Coronavirus 4: path dependence

This morning we ventured to the grocery store for some essentials. I say ‘we’ but my partner and toddler went to the empty playground nearby while I went to do the shopping. Inside, the supermarket had put in place a limit on the number of people who could enter the store at once, both to help in the maintenance of social distancing guidelines and to prevent a rush on toilet paper and other bulky goods that take up a lot of shelf and storage space and so are hard to keep in stock. This meant there was a line to enter the store, but I think I waited all of three minutes. The line to check out was also long as a different worker directed us to an open line instead of everyone just going to the various checkouts, again to maintain social distancing. Now, people will line up for all kinds of things without a peep and most everyone was fine with this arrangement at the supermarket entrance given the potentially (increasingly?) dire state of affairs with the spread of coronavirus. Except for this one guy in line behind me. He loudly scoffed, declared that it was “fucking bullshit” and then called someone on his cell to declare how stupid it was, stating for all to hear that “they should have done this two months ago, it won’t do anything now.” He did not, however, strike me as either a public health expert or as the kind of person who would have been down with social distancing and a short wait to get into the grocery store in late January. He then proceeded to tell the young man directing us into the store as others left how stupid this arrangement is but, sadly, he did not seem to care.

The idea that the proper and most effective time to do whatever patchwork of lockdowns, social distancing, event cancellation and other measures bordering on extreme has passed is, however, a powerful one. Hindsight is usually 20/20, of course, but the difficulty now is that as the time in which less severe measures would be both practically useful and politically palatable, the only possible options become more stringent and that which seemed politically impossible becomes more likely. So, for example, something like 80 million Americans will soon find themselves under state-level mandates to stay at home. Unthinkable just two weeks ago, but then so was the notion that major urban hospitals in places like Seattle and New York City would quickly run out of ventilators, ICU beds, and basic personal protective equipment such as masks and gloves for nurses and doctors. So far Canada has fewer cases than its southern neighbor, both in absolute terms (no surprise) but also in proportion to the population. In the US, there are as of today (March 21 at 3:15 pm as I write this) roughly 67 cases per million people, but in Canada it’s 30 cases per million, according to the confirmed cases reported on the regularly updated Johns Hopkins University map. Yet even here, as I’ve shown in my little grocery jaunt, there are measures in place to keep people in place and there are widespread and lengthy shutdowns of schools, restaurants, city facilities, and other businesses and institutions we use daily and often take for granted. And as I had predicted in my last post, the US-Canada border will now be closed to all but trucks and essential services workers for 30 days. Again, unthinkable even as recently as two weeks ago, but here we are.

So here is path dependence – most western countries did not take decisive, early action to limit the community spread of coronavirus early, and once the material conditions of the viral spread and the limits of health care systems to handle those infected who need help most become quickly apparent, there are fewer and fewer options available. On the former point, it is untenable at this point to say that countries outside of China did not know enough about the novel coronavirus to know it was a threat to global public health as early as mid-January. While the tense US-China relationship has led to accusations of politicizing the virus and differing accounts on who offered aid to whom and when, and who is ultimately responsible for the pandemic, the fact remains that in the US at least, Senators knew of the possibility and danger of a COVID-19 pandemic as early as January 24. We know because several members of the Senate Intelligence Committee received a private briefing from Trump administration officials about the coronavirus at that time and then proceeded to immediately dump stock worth millions of dollars to rake in a big payday on their special information while publicly affirming the President’s statement that the pandemic was at best not a big deal and at worst a hoax devised to make him look bad. 

What could have been done at that time though? South Korea’s experience with the virus provides a useful example. South Korea controlled the spread of coronavirus relatively quickly and effectively through widespread and easy-to-access testing, and contact tracing and targeted quarantine for those testing positive. No need for sealing borders and instituting massive closures and idling of much economic activity. Vietnam, Singapore, and Taiwan also have followed similar strategies, with apparent success. There is a window for this to be effective as a public health containment strategy for the virus. I use a term like ‘less severe measures’ or ‘more severe measures’ as a way of highlighting the relationship between the strictness of limitations on personal mobility and public gatherings and the expected rates of hospitalization and fatality that can be handled by the health system in each place. This is a moving target, and the difference does not seem to be necessarily whether or not a country has a publicly funded or nationalized health system, though if you have one and it’s been properly funded and maintained, that seems to be better than having a privatized and for-profit system, such as in the US. I am no health care system expert, and don’t know enough about the specific national and sub-national nuances and variations in health care spending, quality, and infrastructure to say anything authoritative, but I can say this – austerity kills, especially in the context of a pandemic disease.

The window for less extreme measures has certainly passed in places like Italy, Spain, and France where health care systems have been inundated by a spike in cases needing hospitalization and intensive care. The same may (or will, without a doubt) soon follow in Britain. Germany has as many cases as Spain (over 20,000 right now), but has relatively few deaths so far, and authorities are trying to figure out why, as similar shutdowns have been rolled out across that country. The window for less severe measures has probably now passed in the US too, but even while that space was open to do something less draconian, there seemed to be little to no will to get through it, and not enough material to make really widespread testing available and possible, the result of a series of other failures with regard to accepting and producing tests and making them available to those on the front lines of public health. Canada is linked closely with the US politically and economically, and while shutdowns may have a faster and more beneficial effect in flattening the curve here, the measures local, provincial and federal governments have taken here remain more drastic than those that worked in South Korea because the moment of potential action was not taken. On top of this, Canada must take some actions that are designed to appease the reactionary anti-immigrant impulse that currently dominates in the Trump administration and the Quebec provincial government, turning back irregular migrants crossing into Quebec from the US and seeking asylum, just a day after saying it would accept but quarantine them for 14 days. This will have little to no effect on the actual caseload of coronavirus in Canada, since a bunch of Canadian retirees and travelers are now returning from Florida winter homes and Caribbean cruises and are as or perhaps more likely to bring the virus home with them than asylum seekers at the border. This is especially so given that the US response is to put these migrants into detention centers, where the virus is extremely likely to spread unchecked. 

Now the path open to most states in the West where community spread has taken off narrow and precarious, and with much higher stakes. The chosen policy is lockdown, mass social distancing, and bringing huge chunks of the economy to a halt, requiring massive cash infusions to keep things moving, if the political will exists for that. You could, as I said above, take this path dependence back further to the long-term neoliberal disinvestment in health systems over the last two decades. This then is one of the key material lessons here that is hard to learn but coming fast – austerity kills. The political lesson that we learn is a different story, as political responses can veer off in many different directions, and predicting that in a moment when the ground shifts daily is foolhardy. More on that in a later post. For now I have to retreat from this day’s news for a bit and color with my kid and organize my beans.