When the Pandemic Hits the Most Vulnerable

Tuesday, March 31, 2020 - 12:00am

When the Pandemic Hits the Most Vulnerable

Developing Countries Are Hurtling Toward Coronavirus Catastrophe

Robert Malley and Richard Malley

ROBERT MALLEY is President and CEO of the International Crisis Group and served as White House Coordinator for the Middle East, North Africa, and the Gulf States from 2015 to 2017. 

RICHARD MALLEY is an Infectious Diseases Physician at Boston Children’s Hospital and Professor of Pediatrics at Harvard Medical School.

Imagine if virtually everything about the United States’ ongoing response to COVID-19, the disease caused by the novel coronavirus, goes wrong. That test kit shortages persist for months. That the country utterly fails to bolster the capacity of the hospitals and intensive care units and expand the supply of protective facemasks, gloves, and ventilators. That an already stretched health system proves incapable of tracing, isolation, and quarantine. That ordinary citizens fail to separate themselves from one another and most businesses stay open.

Now, imagine all of that, only several orders of magnitude worse. For any number of developing countries, such a scenario is not a matter of speculation. It’s a likely future, if not an imminent reality.

The novel coronavirus pandemic began mainly in developed countries theoretically better equipped to deal with its repercussions—whether China, South Korea, Singapore, or Italy. Although they, too, are struggling to cope, these nations enjoy relative affluence, strong institutions and political systems, and fairly effective medical systems by global standards. Were anything approximating what has hit those nations to afflict poorer or conflict-ridden ones, the effect could be crushing. That moment, unfortunately, may not be too far off: India, Pakistan, Brazil, Venezuela, Argentina, Nigeria, and South Africa each have hundreds, sometimes thousands, of cases. And as the experience of several current COVID-19 hot spots has shown, only a narrow gap can separate trickle from flood.  

BRACING FOR IMPACT

As of now, it is unclear to what extent the disease has spread to less developed countries, as these do not currently test sufficiently, if at all, for the presence of the virus. Perhaps many of them will be spared a major outbreak, although there is yet no sound scientific rationale for why that might happen. The virus could be highly seasonal and less transmissible in more humid, warmer climates, but so far there is little evidence to support this. Seasonality is a characteristic of well-established viruses, to which people have had opportunity to develop at least partial immunity. This is because in a setting where the population is already somewhat immune, changes in temperature and humidity are far more likely to affect the ability of a virus to spread. But in the case of the new coronavirus, such partial immunity is still lacking entirely. Singapore, despite its consistently warmer and more humid climate, was one of the first countries affected. Any impact weather might have on the coronavirus likely would be modest at best, delaying catastrophe rather than preventing it.

Known COVID-19 risk factors, such as obesity, cardiovascular disease, or hypertension, are more prevalent in high-income countries. Older populations are also more likely to suffer the disease’s worst consequences, whereas many developing countries skew toward the younger. Together, these facts could mean that the virus will hit lower-income countries less harshly. Again, however, any possible benefit would be slight: obesity and cardiovascular disease are still prevalent in poorer countries, whose populations also have to contend with a number of other health issues and environmental conditions that exacerbate the virus’s lethality, from chronic malnutrition to HIV/AIDS, tuberculosis, smoking, and poor air quality. And even the young are at some risk: COVID-19 can be lethal in individuals in their twenties, especially where urgent medical care is lacking.

The bottom line is that COVID-19 will almost certainly strike developing countries. The current low numbers are due either to a lack of detection or to the time lag between when the virus first spreads and when it begins to manifest. When it does strike, it will do so with a vengeance, as these countries bundle together all the most potent risk factors. Their basic health infrastructure is inadequate. They often lack clean running water. They also have high population densities and family cohabitation structures that will impede physical distancing. And when workers depend entirely on their paycheck to survive and the government cannot afford to cover the difference, the cost of shutting down businesses becomes unimaginable. As Ethiopian Prime Minister Abiy Ahmed pointed out [1] in the Financial Times, even a short interruption in planting or harvesting could have devastating consequences on his country’s food supply. All of this will inevitably be compounded by the dramatic global economic slowdown that awaits and which will hit fragile states the hardest, further damaging their resilience.

In short, the countries least able to impose physical distancing and perform contact tracing also tend to have the most overstretched health-care systems and the most precarious economies. A major COVID-19 outbreak in any of them could lead to an almost unfathomable number of dead. Estimates [2] in the United States suggest that roughly five to ten percent of COVID-19 patients require hospitalization in intensive care units (ICUs). In most poorer countries, acute shortages of ICU beds occur even under normal conditions. The United States has roughly 33 ICU beds per 100,000 people. That number drops to around two in India, Pakistan, and Bangladesh. In sub-Saharan Africa, the situation is even more dire: Zambia has 0.6 ICU beds per 100,000; The Gambia has 0.4; and Uganda has 0.1. If the pandemic hits these countries or any others like them, they will almost certainly face a sudden surge of cases that will overwhelm their health-care systems. As a result, the fatality rate from COVID-19—which in wealthier nations is currently estimated to be between 0.25 and three percent [3]—could be much higher in poorer countries. Because overstretched hospitals will not be able to care for people with other potentially treatable medical conditions, the overall mortality rate will be higher still. 

Do the math: if nothing changes, the prospect of millions of deaths is far from unrealistic.

NEXT STEPS

What should be done? Governments in developing countries should, of course, do their best to impose physical distancing, enhance their capabilities for testing and contact tracing, isolate their most vulnerable citizens, and shift their budgetary priorities to public health. But in many places, these interventions will be hard to implement, and they go only so far. Ultimately, much of the response will have to come from the outside—from wealthier states, international financial institutions, and the global health community.

The first step is to take the full measure of the impending crisis, rather than simply hoping for the best just because the worst has not yet materialized. Some immediate steps would help: International organizations or individual states should urgently provide funds so that developing countries can produce or buy medical supplies. Budgetary support and debt relief could free up other resources. The UN has already issued a $2 billion appeal [4] to combat the pandemic. It’s a start, but one that barely scratches the surface of need.

Whatever funds are made available should be spent wisely. Ramping up supplies of personal protective equipment to shield health-care workers makes perfect sense. By contrast, trying to substantially enhance existing ICU capabilities—by providing respirators, for example—would probably be misguided. Given the magnitude of the challenge, the priority should be to ensure that poorer countries can identify infected individuals and the people who were in contact with them and ensure that those with relatively mild symptoms can be diagnosed in testing centers or, ideally, at home rather than seek hospital care. That strategy is the best way to alleviate pressure on already strained health systems and save lives. To implement it, biotechnology companies, nonprofits, and international health organizations must join forces to develop and distribute low-cost testing tools.

Further down the road, if researchers manage to repurpose or develop a drug that can reduce the disease’s severity and make it less lethal, wealthier states should go against type: instead of prioritizing their own citizenry, they ought to simultaneously supply lower- and middle-income nations. The same goes for any future vaccine, which under a best-case scenario will be available 12 to 18 months from now. Because physical distancing and quarantine—the only alternative measures that currently exist to control the virus—are more difficult to implement in most poorer countries, global access to any effective therapeutic or vaccine should be considered a priority, not dealt with as an afterthought. Once the threat posed by COVID-19 has eventually died down, developing countries will once again need massive assistance—this time to help rebuild their economies and make sure they are better prepared for the next pandemic. 

SPILLOVER EFFECTS

Paying attention to the plight of poorer nations will no doubt be a difficult sell at a time when all countries, rich and poor alike, are facing the pandemic and the economic destruction that lies in its wake. Public opinions will resist spending resources abroad when so much is needed at home.

But if humanitarian considerations won’t suffice to make the case, more practical ones should. A pandemic that knows no borders will have ramifications that ignore them, too. However effective border closures may be, they will never fully contain the virus—there inevitably will be seepage, allowing the virus to return to areas where it had been eradicated. Vanquishing COVID-19 only in some places will remain a short-lived success if the disease is not vanquished everywhere.

Even outside the medical realm, spillover effects are likely. Many developing countries could suffer massive death tolls, economic meltdowns, and skyrocketing unemployment and poverty. The resulting social upheaval could take many forms, from violent intrastate conflict to massive refugee flows, a growth in organized crime, or terrorist groups taking advantage of the spreading chaos—each of which could eventually affect Europe and the United States.

A crisis of epic proportions could lie ahead or perhaps is already smoldering, unseen but no less potent. For wealthier nations, helping the developing world weather both the immediate impact of COVID-19 and its longer-term costs is not simply an act of humanitarian altruism. It is a self-serving and urgent necessity.

This is not a war : Coronavirus

This is not a war: Coronavirus pandemic presents unique opportunity to rebuild a sense of common good

By Michael Marder

March 30, 2020 "Information Clearing House" -   Just as previous wars on poverty, drugs & terrorism, a new ‘war on COVID-19’ is doomed to failure if a similar militaristic approach is used. We can only win if we restore the common good ruined by decades of neoliberal policies.

When speaking about the current coronavirus pandemic and a concerted response to it, we should say unequivocally: “This is not a war.” It’s true that this will directly contradict the stance of many world leaders, who have declared a war on the virus. But by denying the necessity of a militaristic framing, we don’t turn a blind eye to how critical the situation is. On the contrary, this will help to search for an alternative way of grappling with the coronavirus crisis, of inspiring people for collective and individual action, and – ultimately – of bringing about a better world after the current pandemic winds down.

Militaristic medicine

Modern western medicine is prone to indulge in militaristically inflected discourses and actions. We say that someone “fights an illness,” that the deceased has “lost a battle” with a lethal affliction, that tumors may be “aggressive” and that, therefore, they should be “aggressively attacked” with chemotherapy. This way of conceptualizing and practicing medicine lends itself easily to a “war on the virus.”

Prehistory of ‘the war on the virus’

Since the 1960s, governments around the world (beginning with the United States) have been extending the discourse of war beyond the context of military hostilities traditionally understood. In 1964, US President Lyndon Johnson announced the start of a “war on poverty” as he attempted to lay the foundations for a welfare state. In 1971, President Richard Nixon called drug abuse “public enemy number one” and declared a “war on drugs.” In 2001, President George W. Bush sounded his call for a global “war on terror” in response to the 9/11 attacks on the World Trade Center in New York. The 2020 ‘war’ on the coronavirus should be seen in the context of these declarations.

Invisible enemy

With each new declaration, the presumed enemy became more and more invisible, lacking recognizable outlines. It — rather than she or he — could be just about anywhere. With the enemy not easily localizable and potentially ever-present, war became total, engulfing all reality.

The logic of war

The invisible enemy that figures in a war on the coronavirus totalizes war by erasing a clear front line. While the line is erased, the front does not disappear: it is drawn between each of us and even within each of us, given the uncertainty of whether or not one is infected with the coronavirus. 

Another element of war that becomes distorted under present circumstances is the real possibility of killing and being killed. Neither the virus itself, nor those it infects, have the intention of killing anyone. So, in a war paradigm, the role of the virus is ambiguous: Is it an enemy or a weapon? Is a potentially infected human body the virus’s weapon, or itself an enemy? Leaders who fall back on militaristic metaphors have the responsibility of thinking through their logic and consequences.

Victory

In wars extended beyond the sphere of armed conflicts between human communities, victory is unattainable. So is defeat. Not only do wars on drugs, terror, and now a virus become all-encompassing; not only do they erase the front line and a discernible enemy figure, but they also have no end in sight, no definite cessation of hostilities. An inflated concept of war runs the risk of becoming a fight for a cause lost from the get-go.

Peace

Assuming that one could declare one’s victory or admit to being defeated in such wars, what would the peacetime that follows look like? In fact, peace is not at all contemplated in hostilities against terror or a virus. The maximalist objective they have is the complete elimination of the enemy, its total annihilation. These are wars without peace and, therefore, without the end that would limit them, in time or in conceptual space.

Destruction of the common good 

After decades of neoliberal policies that have resulted in the privatization of utility companies and pension funds, erosion of workers’ rights, divestment from public healthcare and other vital sectors and services, the experience and the notion of the common good have been rendered hollow. As a result, appeals to a population to act for the common good will fall on deaf ears and will not produce the same desired, emotionally charged effects as a declaration of war, implying the need to mobilize, to combine individual efforts and to make sacrifices.

A unique opportunity

Terrifying and tragic as it is, the coronavirus pandemic presents a unique opportunity — to rebuild a sense of common good, and breathe new meaning into it, grounded on experience. 
We would need to concentrate on the small acts of kindness and solidarity all around us. That includes people offering older neighbors help with buying food, provisions or medicines, caring about the most vulnerable. That is not to mention the enormous risks that medical personnel take in treating people who have contracted the virus. Combined with some government actions, such as abolishing the difference between public and private healthcare systems, these experiences may reinvigorate the notion of the common good. 

If an appeal to the common good were to make sense again, if it were to guide our behavior in a state of crisis, then it would be significantly more effective in overcoming an emergency situation than the frames of war that are again being thrust upon us.

Michael Marder, IKERBASQUE Research Professor in the Department of Philosophy at the University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain. He is the author of numerous scientific articles and 15 books, and contributor to the LA Review of Books, The Guardian, New York Times, El Pais, and other international publications. "Source"

The U.S. is losing its world superpower status

The US is losing its world superpower status – and this time, it might not recover

By Patrick Cockburn

March 30, 2020 "Information Clearing House" - The US may be reaching its “Chernobyl moment” as it fails to lead in combating the coronavirus epidemic. As with the nuclear accident in the Soviet Union in 1986, a cataclysm is exposing systemic failings that have already weakened US hegemony in the world. Whatever the outcome of the pandemic, nobody is today looking to Washington for a solution to the crisis.

The fall in US influence was visible this week at virtual meetings of world leaders where the main US diplomatic effort was devoted to an abortive attempt to persuade the others to sign a statement referring to the “Wuhan virus”, as part of a campaign to blame China for the coronavirus epidemic. Demonising others as a diversion from one’s own shortcomings is a central feature of President Trump’s political tactics. Arkansas Republican senator Tom Cotton took up the same theme, saying that “China unleashed this plague on the world, and China has to be held accountable”.

US failure goes far beyond Trump’s toxic political style: American supremacy in the world since the Second World War has been rooted in its unique capacity to get things done internationally by persuasion or by the threat or use of force. But the inability of Washington to respond adequately to Covid-19 shows that this is no longer the case and crystallises a perception that American competence is vanishing. The change in attitude is important because superpowers, such as the British Empire, the Soviet Union in the recent past or the US today, depend on a degree of bluff. 

They cannot afford to put their all-powerful image to the test too often because they cannot be seen to fail: an exaggerated picture of British strength was shattered by the Suez Crisis in 1956, as was that of the Soviet Union by the war in Afghanistan in the 1980s.

The coronavirus crisis is the equivalent of Suez and Afghanistan for Trump’s America. Indeed, these crises seem minor compared to the Covid-19 pandemic, which will have far greater impact because everybody on the planet is a potential victim and feels threatened. Faced with such a mega-crisis, the failure of the Trump administration to lead responsibly is proving extraordinarily destructive to the US position in the world.

The decline of the US is usually seen as the counterpart to the rise of China – and China has, at least for the moment, successfully got a grip on its own epidemic. It is the Chinese who are sending ventilators and medical teams to Italy and face masks to Africa. Italians note that the other EU states all ignored Italy’s desperate appeal for medical equipment and only China responded. A Chinese charity sent 300,000 face masks to Belgium in a container on which was written the slogan “Unity Makes Strength” in French, Flemish and Chinese.

Such exercises in “soft power” may have limited influence once the crisis is over, though this is likely to be a long time coming. But, while it does so, the message is going out that China can provide essential equipment and expertise at a critical moment and the US cannot. These changes in perception are not going to disappear overnight.

Prophecies that the US is in a state of decline have been two a penny almost as long as the US emerged from the Second World War as the greatest superpower. Yet the much-heralded downfall of the American empire has kept being postponed or has seen others decline even faster, notably the Soviet Union. Critics of “US decline-ism” explain that, while the US may no longer dominate the world economy to the degree it once did, it still has 800 bases around the world and a military budget of $748bn.

Yet the inability of the US military to use its technical prowess to win wars in Somalia, Afghanistan and Iraq has shown how little it has got in return for its vast expenditure.

Trump has not started any wars despite his bellicose rhetoric, but he has used the power of the US Treasury rather than the Pentagon. By imposing tight economic sanctions on Iran and threatening other countries with economic warfare, he has demonstrated the degree to which the US controls the world financial system.

But these arguments about the rise or decline of the US as an economic and military power miss a more important point that should be obvious. The very real decline of the US as a global power, as exemplified by the coronavirus pandemic crisis, has less to do with guns and money than many suppose, and much more to do with Trump himself as both the symptom and cause of American decline.

Put simply, the US is no longer a country that the rest of the world wants to emulate or, if they do, the emulators tend to be authoritarian nativist demagogues or despots. Their admiration is warmly welcomed: witness Trump’s embrace of the Hindu nationalist Indian prime minister Narendra Modi and his cultivation of the younger generation of tyrants such as Kim Jung-un in North Korea and Crown Prince Mohammed bin Salman in Saudi Arabia.

Democratic and despotic rulers will, at least at first, be strengthened by the pandemic, since in times of acute crisis people want to see their governments as saviours who know what they are doing.

But demagogues like Trump and his equivalents around the world are seldom much good at handling real crises, because they have risen to power by exploiting ethnic and sectarian hatreds, scapegoating their opponents and boosting their own mythical achievements.

An example of this is Brazil’s far-right president, Jair Bolsonaro, who accuses his opponents and the media of “tricking” Brazilians about the dangers of coronavirus. Such is the government’s laxity in enforcing any type of lockdown in Rio de Janeiro that in at least three slums, only the local drugs cartels have stepped in to declare and enforce an 8pm curfew.

Trump has always excelled in exploiting and exacerbating divisions in American society and producing simple-minded solutions to mythical crises, such as building the famous wall to stop the entry of Central American migrants into the US. But now he is faced with a real crisis, he is gambling that it will be of short duration and less severe than most experts predict. Polls show that his popularity has risen, probably because frightened people prefer to hear good news rather than bad. So far, the worst outbreaks of the illness have been in New York, Boston and other cities where Trump never had much support. If it spreads with the same intensity to Texas and Florida, then the loyalty of even Trump’s core supporters may evaporate.

The reason why the US is weaker as a country is because it is divided and these divisions will get deeper as long as Trump is in power. Hitherto he has avoided provoking serious crises, and his mishandling of the coronavirus epidemic shows that he was wise to do so. He is polarising an already divided country and this is the real reason for the decline of the US.

Patrick Cockburn is an award-winning Independent columnist who specialises in analysis of Iraq, Syria and wars in the Middle East. He has been with The Independent since 1990. In 2014 he forecast the rise of Isis. He also did graduate work at the Institute of Irish Studies, Queens University Belfast and has written about the effects of the Troubles on Irish and British policy in light of his experience.  "Source"

The U.S.Economy Is Uniquely Vulnerable to the Coronavirus

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Monday, March 30, 2020 - 12:00am

The U.S. Economy Is Uniquely Vulnerable to the Coronavirus

Why America’s Growth Model Suggests It Has Few Good Options

Mark Blyth

MARK BLYTH is William R. Rhodes ’57 Professor of International Economics at Brown University. He is a co-author, with Eric Lonergan, of Angrynomics [1] (Columbia University Press), forthcoming in June 2020.

Two competing epidemiological models currently guide and divide expert opinion on how best to respond to the novel coronavirus. The first, from Imperial College London [2], scared the U.S. and British governments [3] into instituting strict social-distancing measures. It predicted that if left unchecked, COVID-19, the disease caused by the virus, could kill over half a million people in the United Kingdom and 2.2 million in the United States [4]—not counting the many additional deaths caused by the collapse of each country’s health-care system. The second model, developed by researchers at Oxford University [5], suggested that the virus had already infected as much as 40 percent of the British population but that most had shown mild or no symptoms. According to this model, COVID-19 would still cause many deaths, and it would still severely stress health-care systems. But because it predicted fewer critical cases to come, the Oxford model suggested that an indefinite lockdown might not be necessary.

The attractions of the Oxford model are obvious. But if political leaders plan based on the Oxford model and turn out to be living in a world described by the Imperial College London model, they will have made a bad situation much, much worse [6].   

Similarly, high-stakes decisions must be made about how to protect national economies from the effects of COVID-19—decisions that can be predicted with another kind of model. Political economists use “growth models” [7] to describe what countries do to promote growth under normal circumstances, but these models also indicate how countries are likely to respond in the event of a crisis, such as a deadly pandemic. The United Kingdom’s basic growth model [8], for example, is driven by finance, housing, and, above all, domestic consumption. When the British economy got walloped by the coronavirus crisis and everyone was told to stay home, taking measures to boost consumption—such as guaranteeing 80 percent of wages [9]—was the necessary response. By contrast, in Germany, which is essentially a giant export platform sucking in demand from elsewhere, the necessary response included instituting a shorter workweek and guaranteeing company balance sheets [10], but not supporting wages.

For the United States, the question of how best to shield the economy from the effects of the pandemic is more complicated. In growth model terms, the United States is a massive exporter of primary products, aircraft, weapons, oil, services, software, e-commerce, and finance—simply because its economy represents a quarter of global GDP. But most of what drives the U.S. economy is still domestic consumption, and while that isn’t as credit-driven or debt dependent as some analysts [11] have claimed—the United States lies in the middle of the pack of Organization for Economic Cooperation and Development countries in terms of the ratio of household debt to household income [12]—the role that private-sector debt plays in the U.S. economy makes it difficult to respond to a crisis like this one. This reality is thrown into sharp relief when contrasting the U.S. growth model with those of other countries.

BLUNTING THE SHOCK

Trade-dependent growth models, such as those found in northern and western Europe, tend to have large welfare states [13] that act as “shock absorbers,” helping to mitigate the effects of economic shocks. In general, the more open a European country’s economy is to international trade, the bigger the welfare state it constructs to act as a buffer in case trade shuts off. Large welfare states also allow their citizens to carry large amounts of debt [14], since they effectively insure them against periods of unemployment; the most indebted people in the world are not Americans but the Danes and the Dutch.

In contrast, countries with growth models of the Anglo-American variety, especially the United States, tend to have weaker states, lower taxes, and large financial sectors. They have highly flexible labor markets rather than large welfare states, which means they ultimately depend on wages to drive growth. Since those wages have been buying less and less over time [15], credit cards [16], student loans [17], and medical debts [18] have become a standard part of U.S. household budgeting. When those household budgets shrink sharply, their debts are not compensated by the shock absorbers that countries such as the United Kingdom and Germany have in place.

This lack of shock absorbers is integral to the U.S. growth model, and under normal circumstances, it is a feature, not a bug. When systems such as the American one are hit by shocks, they tend to bail out their financial systems to keep credit flowing and let the real economy absorb the blow through unemployment [19] and austerity policies [20]. The assumption is that with no shock absorbers in place, prices and wages will adjust quickly, capital will be redeployed, and growth will return without the need for state intervention. But these are not normal circumstances. And as U.S. policymakers are quickly realizing, the usual playbook is of limited use in the face of the coronavirus pandemic.

DISASTER, AMPLIFIED

During a global economic crisis, the United States has one major advantage over other countries: it prints the global reserve currency. Other countries need U.S. dollars because their banking systems lend in dollars even though they can’t print them. During previous crises such as the 2008 financial crisis, sharp falls in global financial markets have been put right by Federal Reserve actions such as rate cuts and bond-buying programs. But this time, Federal Reserve action has not had its usual calming effect: financial markets have continued to fall, and the dollar’s dominance has failed to prevent a flight into cash [21]. 

Although Congress finally passed a $2 trillion economic stabilization package, its continuing inability [22] to agree on whom to bail out—companies or consumers—reflects tensions in the underlying growth model. The United States typically opts to protect capital and to simply let labor adjust through unemployment. But this instinct—to protect the big players and let workers take the hit—is also a key reason why the coronavirus pandemic is a disaster amplifier for the U.S. growth model in a way that is not true for Germany or even the United Kingdom.

The U.S. growth model works well as long as there is little unemployment, wages are being earned and spent, and credit is being recycled to cover the difference between wages and costs by consumers and companies. But when markets freeze and cannot price assets correctly (no one knows how much United Airlines stock is worth because they don’t know when Americans will be flying again), the growth model collapses. Once that happens, it is hard to find a bottom. The Federal Reserve and Congress can try to put a floor on asset prices by bailing out companies, but there is no bottom for the broader crisis of consumption that occurs when a third of the labor market is laid off and the other two-thirds are locked at home for an extended period of time. In this world, bailing out capital and expecting labor to adjust through wage cuts and unemployment is simply impossible given the scale of the shutdown.

The U.S. growth model is built in such a way that it simply cannot shut down without inflicting catastrophic damage on itself. Because the model is designed to adjust through reduced wages and employment rather than increased welfare outlays, political leaders can contemplate temporary unemployment benefits for a banking-induced shock, but not semipermanent cash transfers [23]—which is what the British are doing—and a near-total collapse in asset values. The British solution is too politically toxic to be anything other than a short-term expedient in the American context. So, once it became clear that—at least according to the Imperial College London model—the epidemiologically correct response was to put the economy in hibernation for several months, U.S. leaders started looking for other solutions.

One alternative solution, put forth by U.S. President Donald Trump but with proponents in many states, is to simply “restart the economy.” The direct cost of doing so, according to the Imperial College London model, could be the deaths of as many as 2.2 million Americans—or, as Texas Lieutenant Governor Dan Patrick bluntly suggested in a recent interview, old people need to die to save the economy [24].

Unfortunately, even if Americans turn out to be living in the world described by the less dire Oxford model, simply restarting the economy may not be feasible if that means up to 70 percent of Americans will catch a disease that requires intensive care in over ten percent of cases [25]. If Americans return to work, these infection rates would effectively shut down labor markets whether the president likes it or not. Consumers are unlikely to flock to malls when they could literally “shop till they drop,” and businesses whose employees are crowding emergency rooms are unlikely to invest in products they would be unable to ship.

The United States, with its 330 million people [26], 270 million handguns [27], 80 million hourly workers [28] with no statutory sick pay, and 28 million medically uninsured [29], faces challenges quite unlike those in other countries. Putting the economy in a freezer for six months or longer would destroy what’s left of its social fabric along with its growth model. But restarting it could turn the pandemic into a plague that could cause as much damage as the freezer.

ABANDONING THE LOCKDOWN

Which of these unappealing paths is the United States most likely to take? Again, examining its underlying growth model is revealing. It suggests that the United States will temporarily bail out companies, partially support consumption, and abandon the lockdown as soon as it can. Trump and those around him seem perfectly willing to gamble a few million lives to save their assets, betting that the health-care system will always be able to care for the elite [30].

If the coronavirus pandemic plays out according to the Imperial College London model, reopening the United States will simply compound the damage inflicted by the U.S. response. If the pandemic takes the course described by the Oxford model, other countries’ economies will sustain less damage than the U.S. economy and will rebound faster because lockdowns cause less economic damage [31] than allowing uncontrolled infections. The U.S. stock market may soar if the Oxford model turns out to be correct, but that will do nothing for the millions of hourly workers who have been laid off, the thousands of small businesses that have gone bankrupt, and the millions of extra infections that will result if the United States opens for business too early.

If the United States goes down this path, it may finally have reached the moment former President Bill Clinton said would never come: when people make money betting against America [32]. After all, if U.S. leaders’ best strategy in a pandemic is to “let it rip,” the rest of the world will soon stop regarding the United States as a model, for growth or anything else