Is America Ready for Coronavirus?

Last week Donald Trump proudly held up a map from the Global Health Security Index and proclaimed that the United States is the most prepared country in the world for fighting Covid-19.

The Global Health Security Index assesses the abilities of countries around the world to prevent, detect, and respond to infectious disease threats. The good news for Americans is that Donald Trump is right. The Global Health Security Index ranks the USA number one! Out of the 195 countries in the index the United States is seen as the country most able to prevent, detect and respond to a major epidemic.

However there is one area of the Global Health Security Index where the United States scores very badly. In the Healthcare Access indicator the USA scores 175th out of all 195 countries. Around 28.5m people in the USA don't have health insurance. This means that America ranks as one of the worst countries in the world for access to health care. This one bad score could have a very large impact on how effective the country is in responding to Covid-19.

Not being able to afford health care could be very important during a national epidemic. If millions of people cannot afford to get tested for the coronavirus then this could help the spread of the virus. If infected individuals aren't identified and isolated then the virus is likely to spread much quicker and more widely than if there is widespread testing. Some states, such as New York, are beginning to ask health insurers to waive fees for coronavirus tests. However most Americans are unaware how much a test will cost them. A situation which will only discourage many people from getting tested.

Another factor which may affect the spread of Covid-19 is the lack of paid sick leave. The United States is just about the only country in the developed world which has no national requirement to offer paid sick leave. This is another area which could dramatically affect the spread of Covid-19. If people infected with coronavirus can't afford to take time off work then they will not self-isolate and will end up infecting many more people than they otherwise would.

Yesterday the UK government announced that it was improving statuary sick pay so that workers will be paid from the first day that they are sick and not the usual fourth day. The UK Prime Minister said that this was so that people with coronavirus symptoms would be more likely to self-isolate and not infect others. In the USA the CDC is also urging sick workers to stay at home. However only 30% of people who earn in the lowest 10% of wages have access to paid sick days. Many of these low-paid workers are in service industries where their jobs involve lots of contact with other people. If sick people can't afford to take time off work then they are going to infect lots of other people.

America can learn a lot from China on the best ways to help contain the spread of Covid-19. The World Health Organization sent 25 international experts to China to investigate the spread of Covid-19, the effect of the virus and the measures taken to stop it. The Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (PDF) presents the investigation's findings. The report says that the number of new diagnoses is declining in China. The report is clear that China has been successful in its containment measures,

"In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history".

The report is just as clear as to which Chinese containment measures have been successful,

"Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures."

To be as successful as China in containing Covid-19 the United States will have to be just as successful in 'rapid diagnosis' and 'immediate case isolation'. Essential to these two measure are widespread testing and people not having to work when infected.

The United States has the best health facilities, the best research facilities and the best epidemiology training programs in the world. As the Global Health Security Index suggests it should be able to respond to Covid-19 better than any other country in the world.

However in order to contain Covid-19  the U.S. government will need to:

1. Ensure that testing for Covid-19 is free
2. Ensure statuary sick pay for those who test positive for Covid-19

Although the need for these two measures is clear there seems little evidence that they are about to be implemented by the U.S. government. It is also unclear whether the American public is ready to understand and accept the 'extremely proactive surveillance' which was fundamental to China's successful measures.