Coronavirus: "This crisis reveals the shortcomings of the American healthcare system"

Text by: Marie Normand Follow

The United States is now the main source of contagion for Covid-19 in the world. For Sarah Rozenblum, researcher in public health and political science at the University of Michigan, this crisis highlights the shortcomings of the American health system.

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RFI: New York is the epicenter of the epidemic in the United States. What are the other areas of greatest concern?

Sarah Rozenblum: We fear the situation in New Orleans and Miami, because Louisiana and Florida have been slow to react. Cities with dense public transportation systems like Chicago or Boston are also sensitive and will most likely experience a significant increase in the number of cases over the next few days. Dallas, Texas, is also a sensitive point, as the state decided to delegate the management of the crisis to local authorities rather than unifying its response. If a county takes aggressive measures but the residents of the neighboring county are not subject to the same restrictions, the measures are not effective. This is already observed at the scale of several states.

What is the situation in Michigan and Illinois where you are now?

There are approximately 5,000 cases in Michigan, where containment is not very restrictive. You can move around, go out shopping or get some fresh air, without having a certificate as is the case in France. The situation is a little worrying, because in some counties, the health infrastructures are of good quality but are already beginning to be congested in the face of the explosion in the number of cases. Requests for medical equipment made by Democratic Governor Gretchen Whitmer have received little attention from the Trump administration . This weekend, the president even had contemptuous remarks towards her.

In Illinois, cases are also increasing, but hospitals are not yet full. Democratic Governor JB Pritzker was a little more aggressive in handling the crisis. He declared a state of emergency a week before, he has closed schools and non-essential businesses and plans to extend the confinement, which is scheduled to end on April 7.

How to explain this patchwork of measures, different according to the States?

This is primarily due to the highly decentralized nature of the American health system where health decisions are taken at the state or local level. In the absence of a crisis, it makes sense. But in the context of a global pandemic, and faced with the exponential increase in the number of cases, it is necessary to harmonize the response at the state and federal levels. This is, moreover, what a manual for pandemic risk preparation written under the presidency of Barack Obama advocated, but which the Trump administration has deliberately chosen to ignore. The government of Donald Trump preferred initially to disengage from the management of the crisis on its health component by prioritizing the economic component. However, it has the possibility of boosting a strategy throughout the territory.

A historic aid plan for the economy has been voted. Did the response of the Trump administration change significantly between the first and second half of March ?

What has characterized the management of the crisis since its inception is an unclear, contradictory political message and decisions taken unilaterally without consultation with public health experts. We are now seeing an inflection in the response from the federal government, which seems to have become aware of the seriousness of the crisis and which is now moving more towards a health response. With the CARES Act, passed on March 27, $ 150 billion will be allocated to hospitals to allow them to strengthen their workforce, buy medical equipment, and increase their reception capacity. But these more proactive measures are counterbalanced by President Trump's unilateral and impulsive statements. A few days ago, the latter had for example announced that he wanted to lift the confinement for the Easter holidays. This does not really make sense in terms of public health since it can catalyze the spread of the epidemic by creating new sources of contagion. These statements confuse the message driven by the administration.

Is obesity, which affects nearly 40 % of Americans, a factor to take into account in this crisis?

The CDC, the federal agency responsible for coordinating the health response, shows that overweight people are indeed at greater risk in the face of the coronavirus epidemic and may present more severe cases. This is of particular concern, particularly for the United States but also for a number of other countries on the American continent.

Do you think this crisis could bring about a new social model or a new health system?

It is possible, but American history shows that it is not always possible. As part of the New Deal, Franklin Roosevelt had to give up the creation of a universal health system in the face of pressure from doctors who refused any interference from the state in their professional activity. Same scenario for Harry Truman, with his compulsory health insurance, in the aftermath of the Second World War. In the aftermath of the September 11 attacks, the management of the crisis was not united either, since it took a long time to allow the first responders - the doctors, the firefighters, the volunteers who developed cancers and respiratory illnesses as a result of their rescue mission - to obtain health insurance when many of them were not covered. The worst disasters do not necessarily lead to radical change.

But this crisis reveals the shortcomings of the American health system and the weakness of its social safety net. Many Americans have health insurance through their employer. However, during the month of March, more than 3 million Americans found themselves unemployed, de facto losing their insurance when they are most likely to turn to the health care system. This is a question that Democratic nomination contestants are considering. Bernie Sanders continues to point out these dysfunctions, the crisis gives weight to his proposal for Medicare for All . The current context allows him to remain in the running for the Democratic nomination, despite disappointing results during the primaries in March, while his opponent Joe Biden is generally not very audible.

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