As the number of coronavirus cases mount in the US, experts are warning that the country is unusually vulnerable to the spread of the disease.
There were 149 cases of coronavirus in the US and 10 people had died from the disease, according to the latest bulletin from the CDC, published at noon on Thursday and reflecting the situation on Wednesday afternoon.
Public health officials and academics are concerned that a mix of high numbers of uninsured people, a lack of paid sick leave and a political class that has downplayed the threat could mean it spreads more quickly than in other countries.
While US drugmakers look best set to find treatments and vaccines, some believe that the country could yet find itself one of the worst affected by a global pandemic.
“The US has certain strengths when it comes to innovation and expertise around diseases, but it also has critical vulnerabilities, especially with our health system,” said Lawrence Gostin, professor in public health law at Georgetown University.
Patchy healthcare regime
The spread of coronavirus could be fuelled by patients reluctant to seek care because of the expense of the US healthcare system. Almost 18m Americans did not have insurance in 2018, according to the Kaiser Family Foundation, a healthcare research organisation.
Even those patients with insurance might struggle to pay their contributions to their care — so-called deductibles or co-pays — as almost 29 per cent were classified as “underinsured” in 2018, according to a Commonwealth Fund survey.
America’s Health Insurance Plans, a trade association of insurers, has said it would remove barriers to virus tests for members, including perhaps waiving a patient’s costs or allowing them to seek care anywhere, not just in an assigned network.
More than 800 experts also signed a letter calling for US policymakers to help the uninsured, but so far, no federal assistance plans have been announced.
Soumi Saha, senior director of advocacy at the Premier alliance of 4,000 hospitals, said doctors would prioritise treatments to billing patients. But she also noted that many hospitals also operated on “razor thin” margins. “The truth is no one truly knows how much this will cost,” she added.
Diagnostic kit shortages
The US has suffered from a shortage of diagnostic kits to test who has the virus, meaning many cases may be going undetected. While South Korea has tested more than 130,000 people, the US public health agency has only been able to test hundreds of samples per day.
The Centers for Disease Control and Prevention (CDC), the leading US public health institute, initially only allowed testing at its own laboratories. This delay meant tests were often restricted to the sickest patients, those who had travelled to affected areas, or had contact with a known sufferer. Doctors say this may have delayed the realisation that the disease was being passed around the community in certain areas of the country.
Another reason for the delay was a problem with the initial test that meant they had to be manufactured again. Peter Kyriacopoulos, chief policy officer of the Association of Public Health Laboratories (APHL), said the original test had also tried to detect other viruses, such as Sars, when it worked better when focused on the new virus, called Covid-19.
At first, patients were having to wait for their samples to be sent to the CDC labs but now they can get results from more local public health labs within 24 hours. The APHL estimated that labs could do at least 10,000 tests a day, when they all come online.
The public capacity will also be bolstered by private labs, after the CDC announced last weekend that it would allow them to use verified tests. Both LabCorp and Quest Diagnostics, major testing companies, have launched tests for Covid-19.
Lack of guaranteed sick pay
While 11 states and 25 cities have passed laws forcing companies to provide paid sickness leave, there remains no federal requirement to do so, and campaigners say about 30 per cent of US workers still have no such entitlement.
Experts say this could exacerbate the spread of coronavirus if workers end up going into work while ill and infecting others, for fear of missing out on salary payments. According to an academic study published in 2012, the lack of workplace policies such as paid sick leave led to 5m extra flu-like illnesses during the H1N1 swine flu outbreak of 2009.
Sherry Leiwant, co-president of A Better Balance, which campaigns for stronger workplace protections, said: “Studies show contagion can really be contained with paid sick leave. People cannot stay at home and self-isolate if they are going to risk their jobs by doing so.”
Confused political response
Initially, President Donald Trump thought coronavirus was purely a Chinese problem, then he dismissed it as a “hoax” perpetrated by Democratic politicians.
When US cases rose and markets tanked, and Mr Trump felt pressure to respond, he asked Mike Pence, the vice-president with a patchy record on science and medicine, to manage the crisis. The result is that there is little confidence in this US administration’s ability to contain the outbreak in the world’s largest economy, before matters worsen sharply.
The lag in implementing widespread testing for the disease exacerbated fears that Mr Trump and his team were complacent in dealing with the outbreak, or deliberately quashed evidence of domestic spread for political purposes.
Bruce Aylward, assistant director-general at the World Health Organization, said: “There are still different messages coming from the [Trump] administration about how serious this is, right at the time when you need people to be as vigilant as possible. The population is your best surveillance system, and they need to be aware of how serious the problem is.”
Health experts say the spread of the disease in the US will depend heavily on whether officials respond quickly enough to the changing situation, including instituting potentially unpopular policies such as banning gatherings of over a certain number of people.
“Ultimately, the US really comes together around joint threats,” said Mr Aylward. “But they now have a very narrow window of time to do so.”