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When historians ask why the United States became the world’s epicenter for the coronavirus, the temptation will be to blame it all on Donald Trump. After all, why wouldn’t they? Trump disbanded the National Security Council’s pandemic response team in 2018. He scrapped an early warning program for pandemics just three months before the current outbreak. Most of his appointees who had been briefed on possible scenarios by outgoing Obama officials fell victim to his administration’s record-breaking turnover rate. And despite having been repeatedly warned about the virus, not least in his January intelligence briefings, Trump played down its severity for months, fatally misinforming his supporters, and even held rallies. Since Trump finally decided to take the pandemic seriously, his response has been halting, chaotic, and even vindictive, seemingly withholding aid to Democratic state governments, while stepping it up for Republican ones. When the history of the pandemic is written, Trump will justifiably get the lion’s share of blame for possibly hundreds of thousands of deaths that the United States is predicted to see.

A Bipartisan Catastrophe And yet this isn’t the whole story. The breathtaking failure of the wealthiest, most technologically advanced empire in human history to deal with this pandemic is the result of a perfect storm of decades of bipartisan decision-making. Perhaps the clearest factor is the continued lack of any form of universal health care in the United States. Opposition to this essential reform has been the official position of the leadership of both major parties since at least 2016. With anywhere between 25 and 54 percent of Americans delaying their search for health care for fear of what it would cost, the reluctance of countless people to get tested or treated certainly assisted the spread of the virus. Those that did seek testing or treatment suffered the consequences, hit with thousands of dollars in medical bills — nearly $35,000 for one woman. This problem has only gotten worse since millions began losing their employer-provided insurance due to the dizzying number of job losses that accompanied weeks of lockdown. But universal coverage is only part of the sorry picture. The US for-profit health care “system” has brought about a spate of closures of hospitals that had ceased being profitable, including at least thirty that went bankrupt in 2019. Things have been particularly severe in rural areas, with 120 rural hospitals closing over the last decade, reaching a high with nineteen closures last year. Not only do such closures push patients to seek treatment outside of their insurance network, meaning more sky-high medical bills. For some people, particularly in isolated rural areas, it leaves them with nowhere to go in the middle of a pandemic.

It’s Called Outsourcing, Larry Decades of neoliberal trade policy have left the United States incapable of a wartime response to this equipment shortage. Its manufacturing base has been hollowed out and shifted overseas. The Trump administration now finds itself scrambling to import medical equipment instead, at a time when sixty-eight countries are restricting exports of medicine and personal protective equipment (PPE), including China. Of total US imports of antibiotics, PPE, and medical devices, China is responsible for 35, 30, and 8.6 percent, respectively, including 42 percent of face shields, 45 percent of protective garments, and 70 percent of mouth-nose-protection equipment. “Why can’t the greatest economy in the history of the world produce swabs, face masks and ventilators in adequate supply?” Larry Summers, Obama’s chief economist, asked on Twitter. As furious Twitter users pointed out to him, he only needed to consult his own words at a 2011 business conference: “We should not oppose offshoring or outsourcing.” Corporate concentration played a role, too. The government had inked a deal in 2009 with the small California-based manufacturer Newport Medical Instruments to make thousands of affordable ventilators, for around $7,000 less than their typical cost. The plan was foiled when the fittingly named Covidien, a much larger manufacturer, bought Newport and five other medical device companies, as part of a trend sweeping the industry at the time. After first demanding more public money for the project and a higher sale price, Covidien canceled the contract altogether two years later, without having produced a single ventilator. According to the New York Times , rival executives suspected the whole affair had been a move to stop Newport from undercutting Covidien’s own ventilator sales.

Cruel and Unusual Punishment Meanwhile, the festering income and wealth inequality that the US political class has either permitted or actively worked to widen has worsened the spread and impact of the virus, particularly among people of color. African Americans have accounted for a staggering 70 and 81 percent of coronavirus deaths in Chicago and Milwaukee, respectively, and their contribution to the death toll far outpaces their share of the population in states in every region of the country. Circumstances born of historical and existing injustices have conspired to produce these grisly numbers. Virtually every aspect of being black in America has made African Americans uniquely exposed to this pandemic: they tend to live in densely populated cities, have higher rates of chronic health problems, disproportionately rely on public transport, and often work in jobs that are especially at-risk for spreading the virus. And decades of draconian anti-drug-and-crime laws also mean they’re overrepresented in prisons. With their cramped, unsanitary conditions and a population containing many older and less healthy inmates, jails are like a primordial soup for sickness. We’ve already seen this in Rikers Island prison, whose estimated infection rate of 9.29 percent is nearly six times the rate in New York City, and which is fast becoming the epicenter of the whole crisis. Horrifying in its own right, this situation is also a ticking time bomb for wider public health: not only might it put further strain on the wheezing US health infrastructure, but the virus can be spread to the outside community through staff, visitors, and prison transfers and releases. With millions belonging to what is still the world’s largest prison population, the US carceral system could well become one more calamity to add to the growing swirl of debris that surrounds this virus.

Centers of Infection While the pandemic has had some positive effects on the criminal justice system, leading to early releases, fewer arrests, and delayed trials, this approach has not been applied across the board by any stretch of the imagination. In many parts of the United States, even as the pandemic crescendos, you can still be arrested for a petty crime and placed for more than twenty-four hours in a holding cell with a dozen other people, as happened to one woman in New York arrested, grotesquely, for allegedly not following social distancing rules. There’s little doubt these practices helped the virus spread in the first place. In some cases, officials are choosing to actually worsen the crisis by moving in the opposite direction on criminal justice. This includes Democratic media darling and New York governor Andrew Cuomo, who rolled back the bail reform that was enacted in his state last year. All of these concerns apply equally to the inhumane, overcrowded immigrant detention centers, another product of Washington’s storied history of bipartisanship. Already, four migrant children have tested positive for COVID-19, and conditions are so dangerous, detainees are actually pleading and hunger-striking to be deported. If immigrant detention centers become the new hotbeds of coronavirus infection, you can thank the aggressive campaign of mass arrests and overcrowded immigration hearings that continued well into March 2020.

Quarantine for Those Who Can Afford It As the virus spreads, it is the massive and growing US underclass of the poor and the just-barely-getting-by that are bearing the brunt of its effects. Every factor that has made African Americans particularly vulnerable applies to the poor more generally, including lack of access to health care — unsurprising, given the racialized nature of poverty in the United States. Already data from New York and Michigan suggests that, as in the rest of the world, it’s the poorest neighborhoods that are being the hardest hit. This is a moral atrocity that will also make the task of containing the pandemic harder. US economic inequality, primitive guarantees for workers’ rights, and a vanishing welfare safety net mean that staying quarantined or locked down was never an option for millions of Americans. Sixty percent of Americans don’t have the savings to cover an unexpected $1,000 expense, and nearly 40 percent can’t even cover a $400 one. By mid-March, thirty-three million didn’t have paid sick leave, a right overwhelmingly reserved for the country’s top earners. Unable to claim unemployment benefits if they quit, and with welfare decimated in the wake of Democratic “welfare reform,” low-wage workers are locked into defying stay-at-home orders and venturing out to work, often using public transport. Phone location data analyzed by the New York Times reveals those who are most likely to stay at home are those with the means to do so.