China is not just a strategic competitor, it is a hostile foreign power. And by controlling the manufacture of critical healthcare supplies—not just iPhones and toasters—they hold significant power over this country and the rest of the world. And they know how to use it—especially in a time of crisis.

The time for pundits and policymakers to get serious about preventing the spread of the Wuhan Virus in America was late January. That was when it became clear that China was facing a serious new public health threat. It was also the time when the one piece of data, an exponentially growing number of infected people, was genuinely terrifying. There was so little information beyond that at the time that one could envision a worst-case scenario of a new virus as infectious as the measles and as deadly as SARS (10 percent mortality rate) or MERS (35 percent).

Thank God, that scenario is off the table. Yet other bad scenarios remain possibilities.

What we know at this point is that the virus is more infectious than the flu. Some studies suggest it is roughly two to three times as contagious. There is also good reason to believe that this virus and the COVID-19 respiratory syndrome that it causes are particularly dangerous to older people and those with underlying health problems. This, of course, is also true of the seasonal flu, but it appears to be much more pronounced with this virus.

What’s more, the range of preexisting or chronic health issues that materially raise susceptibility to serious illness as a result of this virus keeps expanding. At first, doctors thought it was limited to people with respiratory conditions, but they since added high blood pressure, which affects 77.9 million Americans, and diabetes, which affects 30 million Americans. Add in asthma and some other chronic conditions and something like one-in-three Americans may be in the high-risk category.

There is some good news: the vast majority of people who contract the Wuhan Virus will experience only mild symptoms, many will remain completely asymptomatic, and then they will recover.

In other words, this isn’t the plague that killed 30 percent of Europe’s population. But it is a very serious public health threat for a significant portion of our population and that needs to be handled effectively lest the death toll spiral.

The time for handling Wuhan Virus as a threat that we could avoid has passed. It’s here. Now we need to focus on mitigating it’s spread and treating those who develop life-threatening pneumonia and long-term fibrosis of the lungs “as seen in SARS and MERS.” Both are potentially deadly. Worse, the fibrosis doesn’t heal. Its spread can be arrested with treatment so that it doesn’t consume the entire lung, but those who develop it are stuck with it—and all of the accompanying limitations—for life.

The ongoing experience of treating Wuhan Virus has exposed dangerous inadequacies in our healthcare system, in our government’s ability to handle foreseeable public health threats, and even in the way we have ordered our economy. They are all interrelated and they all need fixing.

One thing that became clear very quickly in China is that the Chinese lacked hospital capacity. According to viral videos, they constructed that capacity very quickly. Feel free to take that with a grain of salt if you like. The Chinese were also able to direct production of drugs, N95 masks, and biohazard suits, so that healthcare workers and first responders could do their jobs.

Of course, that’s because China manufactures all of those things in their own country. We do not.

An anonymous Department of Homeland Security official told Reuters of the protective equipment needed by healthcare providers that “very little of this stuff is apparently made in the [United] States, so if we’re down to domestic capability to produce, it could get tough.”

And that’s a major health and national security risk that must be remedied.

The Italian experience, an open society much more like our own, is perhaps more instructive. In mid-February, Italy had very few known cases of coronavirus and none of them were from community infection. That’s when one of the first Americans to contract the virus, Marc Thibault, a vice principal from Rhode Island guiding a school trip, picked it up. He was an otherwise healthy 48-year-old father of two who spent two weeks in the hospital, most of it in intensive care connected to a ventilator, where he was given last rites by a priest. Thibault recovered due to the timely application of expert healthcare and a lot of resources. Again, thank God.

But his experience exposes the weakness in our system. Treating the people with the worst cases of Wuhan Virus is possible—but it takes a lot of resources. When there are one or two or 10 cases, that works. But when we are talking about thousands flooding hospitals, as in Northern Italy, the system breaks down.

There are only so many ICU beds and even when the hospitals convert whole floors from standard care to intensive care, there are only so many respirators, so many doctors and nurses—some percentage of whom will get sick even with extreme preventive measures—and even in the absence of sickness are limited as they become exhausted. What happens next is that healthcare workers must triage the patients and they are left with hard, heartbreaking decisions.

The question isn’t who could we treat and probably save under normal circumstances but rather who has the best chance of survival when there are limited resources and the rest get a palliative and a prayer.

What has been the most galling and dangerous weakness to be exposed—but also the most correctable one—is the realization of how dependent the United States is upon China for lifesaving drugs, for hazmat suits, and for N95 masks.

For all sorts of critical products, we don’t and currently can’t make them ourselves. Ninety-seven percent of antibiotics used in the United States are made in China, 80 percent of the chemical components necessary for the drugs that we do make here come from China. Within one year, nearly the entire production of N95 masks went from “Made in USA” to “Made in China.” The U.S. Strategic Stockpile currently holds just 12 million N95 masks, a small fraction of the 3.5 billion the DHS estimates we would need in the event of a pandemic. This is insane and it must change.

Outsourcing manufacturing to China has done incalculable damage to the United States. It’s impoverished countless towns and many millions of people. It’s shrunk the American middle class and made it more precarious. And that’s led to all kinds of social and political distress from skyrocketing opiate addiction and deaths to an embrace of radical politics.

For some people the connections between these things are too abstract or they just shrug and say, “Well, that’s the market” as if Americans—real people—exist to serve “the market” rather than markets existing to serve Americans by making their lives better. But the simple fact that we can’t make the very products necessary to provide lifesaving healthcare for Americans in a time of crisis isn’t an abstraction. It’s real, it’s dangerous, and it’s time to change.

The Chinese know our lives are dependent upon their good will. The state press agency, Xinhua, published a not so thinly veiled threat targeting the United States on March 4:

If China retaliates against the United States at this time, in addition to announcing a travel ban on the United States, it will also announce strategic control over medical products and ban exports to the United States. Then the United States will be caught in the ocean of new coronaviruses. According to the US CDC officials, most masks in the United States are made in China and imported from China. If China bans the export of masks to the United States, the United States will fall into a mask shortage, and the most basic measures to prevent the novel coronavirus can’t do it. Also according to the US CDC officials, most of the drugs in the United States are imported, and some drugs are imported from Europe. However, Europe also places the production base of these drugs in China, so more than 90% of the US imported drugs are related to China. The implication is that at this time, as long as China announces that its drugs are for domestic use and banned exports, the United States will fall into the hell of the novel coronavirus epidemic.

They’re right and they know it. So let’s take the hint and take responsibility for our own security.

Senator Marco Rubio (R-Fla.) has been a leader on this. In February 2019, he published a report warning, “the U.S. runs the risk of losing important components of its medical supply chain to China’s government-backed industry.” He was prescient.

Late last month, he revisited the subject. “At the time, those seemed like abstract concerns, but we now know they are real,” Rubio wrote. “Americans unable to buy medical masks and who see headlines about potential shortages of critical, irreplaceable drugs will be familiar.” Rubio is working on vital legislation that would address these issues. We could go even further.

Here are a few simple ideas policymakers should act on now. As a national security priority, we must mandate by law that the following items and the materials necessary to make them are manufactured in the United States:

Critical drugs, including antibiotics, antivirals, steroids, and vaccines. Protective gear and medical equipment such as masks, hazmat suits, respirators, and ventilators. Vaccination for highly infectious new viruses should be mandatory and free where necessary.

On Tuesday, the Chinese government announced it would send an aid package to Italy, where the hospitals have been overrun and where respirators and ventilators—often the difference between life and death—are being rationed. That aid package includes 1,000 ventilators, 2 million masks, 100,000 respirators, 20,000 protective suits, and 50,000 test kits. And it’s all a free gift.

The United States didn’t do that because we can’t do that. We don’t have the capacity to supply our own needs let alone provide lifesaving help to an ally like Italy. That’s shameful and we must do better.

China is not just a strategic competitor, it is a hostile foreign power. And by controlling the manufacture of critical healthcare supplies—not just iPhones and toasters—they hold significant power over this country and the rest of the world. And they know how to use it—especially in a time of crisis.