|Lockdown in Rome's Testaccio market (note 1-meter distancing strips) and San Francisco
I had a great gush of it on Monday, watching Donald Trump eat humble pie through clenched teeth, if you’ll forgive the mixed metaphor. After weeks of “We have it very well under control” and “One day – it’s like a miracle – it will disappear,” the current occupant of the White House, the same guy who two years ago closed down the American pandemic preparedness taskforce, had been forced to admit that coronavirus is a real threat and to recite a litany of guidelines for controlling the epidemic. Never one to be outdone by the competition, Trump went the Centers for Disease Control one better: the previous day they had advised no gatherings of over 50 people, he said no more than 10.
Friends have written to me about hearing a nurse in Hawaii say the coronavirus story was “all hype,” a gym mate who thought covid-19 was “just the flu”… According to recent Kaiser Family Foundation polls, an incredible 46% of the US population trust what the President tells them about the coronavirus, and 44% think he’s doing a good job at handling it. That poll was taken between March 11th and 15th, before Trump made his 180º policy swing. What are those gullible Trumpers going to think now? Hopefully they’ll flip in turn, start taking the pandemic seriously, and stop being such a threat to themselves and others.
I must say, though, that my Trumpward Schadenfreude was far outweighed by relief. If the CDC had been allowed at last to make some concrete recommendations, with Trump backing them – if denial is no longer the Administration’s party line – there is now, I think, a good chance the US will escape the worst-case scenario.
Everywhere in the US the social distancing message is sinking in. Here in the San Francisco Bay Area, my current place of refuge, they have now instituted a “shelter-in-place” ordinance on the Italian model. Its rules are somewhat less rigorous – unlike the Italians, we’re allowed to go out for a stroll if we want, and can use our cars if we want to go shopping or hiking outside our immediate neighborhood. And thus far it’s much less rigorous in practice, relying on voluntary compliance rather than on the police cars that roam the streets of Rome in search of errant pedestrians. Between March 11th and March 18th, Italian cops had stopped and checked 1,226,169 people for compliance with the covid-19 ordinance, and given out 51,892 fines. Nobody’s been sent to jail yet, but sentences could theoretically be for up to 12 years.
Where the US is still failing abysmally is in applying the most important antiepidemic tool according to the World Health Organization: “test, test, test.” Anyone with symptoms of possible infection should be tested, their contacts should be traced and tested in turn, and everyone with positive tests plus everyone in each of their households should be quarantined (it’s now clear that the disease can be transmitted even before symptoms develop). As of early this weekItaly had tested 148,657 people; the United States, with a population five times greater, has only tested 41,552, and in a fashion more haphazard than systematic.
Alvin and I have been watching a lot of CNN, whose sole subject by now is the coronavirus. We’ve been shocked by two things: First, the endless direct-to-consumer ads for powerful prescription drugs with potentially fatal side effects, a criminal practice nearly unique to the US. Second, the way coverage of the pandemic has been virtually limited to the US – if it weren’t for a feelgood clip or two of Italians singing on balconies, you’d never know there was coronavirus beyond our borders.
Buried along with any foreign news has been the extraordinary aid that China has been giving countries badly affected by the pandemic to help cope. The Chinese government has started sending Italy everything from coronavirus test kits to ventilators, as well as teams of physicians and nurses experienced in treating the disease. And did you know that Jack Ma, the wealthiest man in China, has promised to give the United States 500,000 coronavirus test kits and 1 million face masks? They left Shanghai this Monday, and may have continued on to the US the same day on military aircraft, for eventual distribution by the CDC. His generous donation, by itself, may make a substantial contribution to stemming the American epidemic.
By the way, Joe Biden was mistaken when he said at Sunday’s debate that the US had refused kits from the World Health Organization.
The Italian lockdown seems to be starting to bear fruit. Admittedly today’s coronavirus news looked bad: Italy has now passed China in total number of deaths. But that death rate, awful though it looks, is starting to rise less rapidly day by day than it was ten days ago, and the growth in the number of covid-19 patients in intensive care has similarly been slowing down (see my charts at the bottom).
The growth in confirmed cases has been improving less strikingly, but you can’t count on those data because they are so dependent on the amount of testing that’s being done.
Let me go back for a moment to the last Democratic debate. Another of Biden’s bad moments was a misguided attack on Italy, when he pivoted from a question about coronavirus into making a dig at Bernie Sanders’ Medicare-for-all. “With all due respect to Medicare-for-all, you have a single-payer system in Italy. It doesn’t work there. It has nothing to do with Medicare-for-all.”
I’d guess Sanders hadn’t been prepped for that particular line of attack, because he didn’t respond, as he should have, that if there hadn’t been a National Health System in Italy things would have been much worse. Aside from the well-organized medical response per se, all Italians knew from the get-go that if they needed testing or treatment they wouldn’t pay a penny out of pocket, so nobody hesitated to seek medical services. And the Italian welfare state helped greatly: all regular wage earners too sick to work, caring for a sick family member, or laid off because of closings knew they would keep earning their salary, or a good chunk of it, for many months.
Italian medicine is terribly underfunded and undersupplied (it has 1/3 as many ICU beds as the US, and spends 1/3 as much on health care), and I haven’t hesitated to point out its uneven quality. But in this crisis the system has really come through, to the extent that resources allow it. The response was well-coordinated, physicians stay efficiently informed of the rapidly shifting national guidelines, private hospitals are commandeered to meet public need, and medical staff are giving their all and beyond; as of today, 13 Italian doctors have died of covid-19.