COVID-19 and the United States Government

By Preethi Krishnan

As of writing this post, with 13,36,184 corona cases and 79,550 fatalities, the United States is the global centre of the COVID-19 pandemic. While swift government response is crucial in terms of expanding testing, contact tracing, provision of PPE, regulating travel, and social distancing, it is important to note that there are no definitive answers as to why some countries are severely affected while others are spared.¹ That said, countries that locked-down early, regulated travel, and expanded testing to identify even non-symptomatic carriers of the virus have been relatively successful in reining in the impact of the pandemic. For all the variations in demographics, environment, and culture that may affect which countries are affected, government response matters.

Government response to COVID-19 can be evaluated in two ways. One, how swiftly the government expands testing, contact tracing, and social distancing. Two, how the government responds to the economic impact of the pandemic. If people do not have a safety net, they may choose work over social distancing, putting themselves and others in danger.² Quick government action is critical to saving lives. Yet, neither the virus nor the government response is as indiscriminate as is often claimed. The spread of the coronavirus and the responses to the pandemic are built on unequal structures of race, class, and citizenship, that has come to define the United States. The pandemic has laid bare the strengths and weaknesses of pre-existing institutions in the US. Given the global influence of the US, the implications of the actions taken by the US government are felt outside the borders of the country as well. First, I will briefly describe the US response in both categories. Then, I will explain how the actions of the US government has impacted various groups in disparate ways, both within and outside the country.

Testing, Tracing, and Social Distancing

Studies show that interventions such as ‘border restrictions, quarantine and isolation, distancing, changes in population behaviour’ play a major role in reducing the transmission of COVID-19.³ There are variations in how countries, even those that were relatively successful, chose to intervene. Some countries, like Malaysia, decided to have a national lockdown, while others, such as South Korea and Hong Kong, did not. But both South Korea and Hong Kong compensated by expanded testing and isolation of infected persons.⁴ In the US, rather than a federal-level lockdown, it was left to the Governors in the states and Mayors of cities to take leadership in establishing stay-at-home orders. By the time the federal-level restrictions on international travel were put in place, the virus had found its way into American society.

The US recorded the first confirmed case on January 21 in Washington state. Travel restrictions to and from China were placed on January 31.  On February 29, the first possible outbreak – with 27 patients and 25 staff members with symptoms associated with COVID-19 – in a nursing facility in Washington state was identified.⁵ According to a Brookings Institute report timeline, even though the US and South Korea identified first confirmed cases at the same time, travel restrictions and cancellation of large public events were put in place in the US much later.⁶  Travel restrictions related to Iran, Italy, and South Korea were ordered on February 29 but a complete ban on international travel was placed only on March 19. The White House advice to restrict gatherings of 10 people or more was placed on March 16, more than two weeks after the major outbreak in the US. On March 24, there were 50,000 cases and 637 deaths.

Cities and states began to establish stay-at-home orders from March 16. While some states, like California, closed down from March 19, Alabama’s stay-at-home order came about only on April 3, by which time, the death toll in the US had risen to 7000 people. New York, the epicentre of the pandemic in the US, established stay-at-home order only on March 22. Not all countries resorted to severe lockdowns internally, but restricting the pandemic did require massive, indiscriminate testing and isolation (that also came with some erosion of privacy).⁷ The US had some major mishaps in expanding testing at the crucial stages of the COVID-19 spread. Why was that?

The New York Times reports that the Centres for Disease Control and Prevention (CDC) violated manufacturing standards that resulted in faulty coronavirus diagnostic test kits that were sent out to public health labs in January.⁸ Diagnostic test kits are necessary to identify active viral infection and to flatten the curve. This set back testing for many crucial weeks in the beginning. The Times report also pointed out that the Food and Drug Administration (FDA) took too long to approve commercial manufacture of the test kits. In March, commercial manufacture of testing kits and high-capacity testing machines helped ramp up testing although, shortages of PPEs and other associated materials continued to hamper testing. While the FDA was faster in approving commercial test kits for antibody tests (tests that identify if the person had a previous infection), the speedy approval process resulted in some faulty kits in the market.⁹ After all the initial confusion, the US has expanded testing since then (26.31 tests per 1000 people). In comparison, other countries have the following rates: Denmark (53.34.11), New Zealand (39.47), Russia (37.34), Germany (32.89), Canada (28.39), United Kingdom (18.71), Sweden (14.7) France (12.73) and Japan (1.68).¹⁰

Source: https://ourworldindata.org/coronavirus-testing#world-map-total-tests-performed-relative-to-the-size-of-population

The US has expanded testing, but the impact of the initial chaos, which some say is representative of the Trump administration, can be seen in the steep death toll that the country continues to see.

While one can criticize the CDC and FDA response at crucial times, the fault-lines in the American healthcare system go much deeper. The cost and complexity of the American healthcare system have been under debate during the recent Democratic Party primaries. In the absence of a single-payer universal healthcare system, there are multiple insurance systems and for-profit and non-profit hospitals that make up the healthcare system in the US. Such complexity is not made for swift expansion of testing at the time of a pandemic. As Katie Thomas, a business reporter covering the healthcare industry for the Times says, ‘There’s people who are covered by Medicare, by Medicaid, by insurance through their employer. It’s all a big mix, and some would say a big mess, and this is all playing into testing, who is testing, and which company do we use, and how do we get our supplies… if LabCorp [a lab], at that moment of the crisis, has a week-long backlog it’s not so easy for a hospital to quickly pivot to a different lab that might have capacity.’¹¹

Besides all the complexity, healthcare cost is yet another nightmare. In 2019, 33% Americans said they would put off treatment for a medical condition because of costs, including 25% who would postpone care even for serious conditions.¹² In 2018, 28.3 million people under 65 were uninsured in the US.¹³ More hospitals are now suing patients for unpaid medical bills.¹⁴ The health insurance system in the US is designed to prevent people from visiting the doctor. In March 2020, the US government signed into law the Families First Coronavirus Response Act that requires public and private insurance plans to cover the cost of COVID-19 testing. But even in this dire situation, the law does not cover the cost of COVID-19 treatment or other associated charges unrelated to testing. Will an uninsured person visit a doctor if they have symptoms of COVID-19? The need for a single-payer universal healthcare system could not be more evident.¹⁵

Economic Impact of COVID-19

COVID-19 impacts people’s lives in terms of both their health and economic outcomes. By April 2020, there was a loss of 20.5 million jobs as the unemployment rate jumped to 14.7 percent, the worst since the Great Depression. Without a safety net, workers may be forced to unfairly choose between livelihood and safety. While big corporations, such as Amazon, made huge profits during the pandemic, social distancing has meant a major set-back for small businesses and their employees. Some of the major government responses were made in this regard.

In March, President Trump signed the Families First Coronavirus Response Act which would provide free coronavirus testing (but no treatment), ensure 12 weeks of paid emergency leave for those infected or caring for a family member with illness; provide additional Medicaid funding (public health insurance for those identified as poor); and, expand food assistance programs and unemployment benefits. The United States is one of the two advanced economies (the other being South Korea), that does not guarantee all workers paid sick leave.¹⁶ That paid sick leave is mandated only at the time of the pandemic is by itself an affront to workers’ rights. But even the emergency paid sick leave was not available to everyone. The New York Times noted that the legislation guarantees sick leave only to about 20% of the private sector workers.¹⁷ Big employers with more than 500 employees, such as McDonald’s and Amazon are not required to provide any paid sick leave.¹⁸ In April, the Labor department allowed small businesses to deny paid leave if it would put them out of business or if they are unable to find substitute workers.¹⁹ Essential workers in Amazon, Instacart, Whole Foods, Walmart, Target and FedEx decided to walk out on work on international Labor Day, May 1, 2020 protesting their employers’ profits at the expense of workers’ safety.²⁰

After several rounds of negotiation between Republicans and Democrats, the Trump administration signed into law a massive $2 Trillion stimulus package in late March. For individuals, the package included stimulus payments of $1200 to adults and $500 for every child under 16 years, based on income, expanded unemployment benefits of $600 from the federal level and more.²¹ The package included $377 billion in federally guaranteed loans to small businesses, $500 billion government lending program for companies and $100 billion for hospitals. Much of the corporate bail-out seems to be without any meaningful oversight.²² The stimulus payment of $1200, which might provide temporary relief to some Americans, is a one-time benefit. It may also not go far in expensive cities like New York and San Francisco. More importantly, not everyone is eligible for the stimulus package. Undocumented immigrants and their US citizen spouses may not get the stimulus check.²³ Thus, some of the people most vulnerable to the infection and the economic impact of the pandemic are least likely to receive the check.

For Americans living pay-check to pay-check, loss of jobs makes it very difficult to pay rent and makes them vulnerable to eviction, a phenomenon that reproduces the cycle of poverty.²⁴ Tenant’s rights movements across the country have made calls for rent relief and a moratorium on eviction. Some states and cities have responded. The federal government issued a 120-day moratorium on evictions from federal housing or property with a federal loan. By April 1, 34 states had issued various levels of moratoriums on evictions.²⁵

The inequalities – race, ethnicity, and citizenship

In the early days of the pandemic, reporters and commentators would say, ‘the virus does not discriminate, it affects everyone’. However, the coronavirus has only highlighted the inequalities embedded in the American institutions which impact people both within and outside its borders. Not all states have released corona case breakdown by race. But a CDC study showed that African Americans are disproportionately affected. The COVID Tracking Project and the Anti-racist Research and Policy Centre have been tracking and analysing data on how the pandemic has affected various racial groups in the United States.²⁶ According to their data, in Wisconsin, African Americans represent 6.70% of the population but constitute 30.53% of those who died as a result of COVID-19. In Michigan, African Americans represent 14.10% of the population and 43.39% of those who died. In Illinois, African Americans represent 14.60% of the population and 33.84% of those who died. The situation is similar in Alabama, Arkansas, DC, Georgia, Kansas, Louisiana, Tennessee and more states.²⁷ These numbers are appalling. Politicians have used these unfortunate circumstances to spew racist remarks about African Americans. But structural racism, rather than genetics make African Americans more susceptible to infection.²⁸ Besides the state of the health infrastructure, a lower proportion of African American (19.7%) and Hispanic workers (16.2%) are able to work from home compared to 37% of Asian workers and 29% of White workers, making them more vulnerable to coronavirus infection.²⁹

The pandemic also saw a surge in anti-Asian racist attacks in the US. While anti-Asian sentiments in the US has a long history, President Trump’s comments and tweets, such as the one where he called the coronavirus a ‘Chinese virus’ did not help the situation.³⁰ More than 1100 self-reported physical and verbal attacks against Asians/Asian Americans have been documented.³¹ Such racist sentiments against Chinese people and Muslims are prevalent among Indians too.³² Recently, the President also signed an executive order that would put on hold Green Card applications for 60 days. Other than creating anxiety for migrants and distracting the media from the administration’s handling of the COVID-19 crisis, such a move seems to have achieved little else in terms of curtailing the pandemic.

Another vulnerable space in the time of COVID-19 is the prison. The New York Times has identified more than 35,400 coronavirus infections and 345 deaths in inmates and staff in state prisons, federal prisons and local jails.³³ Eight of the ten largest coronavirus clusters were in prisons/jails.³⁴ Social distancing is close to impossible in these settings. In these circumstances, activist organizations have called for fewer arrests for minor offences and early release of prisoners vulnerable to the infection and prisoners incarcerated for minor offences.³⁵ Some state governors have responded to these calls. Colorado Governor, Jared Polis and Michigan Governor, Gretchen Whitmer have issued executive orders allowing for some early releases.  New York Governor, Andrew Cuomo issued a directive that would identify, and release 1100 people incarcerated for technical parole violations.³⁶

In a globalized world, the impact of the US response to the pandemic is not restricted to its borders. Asylum seekers at the US-Mexico border have already been suffering from a possibly illegal policy known as the ‘Remain in Mexico’ policy.³⁷ Currently, there are over 32,000 people detained in US Immigration and Customs Enforcement (ICE) facilities, who often live in barracks with over a hundred people.³⁸ The ICE released about 700 people extremely vulnerable to the coronavirus infection but reports suggest that not much precautions are being taken. Dismantling asylum protections, increase in deportations, and severe immigration restrictions during COVID-19 have meant the export of the virus to countries that are much less capable of dealing with the pandemic. At least 99 migrants deported to Guatemala by the US have tested positive for coronavirus according to the public health ministry in Guatemala.³⁹ Deportees from the US make up nearly 20% of the 500 coronavirus cases in Guatemala.⁴⁰ Three people deported to Haiti were also infected. Not only is the US government exporting the virus to vulnerable countries, but President Trump also announced cuts in the US funding to the World Health Organization (WHO). The WHO has said that it may have to slash humanitarian aid to Yemen, a country that is severely reliant on international aid. Yemen identified its first coronavirus case on April 10.⁴¹ For the global power that is the United States, when the President gets annoyed at WHO, children in Yemen suffer.

Conclusion

The US model, if there is one, only shows the critical role played by local leadership and the various movements who demand action. The city of San Francisco was the first in the country to issue stay-at-home orders and those early actions mattered. At the same time, it is difficult to transport a model from one country to another. While there are lessons to be learned, the existing political system, welfare institutions, culture, and environment matters. If people in Hong Kong and South Korea are generally compliant to guidelines about social distancing, the United States saw protests against stay-at-home orders, albeit from a minority of Americans.⁴² The United States has a paradoxical relationship with science in that Americans generally have high regard for science, but are still polarized on politically contentious issues.⁴³ Trust in government is also not a given across countries and it comes at a cost. For example, even as the South Korean model of using smartphone apps to track coronavirus has been lauded, it does come with privacy concerns.⁴⁴ As India moves forward with its own contact tracing app, privacy may be an issue.⁴⁵ Most importantly, the COVID-19 pandemic has only opened up in glaring view some of the deep inequities in the United States. As we see in the US, the coronavirus pandemic is not indiscriminate. The impact of the pandemic has to be examined in the context of class, race, citizenship, gender, and in the case of India, caste. I’ll end with this. We should trust in science and follow government guidelines about social distancing, but let’s also ask these questions to our government.

• Who is impacted by the coronavirus? Do we have demographic data about death rates in the country?
• Who is excluded from the stimulus packages in policy and/or practice?
• How have existing inequities of caste, gender, class, and citizenship seeped into the impact of and response to COVID-19?
• How has COVID-19 impacted migrant labourers who were stuck without work and public transportation?
• What is the impact of COVID-19 in prisons?
• What are some of the privacy concerns as the Indian government moves forward with coronavirus tracing app?

AUTHOR

Preethi Krishnan, Assistant Professor of Sociology, Western Carolina University, United States

Disclaimer: The views and opinions expressed in this article are those of the author/s and do not necessarily reflect the official policy or position of Azim Premji University or Foundation.