produced far faster than experts had estimated and were more effective than they had hoped; accelerating that process won’t help if people can’t or won’t get vaccinated, and especially if they equate faster development with nefarious corner-cutting, as many Americans did this year. Every adult in the U.S. has been eligible for vaccines since mid-April; in that time, more Americans have died of COVID-19 per capita than people in Germany, Canada, Rwanda, Vietnam, or more than 130 other countries did in the pre-vaccine era. This week the Covid-19 pandemic death toll passed 700,000.
Yet the conversation is reminiscent of hurricane discussions in Florida. We were warned the Delta variant was coming with notices that this wasn’t your basic “Cat 1” virus, but more like a “Cat 3” packing some increased punch. “But stuff only hits in those other states. We’re good.” But as mentioned it is not a question of experience, we’d already been through two previous waves of the pandemic. The disaster of Katrina didn’t happen because of a lack of experience with hurricanes; policy choice led to the disaster. The catastrophe of this current wave was for lack of experience; but it wasn’t aided by local policies in some places, individual’s attitudes about vaccinations and masks, and an amazing inclination for some leaders and their followers to take advice from anyone except public health officials and infectious disease specialists.
“Covid-19 delta? No problem, we’re good – almost to that herd immunity here in our state. It’s those other states that are getting hit hard. They don’t want to prepare and get vaccinated, well… that’s on them. Good luck. Here… we’re good.” But one of the underlying assumptions about herd immunity is that it is a closed system, but people from “those other states” are coming here. People from other places will come here when we feel most at ease. And maybe this is the last wave of this virus and its variants. Maybe. But are we prepared for the next emergency which will surely come?