A second major challenge in this pandemic is the capacity of hospitals: bed capacities are lower in the United States than in most other high-income nations. In part this is because we let market forces, who can pay the most, drive the availability of services. There is a misallocation of resources: we have too few intensive care units’ beds and too few ventilators for the crisis we are facing. Many of the hospitals in New York already report that they have reached their capacity and many are “safety-net” hospitals that serve poor patients. Another issue is staffing, we don’t have enough people trained and respiratory therapists to manage the ventilators. One of the reasons for this shortage is that respiratory therapists are traditionally paid less than many other health professionals.
Another third weakness is the lack of universal insurance coverage: we still have around 10% of the population lacking any health insurance and half of Americans reporting that they are underinsured. Those people face high deductibles and copays when they seek healthcare and their out of pocket spending can be very high. We have known for decades that people who lack financial means end up going without care. They avoid going to a doctor and going to hospitals until they are really sick. And in a pandemic like this one, we want people to identify that they have a problem early so that they can be dealt with. The spread of coronavirus may be accelerated by the lack of access to healthcare. Initially, people did not want to face the cost of testing because it wouldn’t be covered by insurance companies. Now insurance companies have agreed that they will cover testing without copay, but even that doesn’t solve the problem: once a person is sick and goes to the hospital, or if they need an ambulance to go to the hospital, they can face significant financial costs.
Another weak point is that Americans may be in worse health than their counterparts in other countries. On average Americans are a bit younger than people in Japan or in Europe. But a higher proportion of the population suffers from chronic diseases: high cholesterol, diabetes, heart problems, and respiratory conditions. The excess burden of chronic diseases is partly a result of inadequate insurance and access to care. We also have a large homeless population that carries its own set of health challenges. All of those individuals are in the high risk category if they get sick with Covid-19. We don’t have the hospital capacity, the ICU and medical capacity and ventilators. In New York City, now the epicenter of the US pandemic, tens of thousands of people are homeless, living in the streets, subways, and in shelters. The virus can be transmitted easily through those communities. Their risk of death is very high. We’ve seen in the last few days a tremendous surge in people, arriving at New York hospitals seriously ill with Covid-19.
We see that every country has a different response to the outbreak. What can be done in the U.S. to contain and mitigate coronavirus?
I’m in New York city, and the State of New York has become the epicenter of the epidemic in the United States within the last two weeks. It’s likely due to a combination of New York being a place with a lot of travelers, and because of the city’s high population density: New York City has two times the population density of Los Angeles.
What we are seeing in the State of New York is a very dramatic response. The first response was a physical distancing strategy (some people call it a social distancing). The state moved quickly to close schools and non-essential businesses, and issue stay-at-home orders: those changes can slow the progression of the disease (as they did very successfully in China). New York started this lockdown a week and a half ago. Hopefully that will reduce the number of people demanding hospital care in the coming weeks.