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Monday, December 09, 2019 {{ new Date().getDay() }}

Reprinted with permission from The American Prospect.

For nearly everyone in America today, the COVID-19 pandemic is unprecedented. Nothing in our experience has prepared us to make sense of what is happening or might happen next. But as we struggle to survive this horror, history and epidemiology may at least provide reference points for thinking about the world ahead.

Epidemics can produce lasting effects on society in at least three ways. The most direct is through the impact on the health and demography of populations. In the 14th century, the bubonic plague wiped out a third of Europe's people, chiefly working-age adults, and the ensuing shortages of labor led to rising wages and the end of serfdom in England and other parts of Western Europe.

A second kind of effect stems from the societal response to an epidemic. After expanding powers to control epidemics, governments have often retained those powers afterward. During a recurrence of the plague in the 15th century, Venice confined arriving ships to outlying islands for 40 days, the origin of our word "quarantine." Although its scientific basis was not understood at the time, the quarantine helped reduce the disease's spread, as 40 days was long enough for infected rats and sailors to die off. In his book Epidemics and Society, the historian Frank M. Snowden argues that such public-health measures contributed to the growing powers of the modern state.

A third kind of effect arises from the meaning that people give to a crisis brought about by an epidemic. When the Spanish invaded the Americas in the 16th century, they brought smallpox and other diseases with them that devastated indigenous peoples. In his classic Plagues and Peoples, the historian William McNeill argues that it wasn't just the mortality from disease that led to the collapse of the Aztec and Inca empires. The faith of the indigenous in their gods and their leaders collapsed in the face of diseases from which the invading Spanish seemed to be mysteriously immune.

Each kind of effect, alone or in combination, can initiate chains of ramifying consequences. It is impossible to see far down these chains, but we can at least ask how the first-order effects of the COVID-19 pandemic may play out over the near term. The principal effects, I suggest, will likely fall into the second and third categories. They will stem from how societies respond to the pandemic and how people interpret it and evaluate the response that political leaders make.

To be sure, we have no certainty at this point (I write at the beginning of May) about how long the pandemic will last and how big its toll will be, though we do know what must happen for the crisis to end. Assuming no sudden discovery of a cure, enough people must become immune for the reproduction number—the additional cases caused on average by an infection—to fall below one and stay there even when social distancing is relaxed. That drop in transmission will likely require immunity among 60 to 90 percent of a population ("herd immunity"), which can develop in two ways. People may acquire immunity from antibodies they develop from an infection, or from a vaccine.

The prospects for both of these developments are uncertain. It is not yet clear what level of immunity, if any, the antibodies may provide, nor how long that immunity would last. Perhaps, due to an unprecedented global effort, scientists and the pharmaceutical industry will be able to develop, test, and manufacture a vaccine in 18 months—the time frame that the public has been led to expect, though that would be far quicker than for any previous vaccine. Incremental improvements in treatment may come sooner, cutting the case fatality rate and limiting the damage to the kidneys, heart, and other organs. But given where we are now, it seems only prudent to assume that the crisis will last well into 2021 and possibly into 2022. If political leaders try to short-circuit vaccine and drug trials and green-light interventions that turn out to be ineffective or even dangerous, or if the virus mutates, the pandemic could be with us even longer.

In March, the high-income countries demonstrated that they were unwilling to try to reach herd immunity by simply letting the pandemic take its course. They chose instead to institute social distancing and lockdowns that have largely succeeded in "flattening the curve," though at enormous economic cost. How to exit from lockdown is now the immediate question. If countries can carry out universal and frequent testing, isolation of the infected, and immediate and thorough contact tracing and quarantine of the exposed, they will be in a stronger position to end lockdowns without catastrophic regression. If antibody tests can be made more reliable as measures of immunity, they may help too, by identifying and certifying people who would be the safest risks for frontline work in the pandemic.

The American performance in dealing with COVID-19 has been astonishingly inept.

The pressures to reopen economies are so powerful, however, that many political leaders are not waiting until a test-isolate-and-trace regime and immunity credentialing are sufficiently developed. For the near term, the world is therefore likely to see periodic outbreaks and waves of COVID-19—a stop-and-go pattern that at best will enable economies to limp along, with a steadily accumulating number of deaths, concentrated among the most vulnerable populations.

The American performance in dealing with COVID-19 so far has been astonishingly inept. Before a pandemic hits, countries often have a window of opportunity to prepare themselves and minimize the toll the disease will take. The United States had that opportunity but lost it because of Donald Trump's obtuse leadership. As a result, America now leads the world in COVID deaths. The early months of the pandemic do not inspire confidence about what will follow.

One conclusion clearly emerges from the early epidemiological and socioeconomic data: The pandemic's primary direct impact is to intensify the health and economic disparities that already exist in American society. African Americans and Latinos are becoming infected and dying at the highest rates, and as unemployment rises, millions of families who live from paycheck to paycheck are being plunged into poverty.

Furthermore, unlike the 14th-century bubonic plague, the COVID-19 pandemic is not going to strengthen labor's bargaining leverage. The reverse seems probable; even after the worst of the pandemic is over, unemployment may be greater than before, and labor's position less secure. (For labor's potential response to the pandemic, see Harold Meyerson's article "The Uncertain Future for Workers.") During the long decline of manufacturing that began in the 1970s, the United States avoided the high unemployment rates of many European countries by creating large numbers of low-paid jobs in retail and other in-person services, which by their nature couldn't be moved overseas. But it is precisely those jobs that are now disappearing as a result of lockdowns and fear of infection, and there is a good chance that many of them won't return.

The retail sector, already under pressure from the digital economy, is likely to undergo accelerated losses as a result of the pandemic. People who previously resisted online shopping have now become reliant on it and may not switch back. While local retail reels from the loss of foot traffic, the pandemic also appears to be accelerating the concentration of retail sales in Amazon, Walmart, Target, and Costco.

More generally, larger firms may gain at the expense of smaller ones that lack sufficient reserves or political connections to get bailed out, a continuation of the trends toward consolidation and monopoly (see David Dayen's article "After the Crisis, Big Business Could Get Even Bigger"). Local newspapers provide another example of accelerated decline: Already sinking, they have been sinking even faster as a result of the loss of local advertising, and some have now sunk for good.

These examples fit into a bigger pattern: the pandemic as an accelerating event. Writing in Foreign Affairs, Richard Haass makes such effects the basis of a general forecast about world politics. "COVID-19," he writes, "will not so much change the basic direction of world history as accelerate it. The pandemic and the response to it have revealed and reinforced the fundamental characteristics of geopolitics today. As a result, this crisis promises to be less of a turning point than a way station along the road that the world has been traveling for the past few decades."

The accelerating developments Haass refers to include great-power discord, resurgent nationalism, and the decline of global cooperation, due in part to the waning of American leadership. America, Haass writes, continues to lose the power of its example: "The federal government's slow, incoherent, and all too often ineffective response to the pandemic will reinforce the already widespread view that the United States has lost its way."

This is one picture of the long-term impact of the pandemic: It will bring about more of the same, only faster. That may turn out to be true; it is usually a good bet that changes that were building yesterday will continue tomorrow. Historical turning points are rare; otherwise, they wouldn't be turning points. But acceleration effects are not necessarily the end of this story. The pandemic could also reverse prevailing patterns and trends.

This is where the second and third types of change—the effects of the societal response and evaluations of the crisis—become especially relevant. Historically, as I mentioned at the outset, public-health responses to epidemics have strengthened governmental powers. After roughly a half-century when government has been in retreat in the United States, the response to the COVID-19 pandemic may now be part of a turnaround. New York Times columnist Jamelle Bouie had a column in mid-March about the pandemic titled "The Era of Small Government Is Over," only a few weeks after his conservative colleague Ross Douthat had a column titled "The Era of Limited Government Is Over." Bouie was writing about the need for government to "take responsibility for economic life on a scale not seen since the New Deal," while Douthat was commenting about the rise of "state-power conservatives" in the Trump era. As the differences between those two accounts indicate, to say that government is on the rebound is not to say what kind of government it will be, or that even after voting for trillions in bailouts, Republicans in Congress won't resume calls for austerity and privatization.


But the pandemic has not only strengthened the rationale for government; it has strengthened the rationale for progressive government. Some of the things we have done under duress—like covering the cost of coronavirus testing and treatment for the uninsured—we would have better done through a universal system coherently organized in advance. A pandemic highlights mutual interdependence: Your health depends on the health of others and on their being able to get health care if they get sick. It depends on the adoption of public-health measures that identity threats of infection before they reach you. And it depends on others being able to stay home from work when they get sick so they don't pass on infections.

More clearly than any other event, the pandemic has exposed the irrationalities of our health system. Job-based health insurance is exhibit number one. Just when Americans not only need health care themselves but need others to have it, millions of people are losing their coverage when they lose their jobs.

The neglect of public health is exhibit number two. A private system that has gobbled up resources has left us unprotected against collective risks; on the eve of the pandemic, the Trump administration was calling for cuts in the budget of the Centers for Disease Control. The absence of paid sick leave is exhibit number three. You may never have thought you had any stake in paid sick leave for supermarket workers, but now your stake should be obvious. The idea that "we're in this together" isn't just a slogan; it's an epidemiological fact.

Reality has taken sides. Many of Trump's supporters believed the president and conservative media when they told them the coronavirus was a hoax or a minor problem. Now many of them must know they were lied to and those lies are costing lives.

Die-hard Trumpians will not change, but many others may be open to persuasion. The whole experience has the potential to unleash rage; the question is against whom that rage will be directed. Trump and the Republicans are trying to direct it against the Chinese and, as always, against liberals and Democrats. But Americans are now in the position of a people left unprepared by their government in the face of a military attack. Trump put them in that position.

Public rage about the pandemic is also likely to increase when it becomes apparent that the powerful and well-connected are getting bailed out and given new tax breaks, while millions of ordinary people have been left to fend for themselves. This, too, is explosive.

Not every pandemic leaves a deep imprint; the 1918 flu pandemic killed more Americans than died in World War I, but it had little effect on American society. We should not assume COVID-19 will change America, and we should be wary of predicting an outcome that corresponds to what we wanted all along. But failing to seize a moment that confirms the logic of social solidarity would also be a mistake. The COVID-19 pandemic could reinforce and accelerate the ugly tendencies of our time. It will be a moment for genuine progress only if we persuade our fellow citizens about the lessons to draw from it.

Paul Starr is co-founder and co-editor of The American Prospect, and professor of sociology and public affairs at Princeton University.

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