Coro­n­avirus is the old movie that we’ve been watch­ing over and over again since Richard Preston’s 1995 book The Hot Zone intro­duced us to the exter­mi­nat­ing demon, born in a mys­te­ri­ous bat cave in Cen­tral Africa, known as Ebo­la. It was only the first in a suc­ces­sion of new dis­eases erupt­ing in the ​‘vir­gin field’ (that’s the prop­er term) of humanity’s inex­pe­ri­enced immune sys­tems. Ebo­la was soon fol­lowed by avian influen­za, which jumped to humans in 1997, and SARS which emerged at the end of 2002. Both cas­es appeared first in Guang­dong, the world’s man­u­fac­tur­ing hub.

We are in the early stages of a medical version of Hurricane Katrina.

Hol­ly­wood, of course, lust­ful­ly embraced these out­breaks and pro­duced a score of films to tit­il­late and scare us. (Steven Soderbergh’s Con­ta­gion, released in 2011, stands out for its accu­rate sci­ence and eerie antic­i­pa­tion of the cur­rent chaos.) In addi­tion to the films and innu­mer­able lurid nov­els, hun­dreds of seri­ous books and thou­sands of sci­en­tif­ic arti­cles have respond­ed to each out­break, many empha­siz­ing the appalling state of glob­al pre­pared­ness to detect and respond to such nov­el diseases.

A new monster

So Coro­na walks through the front door as a famil­iar mon­ster. Sequenc­ing its genome (very sim­i­lar to its well-stud­ied sis­ter SARS) was a piece of cake, yet much infor­ma­tion is still miss­ing. As researchers work night and day to char­ac­ter­ize the out­break they are faced with three major chal­lenges. First, the con­tin­u­ing short­age of test kits, espe­cial­ly in the Unit­ed States and Africa, has pre­vent­ed accu­rate esti­mates of key para­me­ters such as repro­duc­tion rate, size of infect­ed pop­u­la­tion and num­ber of benign infec­tions. The result has been a chaos of numbers.

Sec­ond, like annu­al influen­zas, this virus is mutat­ing as it cours­es through pop­u­la­tions with dif­fer­ent age com­po­si­tions and health con­di­tions. The vari­ety that Amer­i­cans are most like­ly to con­tract is already slight­ly dif­fer­ent from that of the orig­i­nal out­break in Wuhan. Fur­ther muta­tion could be benign or could alter the cur­rent dis­tri­b­u­tion of vir­u­lence which spikes sharply after age 50. The coro­n­avirus is at min­i­mum a mor­tal dan­ger to Amer­i­cans who are elder­ly, have weak immune sys­tems, or chron­ic res­pi­ra­to­ry problems.

Third, even if the virus remains sta­ble and lit­tle mutat­ed, its impact on younger age cohorts could dif­fer rad­i­cal­ly in poor coun­tries and amongst high pover­ty groups. Con­sid­er the glob­al expe­ri­ence of the Span­ish flu in 1918 – 19 which is esti­mat­ed to have killed 1 to 3% of human­i­ty. In the Unit­ed States and West­ern Europe, H1N1 was most dead­ly to young adults. This has usu­al­ly been explained as a result of their rel­a­tive­ly stronger immune sys­tems which over­re­act­ed to the infec­tion by attack­ing lung cells, lead­ing to pneu­mo­nia and sep­tic shock.

In any event, the influen­za found a favored niche in army camps and bat­tle­field trench­es where it scythed down young sol­diers by the tens of thou­sands. This became a major fac­tor in the bat­tle of empires. The col­lapse of the great Ger­man spring offen­sive of 1918, and thus the out­come of the war, has been attrib­uted by some to the fact that the Allies, in con­trast to their ene­my, could replen­ish their sick armies with new­ly arrived Amer­i­can troops.

But the Span­ish flu in poor­er coun­tries had a dif­fer­ent pro­file. It’s rarely appre­ci­at­ed that a major pro­por­tion of glob­al mor­tal­i­ty occurred in the Pun­jab, Bom­bay and oth­er parts of West­ern India where grain exports to Britain and bru­tal req­ui­si­tion­ing prac­tices coin­cid­ed with a major drought. Resul­tant food short­ages drove scores of poor peo­ple to the edge of star­va­tion. They became vic­tims of a sin­is­ter syn­er­gy between mal­nu­tri­tion — which sup­pressed their immune response to infec­tion and pro­duced ram­pant bac­te­r­i­al — as well as viral pneumonia.

This his­to­ry — espe­cial­ly the unknown con­se­quences of inter­ac­tions with mal­nu­tri­tion and exist­ing infec­tions — should warn us that COVID-19 might take a dif­fer­ent and more dead­ly path in the dense, sick­ly slums of Africa and South Asia. With cas­es now appear­ing in Lagos, Kigali, Addis Aba­ba and Kin­shasa, no one knows (and won’t know for a long time because of the absence of test­ing) how it may inter­act with local health con­di­tions and dis­eases. Some have claimed that because the urban pop­u­la­tion of Africa is the world’s youngest, the pan­dem­ic will only have a mild impact. In light of the 1918 expe­ri­ence, this is a fool­ish extrap­o­la­tion. As is the assump­tion that the pan­dem­ic, like sea­son­al flu, will recede with warmer weather.

The lega­cy of austerity

A year from now we may look back in admi­ra­tion at China’s suc­cess in con­tain­ing the pan­dem­ic but in hor­ror at the Unit­ed States’ fail­ure. The inabil­i­ty of our insti­tu­tions to keep Pandora’s Box closed, of course, is hard­ly a sur­prise. Since at least 2000 we’ve repeat­ed­ly seen break­downs in front­line healthcare.

Both the 2009 and 2018 flu sea­sons, for instance, over­whelmed hos­pi­tals across the coun­try, expos­ing the shock­ing short­age of hos­pi­tal beds after years of prof­it-dri­ven cut­backs of in-patient capac­i­ty. The cri­sis dates back to the cor­po­rate offen­sive that brought Ronald Rea­gan to pow­er and con­vert­ed lead­ing Democ­rats into its neolib­er­al mouth­pieces. Accord­ing to the Amer­i­can Hos­pi­tal Asso­ci­a­tion, the num­ber of in-patient hos­pi­tal beds declined by an extra­or­di­nary 39% between 1981 and 1999. The pur­pose was to raise prof­its by increas­ing ​‘cen­sus’ (the num­ber of occu­pied beds). But management’s goal of 90% occu­pan­cy meant that hos­pi­tals no longer had the capac­i­ty to absorb patient influx dur­ing epi­demics and med­ical emergencies.

In the new cen­tu­ry, emer­gency med­i­cine has con­tin­ued to be down­sized in the pri­vate sec­tor by the ​‘share­hold­er val­ue’ imper­a­tive of increas­ing short-term div­i­dends and prof­its, and in the pub­lic sec­tor by fis­cal aus­ter­i­ty and reduc­tions in state and fed­er­al pre­pared­ness bud­gets. As a result, there are only 45,000 ICU beds avail­able to deal with the pro­ject­ed flood of seri­ous and crit­i­cal Coro­na cas­es. (By com­par­i­son, South Kore­ans have more than three times more beds avail­able per thou­sand peo­ple than Amer­i­cans.) Accord­ing to an inves­ti­ga­tion by USA Today ​“only eight states would have enough hos­pi­tal beds to treat the 1 mil­lion Amer­i­cans 60 and over who could become ill with COVID-19.”

At the same time, Repub­li­cans have repulsed all efforts to rebuild safe­ty nets shred­ded by the 2008 reces­sion bud­get cuts. Local and state health depart­ments — the vital first line of defense — have 25% less staff today than they did before Black Mon­day twelve years ago. Over the last decade, more­over, the CDC’s bud­get has fall­en 10% in real terms. Under Trump, the fis­cal short­falls have only been exac­er­bat­ed. The New York Times recent­ly report­ed that ​“21 per­cent of local health depart­ments report­ed reduc­tions in bud­gets for the 2017 fis­cal year.” Trump also closed the White House pan­dem­ic office, a direc­torate estab­lished by Oba­ma after the 2014 Ebo­la out­break to ensure a rapid and well-coor­di­nat­ed nation­al response to new epidemics.

We are in the ear­ly stages of a med­ical ver­sion of Hur­ri­cane Kat­ri­na. After dis­in­vest­ing in emer­gency med­ical pre­pared­ness at the same time that all expert opin­ion has rec­om­mend­ed a major expan­sion of capac­i­ty, we lack basic low-tech sup­plies as well as res­pi­ra­tors and emer­gency beds. Nation­al and region­al stock­piles have been main­tained at lev­els far below what is indi­cat­ed by epi­dem­ic mod­els. So the test kit deba­cle has coin­cid­ed with a crit­i­cal short­age of pro­tec­tive equip­ment for health work­ers. Mil­i­tant nurs­es, our nation­al social con­science, are mak­ing sure that we all under­stand the grave dan­gers cre­at­ed by inad­e­quate stock­piles of pro­tec­tive sup­plies like N95 face masks. They also remind us that hos­pi­tals have become green­hous­es for antibi­ot­ic-resis­tant super­bugs such as S. aureus and C. dif­fi­cile which may become major sec­ondary killers in over­crowd­ed hos­pi­tal wards.

An unequal crisis

The out­break has instant­ly exposed the stark class divide in Amer­i­can health­care. Those with good health plans who can also work or teach from home are com­fort­ably iso­lat­ed pro­vid­ed they fol­low pru­dent safe­guards. Pub­lic employ­ees and oth­er groups of union­ized work­ers with decent cov­er­age will have to make dif­fi­cult choic­es between income and pro­tec­tion. Mean­while, mil­lions of low-wage ser­vice work­ers, farm employ­ees, the unem­ployed and the home­less are being thrown to the wolves.

As we all know, uni­ver­sal cov­er­age in any mean­ing­ful sense requires uni­ver­sal pro­vi­sion for paid sick days. A full 45% of the work­force is cur­rent­ly denied that right and vir­tu­al­ly com­pelled to either trans­mit the infec­tion or set an emp­ty plate. Like­wise, 14 states have refused to enact the pro­vi­sion of the Afford­able Care Act that expands Med­ic­aid to the work­ing poor. That’s why near­ly one in five Tex­ans, for instance, lacks coverage.

The dead­ly con­tra­dic­tions of pri­vate health­care in a time of plague are most vis­i­ble in the for-prof­it nurs­ing home indus­try which ware­hous­es 1.5 mil­lion elder­ly Amer­i­cans, most of them on Medicare. It is a high­ly com­pet­i­tive indus­try cap­i­tal­ized on low wages, under­staffing and ille­gal cost-cut­ting. Tens of thou­sands die every year from long-term care facil­i­ties’ neglect of basic infec­tion con­trol pro­ce­dures and from gov­ern­ments’ fail­ure to hold man­age­ment account­able for what can only be described as delib­er­ate manslaugh­ter. Many of these homes find it cheap­er to pay fines for san­i­tary vio­la­tions than to hire addi­tion­al staff and pro­vide them with prop­er training.

It’s not sur­pris­ing that the first epi­cen­ter of com­mu­ni­ty trans­mis­sion was the Life Care Cen­ter, a nurs­ing home in the Seat­tle sub­urb of Kirk­land. I spoke to Jim Straub, an old friend who is a union orga­niz­er in Seat­tle area nurs­ing homes. He char­ac­ter­ized the facil­i­ty as ​“one of the worst staffed in the state” and the entire Wash­ing­ton nurs­ing home sys­tem ​“as the most under­fund­ed in the coun­try — an absurd oasis of aus­tere suf­fer­ing in a sea of tech money.”

Straub point­ed out that pub­lic health offi­cials were over­look­ing the cru­cial fac­tor that explains the rapid trans­mis­sion of the dis­ease from Life Care Cen­ter to nine oth­er near­by nurs­ing homes: ​“Nurs­ing home work­ers in the prici­est rental mar­ket in Amer­i­ca uni­ver­sal­ly work mul­ti­ple jobs, usu­al­ly at mul­ti­ple nurs­ing homes.” He says that author­i­ties failed to find out the names and loca­tions of these sec­ond jobs and thus lost all con­trol over the spread of COVID-19.

Across the coun­try, many more nurs­ing homes will become coro­n­avirus hotspots. Many work­ers will even­tu­al­ly choose the food bank over work­ing under such con­di­tions and stay home. In this case, the sys­tem could col­lapse — and we shouldn’t expect the Nation­al Guard to emp­ty bedpans.

The way forward

The pan­dem­ic illus­trates the case for uni­ver­sal health cov­er­age and paid leave with every step of its dead­ly advance. While Joe Biden will like­ly face off against Trump in the gen­er­al elec­tion, pro­gres­sives must unite, as Bernie Sanders pro­pos­es, to win Medicare for All. The com­bined Sanders and War­ren del­e­gates have one role to play at the Mil­wau­kee Demo­c­ra­t­ic Nation­al Con­ven­tion in July, but the rest of us have an equal­ly impor­tant role in the streets, start­ing now with the fights against evic­tions, lay­offs, and employ­ers who refuse com­pen­sa­tion to work­ers on leave.

But uni­ver­sal cov­er­age and asso­ci­at­ed demands are only a first step. It’s dis­ap­point­ing that in the pri­ma­ry debates nei­ther Sanders nor War­ren high­light­ed Big Pharma’s abdi­ca­tion of the research and devel­op­ment of new antibi­otics and antivi­rals. Of the 18 largest phar­ma­ceu­ti­cal com­pa­nies, 15 have total­ly aban­doned the field. Heart med­i­cines, addic­tive tran­quil­iz­ers and treat­ments for male impo­tence are prof­it lead­ers, not the defens­es against hos­pi­tal infec­tions, emer­gent dis­eases and tra­di­tion­al trop­i­cal killers. A uni­ver­sal vac­cine for influen­za — that is to say, a vac­cine that tar­gets the immutable parts of the virus’s sur­face pro­teins — has been a pos­si­bil­i­ty for decades, but nev­er deemed prof­itable enough to be a priority.

As the antibi­ot­ic rev­o­lu­tion is rolled back, old dis­eases will reap­pear along­side nov­el infec­tions and hos­pi­tals will become char­nel hous­es. Even Trump can oppor­tunis­ti­cal­ly rail against absurd pre­scrip­tion costs, but we need a bold­er vision that looks to break up the drug monop­o­lies and pro­vide for the pub­lic pro­duc­tion of life­line med­i­cines. (This used to be the case: dur­ing World War Two, Jonas Salk and oth­er researchers were enlist­ed to devel­op the first flu vac­cine.) As I wrote fif­teen years ago in my book The Mon­ster at Our Door—The Glob­al Threat of Avian Flu:

Access to life­line med­i­cines, includ­ing vac­cines, antibi­otics, and antivi­rals, should be a human right, uni­ver­sal­ly avail­able at no cost. If mar­kets can’t pro­vide incen­tives to cheap­ly pro­duce such drugs, then gov­ern­ments and non-prof­its should take respon­si­bil­i­ty for their man­u­fac­ture and dis­tri­b­u­tion. The sur­vival of the poor must at all times be account­ed a high­er pri­or­i­ty than the prof­its of Big Pharma.

The cur­rent pan­dem­ic expands the argu­ment: cap­i­tal­ist glob­al­iza­tion now appears bio­log­i­cal­ly unsus­tain­able in the absence of a tru­ly inter­na­tion­al pub­lic health infra­struc­ture. But such an infra­struc­ture will nev­er exist until peo­ples’ move­ments break the pow­er of Big Phar­ma and for-prof­it healthcare.

This requires an inde­pen­dent social­ist design for human sur­vival that includes — but goes beyond — a Sec­ond New Deal. Since the days of Occu­py, pro­gres­sives have suc­cess­ful­ly placed the strug­gle against income and wealth inequal­i­ty on page one — a great achieve­ment. But now social­ists must take the next step and, with the health­care and phar­ma­ceu­ti­cal indus­tries as imme­di­ate tar­gets, advo­cate social own­er­ship and the democ­ra­ti­za­tion of eco­nom­ic power.

We must also make an hon­est eval­u­a­tion of our polit­i­cal and moral weak­ness­es. The left­ward evo­lu­tion of a new gen­er­a­tion and the return of the word ​‘social­ism’ to polit­i­cal dis­course cheers us all, but there’s a dis­turb­ing ele­ment of nation­al solip­sism in the pro­gres­sive move­ment that is sym­met­ri­cal with the new nation­al­ism. We talk only about the Amer­i­can work­ing class and America’s rad­i­cal his­to­ry (per­haps for­get­ting that Eugene V. Debs was an inter­na­tion­al­ist to the core).

In address­ing the pan­dem­ic, social­ists should find every occa­sion to remind oth­ers of the urgency of inter­na­tion­al sol­i­dar­i­ty. Con­crete­ly we need to agi­tate our pro­gres­sive friends and their polit­i­cal idols to demand a mas­sive scal­ing up of the pro­duc­tion of test kits, pro­tec­tive sup­plies and life­line drugs for free dis­tri­b­u­tion to poor coun­tries. It’s up to us to ensure that ensur­ing uni­ver­sal, high-qual­i­ty health­care becomes for­eign as well as domes­tic policy.

A ver­sion of this piece first appeared at Jacobin.