J.M. Opal is associate professor and chair of the Department of History and Classical Studies at McGill University.
Steven M. Opal is research scientist and clinical professor of medicine, Warren Alpert Medical School of Brown University.
The novel coronavirus is the fifth new virus-borne pathogen to attack humanity in the past half-century, joining HIV-AIDS, Ebola, SARS and the H1N1 flu of 2009. More viruses are likely to emerge as we continue to abuse the delicate biosphere on which life depends.
A larger reflection on how we might better co-exist with our host planet is in order. Here, though, we propose two ways to cope with the pathogens that will come anyway – one in the field of domestic policy, and the other in the area of international relations.
Earlier this year, COVID-19 cases overran health systems in Iran, Italy, Spain and New York. Desperately ill patients swamped ERs and ICUs. Nurses and doctors frantically intubated patients whose oxygen levels were collapsing, sometimes contracting the virus themselves as it sprayed out of victims’ lungs. Modern hospitals came to resemble first-aid tents in war zones, and bodies piled up in churches and ditches.
How could this happen in Milan and Manhattan? Part of the answer is simple enough: Over the past several decades, hospitals have disappeared. In New York between 2000 and 2020, hospital capacity shrunk by 30 per cent as health insurance companies and the governments who love them pushed medical facilities to cover overhead costs. Throughout the United States, the capacity to care shriveled as hospitals behaved like businesses, downsizing when possible and closing when “necessary.” In rural America, some 170 hospitals shut their doors since 2005.
Something similar happened in Italy. Beginning in the 1990s, cuts to the national health service (Servizio Sanitario Nazionale) reduced the number of intensive care beds by more than 50 per cent. In 2009, austerity tightened its grip, leading to drastic declines in the number of doctors and nurses.
Reversing this trend is not enough. For what we need is not just more and larger hospitals for everyday patients, but also separate medical facilities to exclusively handle epidemics. In other words, we need to build hospitals that will normally remain empty. Think of them as epidemiological levees – idle in the calm, but vital in a storm.
Such facilities could be staffed by a skeleton crew of infectious disease specialists and supported by a kind of medical national guard, a corps of trained reservists who could work as nurses, lab techs, security and cleaning staff. We might reward such service by forgiving student debts.
When a new outbreak hits, these epidemic infrastructures would spring to life. They would protect the rest of the health system while concentrating resources for testing, treating and researching the new pathogen.
These buildings would not be for sale or rent. Rather they would be national sites of suitable dignity, set above the blinkered whims of the market in order to protect the health and well-being of the people.
Of course, pandemics don’t respect national boundaries. Since the mid-1800s, many countries have thus formed international protocols to cope with global health emergencies. Institutions such as the World Health Organization, created in 1948, played a crucial rule in eradicating smallpox during the Cold War and then in controlling SARS and Ebola early in this century.
Yet, here again, the novel coronavirus exposed all kinds of faults and failures.
Chinese authorities appear to have hushed up the virus at first. The European Union could not decide on a robust plan for member states, exposing ugly divisions between the wealthy north and the struggling south. Donald Trump blamed everyone but himself and then axed US funding for the WHO. Governments around the world had to bid against each other for vital equipment, with predictable effects: Rich countries hoarded the masks and ventilators, leaving the global south even more vulnerable to a potentially deadly second wave.
Improving international health systems will require more than vague appeals to human goodwill. As with hospital capacity, we need to start with something that is both daring and concrete – a novel adaptation of a proven tool.
Historically, the most effective way for two countries to get along is the bilateral treaty. Usually these treaties deal with military and economic affairs, specifying the location (or absence) of naval bases or the schedule (or absence) of tariffs. Yet, such agreements could also specify what the signatories will do in the event of an outbreak: when and how to close their borders, when and how to organize the return of foreign nationals, and when and how to share particular drugs or materiel.
Far from replacing international institutions, these treaties would reinforce global health efforts, adding teeth to well-established protocols. As more treaties are made, governments will feel pressure to sign on, lest they find themselves cut out of lifesaving deals. They might even find a way to get along with former foes.
These are just ideas. No doubt there are better ones.
But in this new world of emerging pathogens, the most frightening scenario is a docile return to national austerity and international hostility. Moving on from that morbid consensus requires bold, persistent experimentation – a spirit of practical utopianism in the face of grave peril.
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