Americans Are So Done With Covid (and Compassion)
Or How I Got Sick and the “Emergency” Ended
After giving a socko talk on generative Artificial Intelligence at the University of the Azores, I returned to the U.S. with a hacking cough and foggy cold on May 11 and promptly tested positive for Covid. Hence my absence from the blogosphere for more than two weeks.
My return coincided with the lapse of U.S. “Covid emergency” measures, and the pronouncement of the World Health Organization that Covid is no longer “a public health emergency of international concern.” Someone forgot to tell my virus. That got me thinking, once my brain was able to think.
The pandemic caused unimaginable loss and suffering in this country, which led the world in fatalities.[1] According to the CDC, the death toll since the beginning of the pandemic is a mind-boggling 1,128,903; there is barely a family unaffected. Globally, the World Health Organization puts the reported Covid death toll at nearly 7 million; of course, the actual number of deaths is likely to be far higher.
But it also impelled our government to enact social welfare policies that for a few years gave us a taste of what a more humane society might be. For years, the U.S. has had the worst health outcomes of any high income nation, a trend that is deepening despite the extraordinary and increasing cost of our medical care (the U.S. being the only nation among rich peers not to guarantee universal healthcare). Nevertheless, during the pandemic, we managed to provide stimulus checks and childcare allowances, create paid sick and caregiving leave, ban housing foreclosures, evictions and provide rental and housing assistance, and enhance food benefits markedly. Most of those benefits have ended long ago; apparently compassion does not draw voters in this divided nation. Millions were lifted out of poverty, but those numbers will reverse.
Well, at least the Covid statistics are getting better. The CDC reports that new cases of Covid have fallen from a high in January of about 900,000 a week to “just” 45,000 new cases in May. Deaths slowed from close to 4,000 a day to 255 a day between those two points in time. But Covid is still right now the 4th largest cause of death here, as of May 2023, despite the availability of vaccines, boosters, monoclonal antibodies and more.[2]
Of course, the end of the U.S. “emergency” doesn’t mean the end of Covid — it just means the end to certain policy mobilizations, particularly free testing, a change that will impact those on Medicaid and Medicare or uninsured — mainly the poor and the elderly, aka those most at risk — the hardest. Mandatory daily reporting from labs and hospitals and state reporting on vaccine administration are also no longer required in this country, giving us a much hazier picture of what is actually happening.
Most of us can’t wait to abandon the personal restrictions and traumatic memories of the last few years. Gentle reader, I ripped off my mask and kissed my dear husband when I finally tested negative. Sadly, masking has been poisoned as an indicator of political identity, rather than seen as a sign of common courtesy or precaution. When so many people are infectious but symptomless, it’s hard for me to understand why people can’t tolerate a little inconvenience in all the predictable social situations of involuntary crowding, as well as where the sick or vulnerable are sure to be present. In this country, once mask mandates lifted, employers could forbid workers to not wear masks unless they were disabled; keep that in mind when you notice sales help barefaced.
To say the emergency is past in the U.S. means the risk of death for otherwise healthy, younger, wealthier people is now much lower. The vaccines and boosters have lowered hospitalizations and deaths dramatically, making it seem as though severe outcomes are just the due of anti-vaxxers. We should note that many poorer parts of the world have in part “handled” Covid the traditional way: through devastating infections, death of the weakest, and immunity-building for survivors.[3] Both approaches amount to a Darwinian survival of the fittest.
Who is still at great risk? The CDC says the immunocompromised and the elderly. And going forward, we need to add to the list those who cannot afford the cost of the vaccine, or who can’t take the time off work to get vaccinated or continually boosted. Only 15% of our population is up to date on Covid vaccines. And those who contract Covid multiple times appear more likely to suffer the most severe outcomes.
Then let’s factor in diabetes type 2, a condition that affects almost a tenth of the U.S. population. The two diseases correlate closely. Having diabetes is another predictor for severe Covid outcomes such as hospitalization or death. Diabetes is also predominantly a disease of people over 45 years old, and disproportionately affects lower income individuals, Native Americans or Alaskan natives, Blacks, Hispanics and Asian peoples. And people who contract Covid are more likely to develop diabetes, and have anywhere from a 50% to 90% increased chance of functional disability from the condition.
What about long Covid, a menu of continuing symptoms that is difficult to characterize but is often disabling? Here we see a similar risk distribution across marginalized groups.[4] Hispanics, bisexual and transgender individuals, women, and people with less education are the most likely to report continuing effects. The elderly do not seem to report long Covid as much as those under 60 (n.b. some studies come to the opposite conclusion), but this may only reflect that more old people die before they can get around to reporting long Covid. Long Covid also tends to exacerbate preexisting problems of the elderly, including dementia and heart disease, making its long-lasting symptoms more difficult to distinguish.
This speaks to how America distributes risk to rights more generally; those at the social margins receive more risk, fewer rights. The medical profession has a long history of explaining things not yet understood by telling patients, particularly those deemed somehow less reliable or more marginal, “It’s all in your head.” Long Covid is definintely not “all in the head” though it may have a significant neurological component — and anyway, suffering generated by a diseased brains is still suffering. The only thing various experts agree on is that long Covid is generally poorly understood. Patients struggle to get treatment for their symptoms and coverage from insurers. Although the most recent trends indicate the overall percentage of people who self-report long Covid symptoms is declining, the Kaiser Family Foundation found 15% of the nation reports having had long Covid symptoms, with 6% saying they are still suffering.[5] That’s still an awful lot of people. The popular response to this scary factoid is to repress this truth and get on with pre-Covid habits, as though the illness will only cause a couple of weeks’ distress if that.
We are still not that well prepared for the next pandemic, be it a Covid mutation or an avian flu. It won’t do to tell everyone next time to fashion protective gear from old t-shirts. (Full disclosure: I have a large box of adorable, inadequate masks I sewed from the children’s old pyjamas — anyone else have this souvenir?). Personal decisions on masking or vaccinating are not a sound foundation for a public health strategy — but binding national ventilation standards could be. The Administration finally produced guidance for ventilation just as the “emergency” ended, with new CDC standards and a “Clean Air in Buildings” challenge backed with previously allocated funds to encourage local and state governments to improve indoor air quality. Let’s see if all this encouragement is enough; I’m skeptical we’ll see the right outcome until it’s mandated, because revamping ventilation is expensive.
Now is the time to rehearse. We could set in place basic protocols on swiftly developing and approving vaccines, creating and distributing diagnostic tests and protective gear, guaranteeing insurance coverage, and emptying custodial facilities to prevent spread. Stockpiles of multi-use respirators and other protective gear need to be created and distributed around the country. International lab safety standards to prevent and contain leaks need to be agreed and enforced. Surveillance of possible zoonotic and emergent viruses in the wild needs to be stepped up, and research focused on countering these pathogens that can be transmitted between species. We should not have to wait for the declaration of another “emergency” to improve the CDC’s capacity on clear communications and guidance, and give it a broad mandate to requisition data throughout the country and at every level. The CDC also needs authority to flexibly shift its various pools of funding so it can respond nimbly to crises.
Animal societies are not known for rescuing the weakest from mortal danger. But American society is the richest in the world; we might expect our compatriots to behave a bit more generously. Our Constitution does not give more rights to the fittest, and neither should we. Sadly, the rhetoric of “ending” the “emergency” does little to encourage our continuing responsibility to protect each other.
Dinah PoKempner is a bar registered, accomplished, and published expert in international law, human rights, and organizational management. Read more of Dinah’s work on Twitter, LinkedIn, and DinahPoKempner.com
[1] India and Brazil are right after the U.S. in terms of sheer numbers of the dead.
[2] Heart disease, cancer and unintentional injury are the first three, for those who need to know.
[3] See, e.g. Jillian McKoy, “Morgue Data Reveal Africa’s High COVID-19 Death Toll,” Boston University School of Public Health website, June 14, 2022 at https://www.bu.edu/sph/news/articles/2022/morgue-data-reveals-true-covid-19-death-toll-in-africa/
[4] There are conflicting studies as to whether multiple Covid infections increase or decrease the likelihood of reporting long Covid symptoms.
[5] That’s about 500 million and 20 million, respectively.
