Consider the life of someone with the misfortune of contracting coronavirus in the United States. Let’s call her Mary, and let’s say she works at an airport as a baggage agent, helping travelers locate their lost belongings. At work one day she starts feeling run down and develops a dry cough. It’s just a cold, she thinks. Maybe allergies. Her supervisor’s been on her case all week, so she doesn’t call in sick for risk of testing things. She feels worse as the week goes on. The health insurance Mary’s employer offers is too expensive to afford, but she also makes too much money to qualify for Medicaid. A visit to the urgent care near her house might run her $200. Rent, which went up again last year, is due next week. She keeps going to work until, while helping an irate customer find his bag, she starts to have more serious trouble breathing and faints. Her co-worker calls an ambulance. She’s placed on a ventilator on the way to the emergency room and admitted to the intensive care unit for oxygen therapy. A quick test confirms that Mary has 2019-nCoV, the strain of coronavirus causing the current outbreak. She’s placed in quarantine, her desk at the airport is shut down, and all of her co-workers are sent for testing. It’s not clear how many people she infected before winding up in the hospital. If Mary survives, she’ll have tens of thousands of dollars worth of medical debt to show for it. And she won’t be the only one in that position.

There’s a lot we don’t know about the coronavirus, with plenty of rumors and speculation flying around about its mortality rate and source, some of it plainly racist. What we do know is that public health crises, and infectious diseases, are expected to become more of a problem, not less, in the coming decades. “It would be difficult to make a case for climate involvement in this outbreak,” said Colin Carlson, a biologist, Intergovernmental Panel on Climate Change author and postdoctoral fellow at Georgetown University. “What I can tell you is that the rate at which things like this happen is increasing because of climate change.”

Carlson—who studies the relationship between climate change, biodiversity loss, and emerging infectious diseases—likens the situation to the state of attribution science for disasters when Katrina struck New Orleans, before it was possible to say with confidence whether that storm or any other had been caused by the climate crisis. But coronaviruses—in fact a family of viruses including SARS and MERS, in addition to the current coronavirus—generally develop in animals, infecting humans in events called “spillovers.” And scientists now know that climate-induced changes to the earth’s ecosystems are driving species into new habitats, where they can transmit diseases between one another and eventually to humans. Researchers are just now starting to be able to model how many cases of dengue fever and malaria might develop as the earth warms, Carlson told me. And while reducing greenhouse gas emissions is essential, he said, governments should also prepare for the public health effects of whatever level of warming ends up happening.

As with the current coronavirus outbreak, the places hit first and worst by climate-fueled ailments are unlikely to be in North America or Europe. They’ll be concentrated in less affluent countries—ones that share the least historical responsibility for the climate crisis. That doesn’t mean, though, that the U.S. doesn’t face its own serious challenges for dealing with disease in a warming world. The first line of defense against epidemic is a strong and accessible health care system. And in that field, the U.S. is far from prepared.

“We tend to talk about Medicare for All and the Green New Deal separately, but Medicare for All is a climate adaptation strategy,” Carlson said. “In a country that spends the most on health care of anywhere in the developed world, we shouldn’t have preventable deaths caused by a lack of health care. But we have a system that is designed to deny people access to care.”