Ed Yong Talks About COVID-19 And Structural Inequality : Code Switch How was the the richest and most powerful country in the world laid low by a virus only nanometers in size? Ed Yong, a science reporter for The Atlantic, says it's the inequities that have been with us for generations that made our body politic such opportunistic targets.
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The United States' Pre-Existing Conditions

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The United States' Pre-Existing Conditions

The United States' Pre-Existing Conditions

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GENE DEMBY, HOST:

I'm Gene Demby. You are listening to CODE SWITCH from NPR. Shereen is off this week.

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DEMBY: So even now, all these months into our new way of doing things, there is still so much we don't know about SARS-CoV-2, the virus that causes COVID-19. We're still adding to the list of known symptoms, still trying to figure out a testing protocol since so many of the people spreading it don't have any symptoms. Is it entirely airborne? How long does it last on surfaces? When, if ever, will we have a vaccine? And just this Monday, researchers in Hong Kong confirmed that someone was reinfected with coronavirus months after they first contracted it, which is not how viruses typically work.

And leaving aside all these big scientific questions, we still don't know how it's going to affect our country long-term. Airports - still mostly empty. Schools are reopening, and parents are weighing whether it's safe to send their children back to school. Joblessness is at the highest rate since the Great Depression in the 1930s. Millions of people are in danger of losing their homes. And more than 175,000 people in the U.S. have died from this virus. So just how is it that the richest, the most powerful nation in the world has been laid low by a virus that's only a few dozen nanometers in size?

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DEMBY: Ed Yong, a science writer for The Atlantic, has spent the last seven months covering the coronavirus. His September cover story for the magazine is titled "How The Pandemic Defeated America." And in it, he says it's the inequities that have been with us for generations - in some cases, for centuries - that made our body politic such opportunistic targets. In other words, this has a lot to do with class and race. I mean, this is CODE SWITCH, after all. Ed wrote, quote, "water running along a pavement will readily seep into every crack. So, too, did the unchecked coronavirus seep into every fault line in the modern world."

ED YONG: So I mean everything from America's chronic underfunding of public health, which left it vulnerable when this virus started spreading through the country. I'm talking about its understaffed nursing homes and its overstuffed prisons. I'm talking about its health care system, which receives a huge amount of money but struggles with a lack of capacity to surge in a crisis with, you know, wasted funds, its struggles with access to health care, which uniquely in the world is predicated on this weird system of employer-tied insurance. And I'm talking about long-standing inequalities in race and other dimensions that, you know, have clearly been a problem for the health of Americans for decades and centuries but that have manifested in horrible, tragic ways in this pandemic.

So I think the, you know, the overarching thesis of this piece is that SARS-CoV-2 is a new virus, but all the problems that have emerged during this pandemic are not new. They were predictable and preventable. They had been discussed beforehand and just ignored and unheeded and left to fester.

DEMBY: Speaking of the beginning of the pandemic, you write that one of the first crucial mistakes in the federal response to the pandemic in the U.S. happened at the end of January, when instead of ramping up, you know, the manufacturing of tests for COVID-19, President Trump decided instead to focus on shutting down the border. So how did that decision accelerate this crisis that we're in now?

YONG: Well, so I think it's more that it didn't help. You know, the focus on border control, again, was predictable given this president's, you know, own predilections.

DEMBY: About which he's been consistently vocal throughout his presidency.

YONG: Right, exactly. Like, you know - what's the saying? Like if you only have a hammer, everything looks like a nail, right? So, like, if your only policy solution is to create borders and walls and fences, then of course that's what you're going to try and do.

Now, to be fair, it's a wholly intuitive idea. You know, we know that air travel and travel generally spreads outbreaks from one place to another, so it kind of makes sense. You can understand why someone would think, if I just restrict travel, I beat this pandemic.

But the problem is that travel bans are often very porous, so they let people through. And we saw that with Trump's travel ban - had loads of exemptions to it. They're often put in too late. We saw that here. We know that the virus was already spreading within the U.S. by the time that ban was enacted. We know that bans can make problems worse by encouraging people to hide symptoms and try and, like, force their way through anyway - like, find alternative routes. They can sometimes create travel by prompting people to, like, rush to a place where they know that a ban is about to be enforced. And I think most insidiously, they can create this false sense of security where people think that a ban is going to protect them, and they forget to put in all the other measures that they need to actually protect them, like building up testing infrastructure, public health infrastructure.

And I think you could make that strong argument that this is what happened with the U.S. - that too much was placed on border control and very little attention was placed on public health. And all of this meant that America lost this valuable head start when it could have started working out where the virus was and how it was spreading.

DEMBY: So we're in Month 7 of this crisis, as hard as it is to believe. And even now, the president is characterizing the virus as either, you know, a product of China's negligence or China's malfeasance. How is that shaping the way that we, the public, understand the public health - the actual public health response to the virus?

YONG: It's catastrophic. In a pandemic, in any kind of epidemic, you need leaders to offer calm, consistent, evidence-based messaging. And, you know, we are batting 0-3 here. You know, when you have a president who repeatedly lies, who repeatedly downplays the threat of the virus, to go back to the running theme of my piece, all of this was preventable.

I mean, Trump showed us who he was even before his election campaign. In 2014, you could look at how he reacted while as a citizen to the Ebola crisis. You could see the rhetoric that he was using during his election campaign and predict all of this. And I know you can do that because I did that. I wrote a piece in 2016 after the election but before the inauguration saying how Trump would react to the pandemic. And I said that he would focus unduly on border control. He would tweet rashly. He would espouse conspiracy theories. He would not listen to experts, and he would disregard science and evidence. And, lo and behold, that is exactly what he has done.

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DEMBY: After the break, Ed says protecting the U.S. from another catastrophic pandemic and making our country more just - those are actually the same project.

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DEMBY: Stay with us.

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DEMBY: Gene - just Gene. CODE SWITCH.

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DEMBY: Now back to our conversation with Ed Yong of The Atlantic, who says that a major irony of public health is that the better it does its job, the more people tend to ignore it.

YONG: So public health is about preventing people from getting sick in the first place rather than, say, just treating people who show up at the hospital who are already sick. And it means that if you do that well - like if you vaccinate your way out of infectious diseases, if you have better sanitation, if you have better nutrition in your neighborhoods - people just have good health. And we take that for granted.

And so public health has been underfunded for decades now. The budgets that have gone into it have shrunk. The workforce, therefore, has shrunk. And I think partly, it's because of that principle, the better it does its job, the more it's neglected. But I think it's also because Americans have this idea of health as being a matter of personal responsibility rather than a collective good - right? - like, this very pernicious idea that if you are sick, it's because of the bad decisions that you've made. It's to do with, you know, weak life choices rather than all the other systemic factors that affect those choices in the first place.

You know, so in this pandemic, we can see that people from poor communities who do these so-called essential jobs find it harder to protect themselves and their families. Like, how do you socially isolate yourself? How do you, you know, stay at home if you work a low-paid hourly wage job that doesn't give you any kind of paid sick leave?

People from Black and brown communities are disproportionately represented in those jobs, so they are fielding risks for the sake of their lives and livelihoods. And then because of these long-standing inequalities, the long-standing push of health care access away from Black communities, you know, they already have this baseline of poorer health, of poorer neighborhoods, of worse access to insurance, to good care. All of these things mean that Black folks are entering the pandemic with a poorer baseline of health anyway.

Like, you know, a lot of people have again tried to portray this as a matter of individual responsibility. So, you know, much has been said about how Black communities have higher rates of, say, obesity or diabetes, which predispose to COVID-19. And that's often presented as like an answer - you know, full stop - that is why there are these inequalities in infections and deaths, without saying, wait; why do they have higher rates of chronic disease in the first place? Could it possibly be because of, you know, decades of social disinvestment and poorer access to health care? If you just keep on digging down into the actual root causes of it, you see the effects of these long-standing health problems, which have fundamentally to do with racism.

DEMBY: You write that some of the former slave states in the South, some of the reddest states in the country, have also been the states that invest the least in public health spending. And they're also, as it happens, the Blackest states in the country in terms of percentage of population.

YONG: Yeah, I see it as all being connected. So, you know, my colleague at The Atlantic, Vann Newkirk, has written extensively about this, about how access to health care is just sort of another frontier of segregation, right? So the push of health care away from Black communities, the poorer access of Black communities to both hospital-based health care and good, solid public health infrastructure are all related. And, you know, they absolutely manifest in the way the pandemic has swept through Black communities disproportionately this year.

DEMBY: I imagine that some of the same things you're talking about - a sort of divestment from public health spending, generational negligence - is part of why we've seen, you know, Navajo Nation devastated by COVID.

YONG: Yeah, absolutely. So at the end of spring, the Navajo Nation had a higher rate of COVID-19 infection than any state. And, you know, that, again, is a totally predictable result of decades and centuries of disinvestment. You know, people being pushed out of their own lands and being denied access to the water that is rightfully theirs means that, you know, a lot of Indigenous communities live without access to water, you know, don't have the option of, like, washing their hands regularly. Sometimes that water is contaminated by uranium mining that took place on their lands. You know, these folks - many of them live far away from hospitals, in cramped multigenerational homes through which the virus can more easily spread, you know, have, again, higher rates of chronic disease because of poorer access to health care and worse public health infrastructure.

So, yeah, there are many cases throughout the country where these historical sins have once again jeopardized the lives of marginalized folks.

DEMBY: I'm going to ask you about infrastructure - in this case, literal infrastructure. You write that the virus spread most quickly in America's, quote, "sick buildings," you call them - our prisons, our nursing homes. Tell us what you mean by sick buildings.

YONG: So there's this idea that a lot of the indoor spaces we have have standards of ventilation that have been set more for engineering than for human health. And there are many scholars who studied healthy buildings who have argued that we have moved away from practices like better ventilation, like, you know, just using open windows and encouraging fresh air and better circulation that have left us more vulnerable to pathogens and pollutants, which can build up in indoor spaces.

And it's obviously hard to say exactly to what extent this has contributed to the spread of the pandemic, but I don't think it is a coincidence that you're much more likely to contract the virus from an infected person in indoor spaces than outdoor spaces, that most of the outbreaks that we've seen have taken place indoors. Like, obviously that's a factor of, you know, prolonged proximity to crowds. You get all of those in indoor spaces. But I think when we think about epidemics and the spreads of disease, we think about, you know, the virus and the people, and we sort of forget that broader environment in which they exist.

DEMBY: And so prisons and nursing homes, in particular, are cauldrons of this sort of structural sickness.

YONG: Totally. And that's, you know, that's not just to do with the sort of architectural dimension. It's just the way - it's also to do with how we think about people in those spaces - you know, who we ignore and who we marginalize and whose lives we truly care about.

In terms of prison, so much has been written about America's carceral state and its punitive attitudes. The fact that it has so many more incarcerated people than other comparable countries means that there is this very densely packed population that is underserved in terms of its health that was obviously going to be incredibly vulnerable when a, you know, fast-spreading virus like this hit the country. You know, it should be no surprise that prisons became hot spots.

Like in the piece, I wrote that two separate prisons each individually had more cases than the entirety of New Zealand. And since - you know, since we sent this piece to press, that number is now four. So it's getting worse.

And, you know, the same could be said for nursing homes. You know, the fact that nursing homes account for - I think it is 40% of deaths from COVID-19 in America is truly shameful. I think it reflects our attitudes to the oldest among us, people who we're meant to be giving respect and care to, but instead who we often neglect.

DEMBY: One of the first episodes we did after the protests sort of exploded all over the country was about just why so many white people were animated. We just asked our listeners and people who were suddenly paying attention why they were animated. And this sort of vicarity (ph) that people talk about because of COVID, because of the pandemic - economic vicarity (ph), sort of the health vicarity (ph) - right? - that came up in almost every response. I mean, Trump came up. It was Trump and COVID. Those were the two things. Almost more than proximity to Black people - right? - it was a sort of understanding that there's this - you know, this continuum of broken institutions across American life that were failing them. And so they started to be able to, like, imagine how that might look for other people.

YONG: It's a bit funny that so many people have suddenly discovered that health inequalities exist. Like, the very notion of health inequities seems to, like - you know, like, there's just a ton of people going, what?

I think in fairness, like, this is also a thing that I feel I have insufficiently acknowledged in my past reporting. Like, I did a piece in 2018 for The Atlantic about whether America was ready for the next pandemic. And, you know, spoilers - no, which was the case I made then and still the case I make now. But, you know, that piece does deal with, like, the political aspects. It deals with Trump. It deals with many of our psychological failings. It deals with biomedical stuff like vaccine manufacturing. But it doesn't mention inequalities at all, and I think that looks like a massive hole in retrospect.

And so, like, I am speaking about this sort of shift in understanding from a personal note, too. Like, I think the extent of this and also, like, the long history that has led up to how inequalities have manifested in the pandemic is something that I am, like, now also grappling with and, like, you know, just will not stop talking about it because it's crucial. It's foundational.

DEMBY: You mention this sort of social psychology of pandemics, and we've talked about this on the show - how they spark civil disobedience and unrest. And you mentioned that this has been a moment for people to really think about the deep inequities in our society that have been with us all along from the beginning of this country. You write that tackling these problems requires radical introspection. So I'm just curious, Ed, like what does radical introspection look like to you?

YONG: I think that throughout much of the year, people have asked themselves, how can we get back to normal, right? We want some semblance of our previous lives back. And I think radical introspection begins with understanding that normal wasn't so great for everyone, you know, that normal included a swath of inequalities, of long-standing problems that we had come to tolerate. You know, we had almost come to accept what should've been unacceptable. And I think we need to recognize all the ways in which normal failed us.

In all the dimensions we've already talked about - you know, the carceral state, the health care system, you know, the legacy of racism and colonialism - if we can't even look all of those problems in the face, we're just going to be weak again the next time 'round.

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YONG: I think the problem is that many of the truly great challenges of our time, so everything from pandemics to climate change, require us to look, like, full-on at the weaknesses that our societies have and have accumulated. And, you know, that's hard. It takes a lot of work. You know, it's like - it's like staring at the sun. You can't just look straight at it, but you kind of have to because I think the pandemic has shown us that we don't have a choice, right? We should now be able to very clearly see what happens when we allow historical negligence to accumulate.

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DEMBY: Ed Yong is a staff writer at The Atlantic, where he covers science. His piece in the September issue of The Atlantic is called "How The Pandemic Defeated America." Thank you so much for doing this, Ed.

YONG: Yeah, thanks for having me. Stay safe.

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DEMBY: All right, y'all, that's our show. You can follow Shereen at @RadioMirage - all one word - and me at @GeeDee215. That's @GeeDee215. We want to hear from you. Our email is codeswitch@npr.org. And subscribe to the podcast on NPR One or wherever you get your podcasts. Oh, yeah. We have a newsletter. It's really dope. You should check it out. You can subscribe to that at npr.org/newsletters.

This episode was produced by Alyssa Jeong Perry and edited by Leah Donnella. And we'd be remiss if we did not shout out the rest of the CODE SWITCH massive - Jess Kung, Kumari Devarajan, Karen Grigsby Bates, LA Johnson, Natalie Escobar and Steve Drummond. I'm Gene Demby. Shereen will be back next week. Be easy, y'all.

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