An alternative history of coronavirus in the U.S.

About a month and a half ago, a friend in Oregon texted me about the coronavirus. I live in Taiwan. “How bad is it?” She asked.

“It’s not a big deal,” I answered. “We’ve got about 30 cases. Masks were sold out at pharmacies for a while, but then the government started rationing them, and had some factories ramp up production. Schools were closed for a couple of weeks after Chinese New Year. But life is quite normal here.”

The irony is that, in Taiwan, life is still quite normal.

The case count now in Taiwan is about 380. In early March, they had no new cases for several days. But over the past few weeks, international travelers have brought the vast majority of new cases. Our lives here, however, haven’t changed much. We still go out to eat. We still go out for coffee. Malls, community centers, schools are all open and in operation. Though many of them will check your temperature when you enter, to ensure you don’t have a fever. And, of course, there’s lots of mask wearing.

As of this writing, Taiwan has had five deaths. Five. The number of deaths per million: 0.2. The U.S. has had 14,797 deaths. Number of deaths per million: 45.

Taiwan’s experience is an alternate history — the history the U.S. could have had.

It’s the experience that we all have had when living through other potential threats. When avian flu, Ebola, SARS, and many other outbreaks happened, I lived in the States. And I didn’t think much about them: read the news, feel a little concerned, and go about my day. These were all potentially dangerous. But the U.S. government seemingly handled them well, and therefore, quietly, at least from the perspective of the average citizen.

Of course, each of these prior outbreaks had their own particular features. The ease with which COVID-19 spreads, even among those with no symptoms (or barely noticeable symptoms) makes it uniquely challenging. And there is luck involved, too. But it’s impossible to swallow the idea that what’s happening in the U.S. was inevitable.

Like Katrina, the underlying cause of the U.S. outbreak is a natural phenomena (exacerbated by our encroachment into wildlife spaces). But the causes of the current U.S. disaster are man-made. The number of lives lost, the collapsing economy. These are the result of specific decisions made by specific people at specific times. The CDC testing fiasco, perhaps. Or losing key health security personnel in the executive branch months before. Or the endless delays, waffling, and downplaying of the threat.

Of course, the decentralized nature of U.S. governance doesn’t make handling these threats any easier. But the U.S. has effectively handled many threats before.

No doubt there will be a stream of postmortems trying to identify which of these decisions — and many more — were most at fault. Will we learn from these postmortems? Perhaps.

But causation is a funny thing. It can be viewed at several different levels. And I can’t help but think that the broader cause of the catastrophe is our dysfunctional relationship with science and scientific evidence.

Consider the advantages that the United States had in confronting COVID-19.

The U.S. is halfway around the world from China, the source of the outbreak. People just don’t travel between the U.S. and China that often. Flights between Taiwan and mainland China are, however, ridiculously frequent. There are close cultural, personal, and business ties. For these reasons, Taiwan was considered to be at a very high risk of a bad outbreak.

The U.S. had time to observe — and learn from — other countries’ responses to the virus. Taiwan, Singapore, Japan, and South Korea didn’t have that luxury, due to their proximity and relationship to China.

The U.S. also has probably the greatest collection of medical and scientific expertise in the world. Taiwan is no slouch in this department. But the amount of money that the U.S. spends on medical and scientific research is staggering by comparison. We bring in experts from around the world to work at our universities and hospitals.

U.S. business and industry is similarly strong. The U.S. economy is roughly 35 times the economy of Taiwan. But now it’s Taiwan — a small island that mobilized and prepared for this — that’s sending millions of masks to countries around the world (including the U.S.).

The U.S. has experience in doing this. Although the U.S. healthcare system is fractured, confusing, and ridiculously expensive compared to what the rest of the world pays for comparable care, the U.S. ability to confront an epidemic was (previously) thought to be quite high. In nearly every outbreak of the past 20 years, the U.S. was the one coordinating international responses to contain and mitigate the harm from dangerous pathogens.

It’s not that the U.S. didn’t have the expertise to confront the virus. It did. It’s that the U.S. did not — or could not — leverage this expertise in any way. This is the troubling thought that will remain even after virus has run its terrible course: that the U.S. will still be vulnerable to future threats without drastic change in the relationship between policy-making and evidence.

And visions of what might have been, had we leveraged our immense advantages, will continue to haunt me.

Cover image by Tommy on Unsplash.


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