“My wife made me promise to wipe everything down,” I said.
As a public health adviser and community epidemiologist who spent most of the 1990s working with tuberculosis and HIV/AIDS patients in New York City and Chicago, I felt I had some relevant experience in these matters. After all, those were both infectious diseases that not only killed many people but also scared other people to death. Though I conducted hundreds of contact investigations for tuberculosis and interviewed just as many infectious patients over those years, I had never converted on a TB test. I had learned early that good information and appropriate precaution was your best protection, and that irrational fear and panic were potentially more destructive than any bacteria or virus could be.
I think I was right about those things. But as I sat there on that plane, laughing with my fellow jaded public health veteran, I was utterly wrong about the coronavirus and COVID-19.
When I returned to the United States, on March 7, the world was beginning to change. Italy was exploding with COVID-19, and now masks were everywhere. I had empty seats next to me this time, but the plane was full of people returning to Detroit from all over the world. I heard college students behind me talking about their spring break adventures in Ethiopia and other exotic locales. The heavy-set man in front of me leaned back in his seat so far that I might as well have been sleeping in the same bed with him. Still, I was unmasked and unworried.
After deplaning, I hustled my bags through customs and out to the street. I had somehow gotten some sleep during the flight, but I needed to eat and rest a bit. After all, I had a big public concert event that night, a fundraiser that I had been planning for months. We were hoping for a really big crowd.
I know what you’re thinking because it’s the same thing I’m thinking now: I probably carried the coronavirus directly from Europe right smack into a large group of people gathered together in close quarters in Detroit, a field of fresh meat primed for infection, another spark feeding the maelstrom that would become all too apparent by the end of the month.
Luckily, that’s not what happened — at least as far as I know. First of all, our event didn’t draw that many people, maybe 30 or 40 at the most, and they didn’t come close to filling the spacious union hall that we’d reserved. That was disappointing to me at the time, but now I look back with relief. Now I look back and wonder, What the hell was I thinking?
As we later learned, there were people who very clearly saw what was coming, but appropriate steps were not taken. Testing, for example. Any epidemiologist knows that to contain an infectious disease, you need to know where it is and how it’s spreading. Then you can work in concentric circles, do contact tracing, effectively use quarantine or implement cordons sanitaire, deny the virus the real estate it needs to accelerate into the sea of bodies that provide its sustenance.
But without testing and reporting — what epidemiologists call surveillance — you’re basically shooting in the dark at an invisible enemy. When I returned from Europe on March 6, South Korea was already testing 10,000 people a day — more than the entire U.S. had tested up to that time. Because we were so far behind in testing and because we had no idea where the virus was, we effectively had to treat the entire country as though it was in quarantine. Put the brakes on — full stop.
And that’s effectively where we still stand today.
Watching the coronavirus wreak havoc on nearby Detroit, while largely confined to my house in Dearborn, was an all-too-familiar helpless feeling. Poor Black and brown bodies were predictably falling victim to the latest in a long line of plagues. I pulled my own book off the shelf, the one I wrote back in 2004 based on nearly 10 years of working directly with tuberculosis patients, carrying out contact investigations, and directly observing antibiotic therapy all around the poorest and most neglected areas of New York City and Chicago. In the book’s conclusion, I tried to make some recommendations and sound a warning call:
In 1959 Rene Dubos prophetically wrote that there is no utopia free of maladies that awaits us, in the near or distant future. But no matter what the next affliction may be, we can do no better than caring for the commons. Those consumed in the cities cry out to us. Tuberculosis, a persistent reminder of the poverty we allowed to fester, points us back to the neglected pursuit of the public health.It reminded me that years of painful experience and books full of cultivated knowledge and wisdom do not guarantee that we actually learn anything, either as individuals or as a society. We went on to make the same mistakes, or more accurately, we made different choices, in line with different priorities. Our government cut funding to the very agencies that were responsible for monitoring and preparing for the pandemics that, in a globally connected ecosystem, were all but inevitable.
Is there any evidence that universal basic income and access to health care will either stave off future pandemics or reduce their impact? This is something that needs to be researched, but I predict that the long-term societal impacts and distribution of negative outcomes will be mitigated by social welfare and universal health care, with less extreme differences between the wealthy and the poor, and more social cohesion in the response and the recovery.
Let research be done on this to figure it out. This time, let us listen to the lessons.
Paul Draus is a professor of sociology at the University of Michigan-Dearborn and the author of Consumed in the City: Observing Tuberculosis at Century’s End.
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