Group items tagged

bloated, inefficient health-care system

Racist policies that have endured since the days of colonization and slavery left Indigenous and Black Americans especially vulnerable

decades-long process of shredding the nation’s social safety net

same social-media platforms that sowed partisanship and misinformation during the 2014 Ebola outbreak in Africa and the 2016 U.S. election became vectors for conspiracy theories

the COVID‑19 debacle has also touched—and implicated—nearly every other facet of American society: its shortsighted leadership, its disregard for expertise, its racial inequities, its social-media culture, and its fealty to a dangerous strain of individualism.

SARS‑CoV‑2 is neither as lethal as some other coronaviruses, such as SARS and MERS, nor as contagious as measles. Deadlier pathogens almost certainly exist. Wild animals harbor an estimated 40,000 unknown viruses, a quarter of which could potentially jump into humans. How will the U.S. fare when “we can’t even deal with a starter pandemic?,”

The U.S. cannot prepare for these inevitable crises if it returns to normal, as many of its people ache to do. Normal led to this. Normal was a world ever more prone to a pandemic but ever less ready for one. To avert another catastrophe, the U.S. needs to grapple with all the ways normal failed us

Many conservationists jump on epidemics as opportunities to ban the wildlife trade or the eating of “bush meat,” an exoticized term for “game,” but few diseases have emerged through either route. Carlson said the biggest factors behind spillovers are land-use change and climate change, both of which are hard to control. Our species has relentlessly expanded into previously wild spaces. Through intensive agriculture, habitat destruction, and rising temperatures, we have uprooted the planet’s animals, forcing them into new and narrower ranges that are on our own doorsteps. Humanity has squeezed the world’s wildlife in a crushing grip—and viruses have come bursting out.

This year, the world’s coronavirus experts—and there still aren’t many—had to postpone their triennial conference in the Netherlands because SARS‑CoV‑2 made flying too risky.

In 2003, China covered up the early spread of SARS, allowing the new disease to gain a foothold, and in 2020, history repeated itself. The Chinese government downplayed the possibility that SARS‑CoV‑2 was spreading among humans, and only confirmed as much on January 20, after millions had traveled around the country for the lunar new year. Doctors who tried to raise the alarm were censured and threatened. One, Li Wenliang, later died of COVID‑19. The World Health Organization initially parroted China’s line and did not declare a public-health emergency of international concern until January 30. By then, an estimated 10,000 people in 20 countries had been infected, and the virus was spreading fast.

it found a nation through which it could spread easily, without being detected

“By early February, we should have triggered a series of actions, precisely zero of which were taken.”

Even after warnings reached the U.S., they fell on the wrong ears. Since before his election, Trump has cavalierly dismissed expertise and evidence. He filled his administration with inexperienced newcomers, while depicting career civil servants as part of a “deep state.” In 2018, he dismantled an office that had been assembled specifically to prepare for nascent pandemics. American intelligence agencies warned about the coronavirus threat in January, but Trump habitually disregards intelligence briefings. The secretary of health and human services, Alex Azar, offered similar counsel, and was twice ignored.

countries “rely on bans to the exclusion of the things they actually need to do—testing, tracing, building up the health system,”

genetic evidence shows that the specific viruses that triggered the first big outbreaks, in Washington State, didn’t land until mid-February. The country could have used that time to prepare. Instead, Trump, who had spent his entire presidency learning that he could say whatever he wanted without consequence, assured Americans that “the coronavirus is very much under control,” and “like a miracle, it will disappear.” With impunity, Trump lied. With impunity, the virus spread.

A study showed that the U.S. could have averted 36,000 COVID‑19 deaths if leaders had enacted social-distancing measures just a week earlier. But better late than never: By collectively reducing the spread of the virus, America flattened the curve. Ventilators didn’t run out, as they had in parts of Italy. Hospitals had time to add extra beds.

Tests were in such short supply, and the criteria for getting them were so laughably stringent, that by the end of February, tens of thousands of Americans had likely been infected but only hundreds had been tested.

Sabeti’s lab developed a diagnostic test in mid-January and sent it to colleagues in Nigeria, Sierra Leone, and Senegal. “We had working diagnostics in those countries well before we did in any U.S. states,”

In response to the global energy crisis of the 1970s, architects made structures more energy-efficient by sealing them off from outdoor air, reducing ventilation rates. Pollutants and pathogens built up indoors, “ushering in the era of ‘sick buildings,’ ” says Joseph Allen, who studies environmental health at Harvard’s T. H. Chan School of Public Health. Energy efficiency is a pillar of modern climate policy, but there are ways to achieve it without sacrificing well-being. “We lost our way over the years and stopped designing buildings for people,”

The indoor spaces in which Americans spend 87 percent of their time became staging grounds for super-spreading events. One study showed that the odds of catching the virus from an infected person are roughly 19 times higher indoors than in open air. Shielded from the elements and among crowds clustered in prolonged proximity, the coronavirus ran rampant in the conference rooms of a Boston hotel, the cabins of the Diamond Princess cruise ship, and a church hall in Washington State where a choir practiced for just a few hours.

Between harsher punishments doled out in the War on Drugs and a tough-on-crime mindset that prizes retribution over rehabilitation, America’s incarcerated population has swelled sevenfold since the 1970s, to about 2.3 million. The U.S. imprisons five to 18 times more people per capita than other Western democracies. Many American prisons are packed beyond capacity, making social distancing impossible. Soap is often scarce. Inevitably, the coronavirus ran amok. By June, two American prisons each accounted for more cases than all of New Zealand. One, Marion Correctional Institution, in Ohio, had more than 2,000 cases among inmates despite having a capacity of 1,500.

America’s nursing homes and long-term-care facilities house less than 1 percent of its people, but as of mid-June, they accounted for 40 percent of its coronavirus deaths. More than 50,000 residents and staff have died. At least 250,000 more have been infected. These grim figures are a reflection not just of the greater harms that COVID‑19 inflicts upon elderly physiology, but also of the care the elderly receive. Before the pandemic, three in four nursing homes were understaffed, and four in five had recently been cited for failures in infection control. The Trump administration’s policies have exacerbated the problem by reducing the influx of immigrants, who make up a quarter of long-term caregivers.

the Department of Health and Human Services paused nursing-home inspections in March, passing the buck to the states. Some nursing homes avoided the virus because their owners immediately stopped visitations, or paid caregivers to live on-site. But in others, staff stopped working, scared about infecting their charges or becoming infected themselves. In some cases, residents had to be evacuated because no one showed up to care for them.

its problematic attitude toward health: “Get hospitals ready and wait for sick people to show,” as Sheila Davis, the CEO of the nonprofit Partners in Health, puts it. “Especially in the beginning, we catered our entire [COVID‑19] response to the 20 percent of people who required hospitalization, rather than preventing transmission in the community.” The latter is the job of the public-health system, which prevents sickness in populations instead of merely treating it in individuals. That system pairs uneasily with a national temperament that views health as a matter of personal responsibility rather than a collective good.

“As public health did its job, it became a target” of budget cuts,

Today, the U.S. spends just 2.5 percent of its gigantic health-care budget on public health. Underfunded health departments were already struggling to deal with opioid addiction, climbing obesity rates, contaminated water, and easily preventable diseases. Last year saw the most measles cases since 1992. In 2018, the U.S. had 115,000 cases of syphilis and 580,000 cases of gonorrhea—numbers not seen in almost three decades. It has 1.7 million cases of chlamydia, the highest number ever recorded.

In May, Maryland Governor Larry Hogan asserted that his state would soon have enough people to trace 10,000 contacts every day. Last year, as Ebola tore through the Democratic Republic of Congo—a country with a quarter of Maryland’s wealth and an active war zone—local health workers and the WHO traced twice as many people.

Compared with the average wealthy nation, America spends nearly twice as much of its national wealth on health care, about a quarter of which is wasted on inefficient care, unnecessary treatments, and administrative chicanery. The U.S. gets little bang for its exorbitant buck. It has the lowest life-expectancy rate of comparable countries, the highest rates of chronic disease, and the fewest doctors per person. This profit-driven system has scant incentive to invest in spare beds, stockpiled supplies, peacetime drills, and layered contingency plans—the essence of pandemic preparedness. America’s hospitals have been pruned and stretched by market forces to run close to full capacity, with little ability to adapt in a crisis.

“We’re designed for discrete disasters” like mass shootings, traffic pileups, and hurricanes, says Esther Choo, an emergency physician at Oregon Health and Science University. The COVID‑19 pandemic is not a discrete disaster. It is a 50-state catastrophe that will likely continue at least until a vaccine is ready.

American hospitals operate on a just-in-time economy. They acquire the goods they need in the moment through labyrinthine supply chains that wrap around the world in tangled lines, from countries with cheap labor to richer nations like the U.S. The lines are invisible until they snap. About half of the world’s face masks, for example, are made in China, some of them in Hubei province. When that region became the pandemic epicenter, the mask supply shriveled just as global demand spiked. The Trump administration turned to a larder of medical supplies called the Strategic National Stockpile, only to find that the 100 million respirators and masks that had been dispersed during the 2009 flu pandemic were never replaced. Just 13 million respirators were left.

The supply of nasopharyngeal swabs that are used in every diagnostic test also ran low, because one of the largest manufacturers is based in Lombardy, Italy—initially the COVID‑19 capital of Europe. About 40 percent of critical-care drugs, including antibiotics and painkillers, became scarce because they depend on manufacturing lines that begin in China and India. Once a vaccine is ready, there might not be enough vials to put it in, because of the long-running global shortage of medical-grade glass—literally, a bottle-neck bottleneck.

As usual, health care was a matter of capitalism and connections. In New York, rich hospitals bought their way out of their protective-equipment shortfall, while neighbors in poorer, more diverse parts of the city rationed their supplies.

Travel bans make intuitive sense, because travel obviously enables the spread of a virus. But in practice, travel bans are woefully inefficient at restricting either travel or viruses. They prompt people to seek indirect routes via third-party countries, or to deliberately hide their symptoms. They are often porous: Trump’s included numerous exceptions, and allowed tens of thousands of people to enter from China. Ironically, they create travel: When Trump later announced a ban on flights from continental Europe, a surge of travelers packed America’s airports in a rush to beat the incoming restrictions. Travel bans may sometimes work for remote island nations, but in general they can only delay the spread of an epidemic—not stop it.

the indiscriminate lockdown was necessary only because America’s leaders wasted months of prep time. Deploying this blunt policy instrument came at enormous cost. Unemployment rose to 14.7 percent, the highest level since record-keeping began, in 1948. More than 26 million people lost their jobs, a catastrophe in a country that—uniquely and absurdly—ties health care to employment

In the middle of the greatest health and economic crises in generations, millions of Americans have found themselves disconnected from medical care and impoverished. They join the millions who have always lived that way.

Elderly people, already pushed to the fringes of society, were treated as acceptable losses. Women were more likely to lose jobs than men, and also shouldered extra burdens of child care and domestic work, while facing rising rates of domestic violence. In half of the states, people with dementia and intellectual disabilities faced policies that threatened to deny them access to lifesaving ventilators. Thousands of people endured months of COVID‑19 symptoms that resembled those of chronic postviral illnesses, only to be told that their devastating symptoms were in their head. Latinos were three times as likely to be infected as white people. Asian Americans faced racist abuse. Far from being a “great equalizer,” the pandemic fell unevenly upon the U.S., taking advantage of injustices that had been brewing throughout the nation’s history.

Of the 3.1 million Americans who still cannot afford health insurance in states where Medicaid has not been expanded, more than half are people of color, and 30 percent are Black.* This is no accident. In the decades after the Civil War, the white leaders of former slave states deliberately withheld health care from Black Americans, apportioning medicine more according to the logic of Jim Crow than Hippocrates. They built hospitals away from Black communities, segregated Black patients into separate wings, and blocked Black students from medical school. In the 20th century, they helped construct America’s system of private, employer-based insurance, which has kept many Black people from receiving adequate medical treatment. They fought every attempt to improve Black people’s access to health care, from the creation of Medicare and Medicaid in the ’60s to the passage of the Affordable Care Act in 2010.

A number of former slave states also have among the lowest investments in public health, the lowest quality of medical care, the highest proportions of Black citizens, and the greatest racial divides in health outcomes

As of early July, one in every 1,450 Black Americans had died from COVID‑19—a rate more than twice that of white Americans. That figure is both tragic and wholly expected given the mountain of medical disadvantages that Black people face

Native Americans were similarly vulnerable. A third of the people in the Navajo Nation can’t easily wash their hands, because they’ve been embroiled in long-running negotiations over the rights to the water on their own lands. Those with water must contend with runoff from uranium mines. Most live in cramped multigenerational homes, far from the few hospitals that service a 17-million-acre reservation. As of mid-May, the Navajo Nation had higher rates of COVID‑19 infections than any U.S. state.

Americans often misperceive historical inequities as personal failures

the largely unregulated, social-media-based communications infrastructure of the 21st century almost ensures that misinformation will proliferate fast. “In every outbreak throughout the existence of social media, from Zika to Ebola, conspiratorial communities immediately spread their content about how it’s all caused by some government or pharmaceutical company or Bill Gates,”

Rumors coursed through online platforms that are designed to keep users engaged, even if that means feeding them content that is polarizing or untrue. In a national crisis, when people need to act in concert, this is calamitous. “The social internet as a system is broken,” DiResta told me, and its faults are readily abused.

Like pandemics, infodemics quickly become uncontrollable unless caught early.

In 2016, when DiResta spoke with a CDC team about the threat of misinformation, “their response was: ‘ That’s interesting, but that’s just stuff that happens on the internet.’ ”

The WHO, the CDC, and the U.S. surgeon general urged people not to wear masks, hoping to preserve the limited stocks for health-care workers. These messages were offered without nuance or acknowledgement of uncertainty, so when they were reversed—the virus is worse than the flu; wear masks—the changes seemed like befuddling flip-flops.

the United States underperformed across the board, and its errors compounded. The dearth of tests allowed unconfirmed cases to create still more cases, which flooded the hospitals, which ran out of masks, which are necessary to limit the virus’s spread. Twitter amplified Trump’s misleading messages, which raised fear and anxiety among people, which led them to spend more time scouring for information on Twitter.

By tying career advancement to the publishing of papers, academia already creates incentives for scientists to do attention-grabbing but irreproducible work. The pandemic strengthened those incentives by prompting a rush of panicked research and promising ambitious scientists global attention.

In March, a small and severely flawed French study suggested that the antimalarial drug hydroxychloroquine could treat COVID‑19. Published in a minor journal, it likely would have been ignored a decade ago. But in 2020, it wended its way to Donald Trump via a chain of credulity that included Fox News, Elon Musk, and Dr. Oz. Trump spent months touting the drug as a miracle cure despite mounting evidence to the contrary, causing shortages for people who actually needed it to treat lupus and rheumatoid arthritis. The hydroxychloroquine story was muddied even further by a study published in a top medical journal, The Lancet, that claimed the drug was not effective and was potentially harmful. The paper relied on suspect data from a small analytics company called Surgisphere, and was retracted in June.**

Science famously self-corrects. But during the pandemic, the same urgent pace that has produced valuable knowledge at record speed has also sent sloppy claims around the world before anyone could even raise a skeptical eyebrow.

No one should be shocked that a liar who has made almost 20,000 false or misleading claims during his presidency would lie about whether the U.S. had the pandemic under control; that a racist who gave birth to birtherism would do little to stop a virus that was disproportionately killing Black people; that a xenophobe who presided over the creation of new immigrant-detention centers would order meatpacking plants with a substantial immigrant workforce to remain open; that a cruel man devoid of empathy would fail to calm fearful citizens; that a narcissist who cannot stand to be upstaged would refuse to tap the deep well of experts at his disposal; that a scion of nepotism would hand control of a shadow coronavirus task force to his unqualified son-in-law; that an armchair polymath would claim to have a “natural ability” at medicine and display it by wondering out loud about the curative potential of injecting disinfectant; that an egotist incapable of admitting failure would try to distract from his greatest one by blaming China, defunding the WHO, and promoting miracle drugs; or that a president who has been shielded by his party from any shred of accountability would say, when asked about the lack of testing, “I don’t take any responsibility at all.”

Trump is a comorbidity of the COVID‑19 pandemic. He isn’t solely responsible for America’s fiasco, but he is central to it. A pandemic demands the coordinated efforts of dozens of agencies. “In the best circumstances, it’s hard to make the bureaucracy move quickly,” Ron Klain said. “It moves if the president stands on a table and says, ‘Move quickly.’ But it really doesn’t move if he’s sitting at his desk saying it’s not a big deal.”

everyday Americans did more than the White House. By voluntarily agreeing to months of social distancing, they bought the country time, at substantial cost to their financial and mental well-being. Their sacrifice came with an implicit social contract—that the government would use the valuable time to mobilize an extraordinary, energetic effort to suppress the virus, as did the likes of Germany and Singapore. But the government did not, to the bafflement of health experts. “There are instances in history where humanity has really moved mountains to defeat infectious diseases,” says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “It’s appalling that we in the U.S. have not summoned that energy around COVID‑19.”

People suffered all the debilitating effects of a lockdown with few of the benefits. Most states felt compelled to reopen without accruing enough tests or contact tracers. In April and May, the nation was stuck on a terrible plateau, averaging 20,000 to 30,000 new cases every day. In June, the plateau again became an upward slope, soaring to record-breaking heights.

It is no coincidence that other powerful nations that elected populist leaders—Brazil, Russia, India, and the United Kingdom—also fumbled their response to COVID‑19. “When you have people elected based on undermining trust in the government, what happens when trust is what you need the most?”

Drawn to novelty, journalists gave oxygen to fringe anti-lockdown protests while most Americans quietly stayed home. They wrote up every incremental scientific claim, even those that hadn’t been verified or peer-reviewed.

The virus was never beaten in the spring, but many people, including Trump, pretended that it was. Every state reopened to varying degrees, and many subsequently saw record numbers of cases. After Arizona’s cases started climbing sharply at the end of May, Cara Christ, the director of the state’s health-services department, said, “We are not going to be able to stop the spread. And so we can’t stop living as well.” The virus may beg to differ.

The long wait for a vaccine will likely culminate in a predictable way: Many Americans will refuse to get it, and among those who want it, the most vulnerable will be last in line.

It is almost unheard-of for a public-health measure to go from zero to majority acceptance in less than half a year. But pandemics are rare situations when “people are desperate for guidelines and rules,” says Zoë McLaren, a health-policy professor at the University of Maryland at Baltimore County. The closest analogy is pregnancy, she says, which is “a time when women’s lives are changing, and they can absorb a ton of information. A pandemic is similar: People are actually paying attention, and learning.”

As the economy nose-dived, the health-care system ailed, and the government fumbled, belief in American exceptionalism declined. “Times of big social disruption call into question things we thought were normal and standard,” Redbird told me. “If our institutions fail us here, in what ways are they failing elsewhere?” And whom are they failing the most?

It is hard to stare directly at the biggest problems of our age. Pandemics, climate change, the sixth extinction of wildlife, food and water shortages—their scope is planetary, and their stakes are overwhelming. We have no choice, though, but to grapple with them. It is now abundantly clear what happens when global disasters collide with historical negligence.

America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies. It should strive to prevent sickness instead of profiting from it. It should build a health-care system that prizes resilience over brittle efficiency, and an information system that favors light over heat. It should rebuild its international alliances, its social safety net, and its trust in empiricism. It should address the health inequities that flow from its history. Not least, it should elect leaders with sound judgment, high character, and respect for science, logic, and reason.

The continent averages less than one intensive care bed and one ventilator per 100,000 people, Reuters found.

Donations have poured in from a foundation set up by Chinese billionaire Jack Ma, and the World Bank is helping procure more than $1 billion worth of equipment for Africa.

even in a best-case scenario, Africa could need at least 111,000 more intensive care beds and ventilators - more than 10 times the number it has at present.

Tanzania, publicly criticised by the WHO for not restricting large gatherings, has sometimes gone for days without updating its coronavirus figures and has refused to tell donors anything about its public health resources

In Madagascar, where the president is pushing a botanically-based remedy untested in an international clinical trial, the health ministry took five weeks to respond to Reuters questions about the number of ventilators in the country.

The WHO does not have the funds to carry out detailed surveys on a regular basis, Yao said. "Information is critical for us to better help," he told Reuters. "It's difficult to anticipate their overall needs if you don't have accurate information."

around 685 tests have been carried out per million people - far below the 37,000 per million in Italy or 22,000 in the United States.

South Africa accounts for 30% of Africa’s tests, although it has less than 5% of the population. Nigeria, which has 15% of the population, has carried out just 2% of testing; it began by testing strategically then broadened it out, Health Minister Osagie Ehanire said. Chad and Burundi have carried out fewer than 500 tests each. Chad said it didn’t have enough testing kits and staff after many of them had fallen ill; Burundi did not respond. Tanzania carried out 652 tests and identified 480 cases.

The Africa CDC, set up by the African Union in 2017, worked with the WHO to rapidly roll out testing. In January, only South Africa and Senegal could test for the new coronavirus, but now all African countries can perform tests apart from tiny Lesotho and the island nation of Sao Tome and Principe.

Intensive care beds are expensive, difficult to run, and very unevenly distributed. Chad, an oil-rich but impoverished nation of 15 million people, has only 10, whereas the island nation of Mauritius, a financial hub home to 1.2 million, has 121.

The continent’s three giants - Nigeria, Ethiopia and Egypt - have 1,920 intensive care beds between them for more than 400 million people

Kenya has 518 beds in its public and private facilities, but 94% are already occupied by non-COVID-19 patients

Under a best-case scenario - what Imperial College researcher Charlie Whittaker described as a complete lockdown for an indefinite time - at least 121,000 critical care beds will be needed at the peak of the pandemic on the continent, Reuters found. That compares with 9,800 at present

Africa has no history of building ventilators. South Africa’s state-owned defence company Denel plans to begin making them, and institutions in Kenya and Senegal have developed prototypes. But authorities in Senegal say they’ve only certified imports before; it could take months to get a prototype certified and mass-produced.

In many nations like Nigeria, South Sudan and Zimbabwe, electricity is extremely unreliable and hospitals depend on diesel-powered generators. Some health facilities in poorer, often rural, areas are unable to pay for the constant refueling and maintenance they need.

Continent-wide, one doctor serves an average of 80,000 people, World Bank data shows. There are more in wealthy Mauritius - 2 doctors per 1,000 - but countries like Liberia, Malawi or Burundi have far fewer.

only nine countries have one or more physicians qualified to administer anaesthetics per 100,000 people, according to the World Federation of Societies of Anaesthesiologists. Most have staffing levels comparable to Afghanistan or Haiti.

the World Bank is helping more than 30 African nations source medical supplies. South Sudan recently received a donation of five ventilators, bringing its total to nine. But the new ventilators have yet to be plugged in because the isolation centre is being expanded

Private hospitals are generally better staffed, but their revenues have dropped by an average of 40% since March, mostly due to a decline in elective surgeries and regular outpatient chronic treatment, said the Africa Healthcare Federation, an umbrella organisation for the private healthcare sector. Private hospitals are also having to spend more on protective equipment, and private insurance companies are delaying settling claims in many countries, said Dr. Amit Thakker, the head of the federation.

U.N. relief officials and aid organizations are bracing for what they fear could be a cataclysmic second phase of the pandemic: spreading in the close-quarters encampments of the world’s more than 25 million refugees and another 40 million internally displaced people.

More than 3 billion people lack access to hand-washing facilities, depriving them of one of the most effective first lines of defense against the spread of the coronavirus, according to UNICEF

the effort to ramp up an international aid response is being hampered by the quest to ensure the safety of international staff. Those concerns have been amplified by the announcement last week that David Beasley, the executive director of the Rome-based World Food Program, had been infected with the coronavirus. Some international relief agencies have recalled senior field officers, fearing they could be infected.

Konyndyk, who worked on the response to the Ebola epidemic in West Africa for the U.S. Agency for International Development, said that U.N. and relief agencies are having to balance ensuring the health of their own staff with delivering care to needy communities.

“You would have a hard time designing a more dangerous setting for the spread of this disease than an informal IDP settlement,” he said. “You have a crowded population, very poor sanitation … very poor disease surveillance, very poor health services. This could be extraordinarily dangerous … and I don’t think that’s getting enough global attention yet.”

In conflict-riven countries from Afghanistan to South Sudan to Yemen, dismal health care infrastructures are already overburdened after years of fighting

After five years of war, with millions of people on the brink of famine, Yemen’s population is more vulnerable to a coronavirus outbreak than those of most other countries. The conflict has left most of the country’s population effectively immunocompromised,

“For many population groups, living in overcrowded conditions, social distancing is a challenge or impossible,” according to the Assessment Capacities Project report. Many countries that host refugee camps, such as Afghanistan and Bangladesh, are likely to be overwhelmed by the health needs of their own citizens. Nations with weak health systems “may struggle to screen, test, and contain the epidemic for the host population let alone the refugees,”

In Gaza, the U.N. Relief and Works Agency (UNRWA), which provides primary care for about 70 percent of the territory’s more than 1.8 million people, is bracing for the likely arrival of the coronavirus in one of the most densely populated place in the world. The U.N. agency—which the Trump administration defunded last year and has sought to dismantle—has some 22 medical clinics in Gaza, putting it on the front lines of the defense of the coronavirus.

“I’m told that there are 60 ICU beds in the hospitals,” Matthias Schmale, the director of Gaza’s UNRWA operations, told Foreign Policy. “If there is a full-scale outbreak the hospital sector won’t cope.”

The leaders of major relief organizations are pressing donors to grant them greater flexibility to redirect funding from existing programs that are likely to be paralyzed by the pandemic and use that money for programs—including clean water and sanitation projects—that could help stem the crisis.

“As bad as it is now in the well-organized and affluent north, with health systems, good sanitation, and big infrastructure, imagine how it will be when it will hit crowded camps with refugees and displaced people,” said Egeland, who spoke by telephone from quarantine in Norway.

sweeping U.S. and U.N. economic sanctions imposed on governments in Iran, North Korea, and Venezuela are hampering relief efforts.

Egeland acknowledged that most U.N. sanctions regimes, including those for Iran and North Korea, include exemptions for the import of humanitarian goods. But the sanctions have scared financial institutions from providing vital financial services to relief agencies. “Not a single bank had the guts to transfer money, because they were all afraid to be sued by the U.S. government,”

The World Health Organization announced earlier this year that more than $675 million will be required through April—including $61 million for its own activities—to mount an international campaign against the virus. Though WHO’s Director-General Tedros Adhanom Ghebreyesus said recently that more money would be needed. On Feb. 17, UNICEF issued an urgent request for $42.3 million to support the coronavirus response. It will be used to reduce transmission of the virus by promoting distance learning for kids who can’t attend school and public information aimed at shooting down misinformation.

Guterres, meanwhile, expressed concern that the pandemic could claw back decades of efforts to raise international health standards and to scale back the most extreme levels of poverty, and undercut U.N. sustainable development goals, which are designed to improve the standard of living around the world by the year 2030.

“COVID-19 is killing people, as well as attacking the real economy at its core—trade, supply chains, businesses, jobs,” Guterres said. “Workers around the world could lose as much as $3.4 trillion.”

“We need to focus on people—the most vulnerable, low-wage workers, small and medium enterprises,” Guterres said. “That means wage support, insurance, social protection, preventing bankruptcies and job loss. That also means designing fiscal and monetary responses to ensure that the burden does not fall on those who can least afford it. The recovery must not come on the backs of the poorest—and we cannot create a legion of new poor. We need to get resources directly into the hands of people.”

Despite testing far less than its neighbors, Somalia has the highest death toll in East Africa. On April 17 and 18, 72 people were tested, out of which 55 were confirmed positive, a staggering 76 percent infection rate. Since this revelation, the Somali government has stopped sharing the numbers of people tested with the public.

Anecdotal accounts of COVID-19 symptoms and a spike in burials abound. “There is extraordinary community transmission. Infections and deaths are out of control,” explained a Mogadishu doctor on the condition of anonymity. “And why visit a hospital if they can’t treat you?” Somalia’s health infrastructure is mere scaffolding: scarce public hospitals struggling with a lack of equipment, unaccredited doctors in private facilities offering unaffordable services, and medication that is as low-grade as it is scarce.

Somalia’s best-equipped medical institution, Erdogan Hospital in Mogadishu, was shut down in April after 3 of its doctors were infected. Martini Hospital—kitted with 76 beds—is the only medical facility in the whole country designated to treat the infected

Answers to this acute health crisis lie in part with the government’s 2020 budget, which allocated $9.4 million for health spending, a mere 2 percent of the national budget. A whopping $146.8 million was reserved for security institutions—a telling indication of a cash-strapped state facing widespread security threats.

The group heralded the disease as divine punishment for the treatment of Muslims globally. Weaponizing the disease, al-Shabab ushered in Ramadan with an attempted vehicle-borne explosive attack at a military base on the first full day of the holy month.

Like the virus, al-Shabab transcends national borders and presents risks not only to Somalia but to its pandemic-weakened neighbors, particularly Kenya, which has weathered violent attacks from the group for years. Born out of a power vacuum itself, al-Shabab will capitalize on lapses in states’ security apparatus as governments redirect resources from preempting terror attacks to enforcing curfews

risks reversing critical security gains

Kenya’s northeastern towns lying on its border with Somalia have been particularly vulnerable to devastating al-Shabab attacks. In response to the illegal smuggling of people and goods from both Somalia and Ethiopia, Kenyan security authorities have recently ramped up aerial surveillance along its borders, in part, to curtail cross-border infection. Ethiopia’s health minister announced last week that 13 of its new cases were imported via illegal migration from Djibouti and Somalia

More than 80 percent of global trade passes through the Gulf of Aden

the resurgence of piracy can be expected

For more than a year now, the central government has been embroiled in a rancorous fight with two of its federal states. This being an election year, the fledgling Somali state finds itself at a critical juncture. It remains to be seen whether federal elections will be postponed, following in the footsteps of neighboring Ethiopia.

The disappearance of remittances—a lifeline for millions on the continent and estimated at $1.4 to $2 billion annually in Somalia alone—makes the situation all the more desperate. These critical cash flows have dried up as a global recession sets in and incomes of workers in the diaspora shrink.

harrowing statistics from across Europe show that Somali communities have been disproportionately affected by COVID-19. In Sweden, Somalis are dying from the virus at “an astonishing high rate” according to the BMJ despite accounting for only 0.69 percent of the population. The World Bank is calling on governments to designate remittance companies as an essential service, a crucial step to easing restrictions on these financial flows.

The populations most at risk in Somalia are those living in the densely populated camps scattered across the country. More than 2.5 million internally displaced people live in these cramped conditions, already weakened by malnutrition and compromised immune systems, and with limited access to clean water, soap, or bathrooms.

According to the World Food Programme, the number of food-insecure people in East Africa is projected to reach up to 43 million in the next few months—more than double what it is now—sparking fears of conflict over scarce resources.

The specter of drought and famine, alongside the unforgiving plague of locusts that has ravaged crops in recent months

deadly flash floods

will force more people to move, compounding the internal displacement crisis and heightening intercommunal tensions  even as it spreads the disease further

Border closures across the region have throttled migration flows, making it ever harder for people to escape conflict or starvation. This will simply force migration into the shadows, opening up avenues for human trafficking and exploitation. Irregular movement of refugees has already been observed across the Horn of Africa’s highly porous borders.

During  Friday prayers at Mogadishu’s Marwazi mosque on April 10, armed forces tried to forcibly disperse a congregation of worshippers without notice. A massive demonstration broke out, and shoulder-to-shoulder prayers continue across the country today

Riots swept the streets of Mogadishu again on April 24 in response to the fatal shooting of two innocent civilians by police as they tried to enforce a curfew. Ramadan, replete with nightly rounds of public taraweeh prayers, is likely to catalyze disease spread in the absence of clear communication with communities and Islamic leaders.

The virus demands self-sufficiency. Countries are forced to make do with their own systems, however broken.

government’s restrictions on press freedom and access to information about the novel coronavirus to the detriment of its own people

As has often been the case in the disaster-prone country, it will be up to grassroots community groups, the private sector, and members of the diaspora to mobilize en masse to contain the crisis.

Two officials at the Ministry of Health have already been arrested on corruption allegations related to COVID-19 response donations, denting public confidence.

With domestic flights suspended, it is all the more critical to invest in hospital and testing capacity across the country. This cannot be achieved without genuine collaboration between the federal government and its constituent member states.

Waters has no health insurance when he’s back in the U.S. (even as a nurse). Working on the front lines during a global pandemic is probably not the best place for an uninsured nurse. Like most expats, Waters has private health insurance that will cover him in literally any country in the world… except the U.S.

David’s visa is entirely tied to his job, which he fears will be axed soon in a country economically crushed by this pandemic. He could theoretically apply for other jobs before his visa expires, but not in reality. “The police won’t even let me leave my house!” If he loses his job, he’ll be forced to go home, though he hasn’t a clue where “home” would be. That and he would have no job, place to live, or health insurance. 

The uncertainty around visas is also hard on couples and families who have visas tied exclusively to their relationship, even though these are oftentimes the most secure ones to have

“Immigrants are the ones blamed during economically hard times,” says Schober, “and people look for a scapegoat.” It’s pretty universal for humans to have less compassion for people they don’t have something in common with, he says, so foreigners around the world are often the most vulnerable.

Immigration lawyer Diana Moller of Seattle says she’s concerned about green card holders who are stuck abroad. Legally, they can return to the U.S., but many are under lockdown due to the virus. In order for them to apply for citizenship, they can’t be overseas for long. “If a client is outside the U.S. more than six months, their continuous physical presence is at risk of being broken.” If they’re gone for a year, they’ll have to wait four years and one day before eligible again for citizenship.

Before any of the virus chaos started, the U.S. has notoriously made it hard for many (not rich) foreigners to live, work, or permanently immigrate here, but the pandemic has led some to just abandon ship entirely and go home.

Stéphane’s most recent visa was up for renewal again this spring, but the pandemic forced him and his wife to consider the risk of him losing his work contract, thus being locked into NYC illegally with no job, no way to pay rent, and no health insurance. “The U.S. looked like the worst place to be an illegal immigrant,” he says—especially during a pandemic. So he gave up the American life he spent five years building and took his family back to France, even though it means he’s now starting over. “The French health care/social net is way better and higher education is relatively cheap and good quality,”

Like every single American I spoke with, Sarah is pretty scared of getting sick in the U.S. due to lack of good insurance. “Honestly, my life would have been so much easier if me and my boyfriend had just gotten married two years ago,” like they’d considered. France is her home but she’s not allowed there any time soon. “I wish I’d just stayed in France.” She would have been illegal until getting married, but she would have at least been with him. And insured. 

“A good thing about having an ineffective Congress is that immigration changes are slow,” says Schober. “They can never agree on anything.”

important to remember that people working in immigration are doing their best to care for such a vulnerable group of people right now. Some are even putting their lives and health at risk to show up at court for their clients. Schober says it’s especially important to remember that the present situation will take a lot of patience from both the attorney and client. But for now, it’s a waiting game for millions of people in limbo around the world, all wondering if the countries they have built their lives in will soon change the rules and make them return home… wherever that is. 

The flu vaccine that Americans receive at drugstores and doctors’ offices is based on work that the CDC and Food and Drug Administration conduct through the WHO

Since 2004, the U.S. has helped build a global network of WHO flu centers, buying lab equipment and training scientists. The centers in more than 100 countries collect samples from sick people, isolate the viruses and search for any new viruses that could cause an epidemic or pandemic. The CDC houses one of five WHO Collaborating Centers that collect these virus samples, sequence the viral RNA and analyze reams of data on flu cases around the world, while the FDA runs one of the four WHO regulatory labs that help vaccine makers determine the correct amount of antigen, which triggers the immune response, to include in vaccines.

The Trump administration’s plan to bypass the WHO and address global health problems directly with foreign governments will run into trouble in the Middle East, South Asia, Africa and other regions where Americans encounter hostility or have difficulty operating

The onslaught of the coronavirus has hurt immunization activities worldwide, causing a rise in measles and other diseases.

fear that the U.S. decision will endanger a WHO-led program that has come tantalizingly close to the eradication of polio

The uncertainty has caused concern in the pharmaceutical industry as well as the government, officials said. The CDC could lose access to the data and virus samples that protects Americans from potentially deadly strains of flu from around the world.

“People coming into countries in WHO shirts to work on polio or AIDS are less threatening,”

“No one is looking for U.S.-based alternatives to WHO,” he said. “Dead on arrival. There is no way they are going to be supported or even accepted.”

The WHO has a history of bringing together ideological rivals. William Foege, a CDC director under Presidents Ronald Reagan and Jimmy Carter, credits the global agency for uniting American scientists and their counterparts from the Soviet Union during the Cold War to eradicate smallpox in a little more than a decade.

“It’s not a failed bureaucracy,” said Foege, who worked on the international fight against smallpox. “If you go there and see all they do every year, and they have a budget for the entire world that’s smaller than many medical centers in this country.”

global health experts across the political spectrum admit that the WHO needs reform

“In general, the WHO is deferential to member states,” Kolker said. “Yes, it should have been more aggressive in response to Chinese obstruction. Tedros surely realizes the public statements were too deferential to China. But the organization is not dominated by China. Its weaknesses reflect the challenges we have long faced in international collaboration on public health.”

“There’s one country that’s desperate for the United States to leave the WHO, and that’s China,” Sen. Chris Murphy, a Connecticut Democrat, said at a hearing Thursday of the U.S. Senate Committee on Foreign Relations. “They are going to fill this vacuum. They are going to put in the money that we have withdrawn, and even if we try to rejoin in 2021, it’s going to be under fundamentally different terms because China will be much more influential because of our even temporary absence from it.”

Not only is China offering aid to virus-hit countries, but it is also touting its success in bringing its own epidemic under control. It has, in effect, rolled extreme public health crackdowns into the broader “Beijing Consensus” or  “China Model” of totalitarian state capitalism that it has been promoting since the advent of the 2007-2009 global financial crisis.

If the United States and European Union are now in crisis, it is because they failed to act decisively to break the wave when they first knew it knew was coming. But these were failures of policy, not failures of democracy.

Western democracies may ultimately lose the coronavirus propaganda war, but China certainly won’t win it

it is particularly worrying how far the coronavirus is spreading within the political elite in countries where many senior politicians are over 60, making them especially at risk. In Burkina Faso, a country that has experienced more than its fair share of instability in recent years—and which is currently struggling against an insurgency—the ministers of foreign affairs, education, the interior, and mines have all tested positive.

In Nigeria, one of the most economically and politically important countries on the continent, Abba Kyari, the chief of staff to 77-year-old President Muhammadu Buhari, has come down with the disease. Although media outlets have reported that Buhari tested negative, this has not stopped damaging rumors that the often ill president has been incapacitated from circulating in Twitter.

The world should also be paying close attention to Iran, where media censorship has obscured the extent of the crisis. So far, two vice presidents and three cabinet officials are known to have gotten the virus. It is also estimated that 10 percent of parliament and many prominent figures within the Islamic Revolutionary Guard Corps are sick—including a senior advisor to the 80-year-old supreme leader, Ayatollah Ali Khamenei, raising questions about his health.

A leadership crisis is just one of the potential sources of political instability the coronavirus could spark. Others include the risk of popular unrest and the debt crises that will soon engulf many countries around the world. Along with the fact that some of the main providers of foreign aid are now preoccupied with their own financial crises, there is a serious risk that politically and economically weak states will face a perfect storm of elite deaths, debt, mass unemployment, and social unrest

In countries where poverty is widespread, health systems are weak, and the cost of food is high, citizens are already under intense financial pressure. Despite earning the least, those who live in slum areas around capital cities often have to pay more for access to water and food than those who have valuable properties in the city centers. While the cramped conditions of slum living make it implausible to self-isolate, limited and inconsistent income make it impossible to buy in bulk—or to stay home for weeks on end without working and risk starvation. For many of the poorest people in the world, hunger is just a few days away

Already, there have been sporadic incidents of unrest in a number of countries, including prison protests in Italy. Meanwhile, heavy-handed efforts to enforce the curfew threaten to further erode public confidence in the government and the security forces. There are reports of widespread human rights abuses being committed in Kenya and South Africa, where the police have been using water cannons and rubber bullets to enforce the lockdown.

Unless the deferral of debt goes hand in hand with debt cancellation and long-term rescheduling, the end of the coronavirus crisis could be followed by a series of economic collapses across the developing world. In turn, this will undermine the ability of governments to provide affordable fuel and food, further increasing the risk of public unrest.

Civil wars, political instability, and poverty kill millions of people every year. These deaths rarely elicit the kind of comprehensive media coverage that COVID-19 has received, but they are no less important. It is possible to prevent the worst political consequences of the coronavirus but only if governments and institutions act now. Wealthy nations must increase their aid budgets rather than cut them, and international organizations must anticipate and work to avoid political crises more proactively than ever before. That is the only way to collectively survive the present in a way that does not undermine the future.

By exploiting governance gaps, terrorists and insurgents gain valuable propaganda victories

by launching public health campaigns and dispensing information and advice on how to avoid being infected, terrorist and insurgent groups can position themselves as a trusted voice on these issues.

Good governance and competent public administration are the best medicine for pandemics and insurgencies alike.

We realize that what we do now, well or badly, will be remembered later on. This sense of enacting history matters. For some of us, it partly compensates for the disruption of our lives.

Actually, we’ve already been living in a historic moment. For the past few decades, we’ve been called upon to act, and have been acting in a way that will be scrutinized by our descendants. Now we feel it. The shift has to do with the concentration and intensity of what’s happening. September 11th was a single day, and everyone felt the shock of it, but our daily habits didn’t shift, except at airports; the President even urged us to keep shopping. This crisis is different. It’s a biological threat, and it’s global. Everyone has to change together to deal with it. That’s really history.

There are 7.8 billion people alive on this planet—a stupendous social and technological achievement that’s unnatural and unstable. It’s made possible by science, which has already been saving us. Now, though, when disaster strikes, we grasp the complexity of our civilization—we feel the reality, which is that the whole system is a technical improvisation that science keeps from crashing down

Today, in theory, everyone knows everything. We know that our accidental alteration of the atmosphere is leading us into a mass-extinction event, and that we need to move fast to dodge it. But we don’t act on what we know. We don’t want to change our habits. This knowing-but-not-acting is part of the old structure of feeling.

Do we believe in science? Go outside and you’ll see the proof that we do everywhere you look. We’re learning to trust our science as a society. That’s another part of the new structure of feeling.

it is the first of many calamities that will likely unfold throughout this century. Now, when they come, we’ll be familiar with how they feel.

water shortages. And food shortages, electricity outages, devastating storms, droughts, floods. These are easy calls. They’re baked into the situation we’ve already created, in part by ignoring warnings that scientists have been issuing since the nineteen-sixties

Imagine what a food scare would do. Imagine a heat wave hot enough to kill anyone not in an air-conditioned space, then imagine power failures happening during such a heat wave.

science fiction is the realism of our time

Science-fiction writers don’t know anything more about the future than anyone else. Human history is too unpredictable; from this moment, we could descend into a mass-extinction event or rise into an age of general prosperity. Still, if you read science fiction, you may be a little less surprised by whatever does happen. Often, science fiction traces the ramifications of a single postulated change; readers co-create, judging the writers’ plausibility and ingenuity, interrogating their theories of history. Doing this repeatedly is a kind of training. It can help you feel more oriented in the history we’re making now. This radical spread of possibilities, good to bad, which creates such a profound disorientation; this tentative awareness of the emerging next stage—these are also new feelings in our time.

remember that you must die. Older people are sometimes better at keeping this in mind than younger people. Still, we’re all prone to forgetting death. It never seems quite real until the end, and even then it’s hard to believe. The reality of death is another thing we know about but don’t feel.

This mixture of dread and apprehension and normality is the sensation of plague on the loose. It could be part of our new structure of feeling, too.

there are charismatic mega-ideas. “Flatten the curve” could be one of them. Immediately, we get it. There’s an infectious, deadly plague that spreads easily, and, although we can’t avoid it entirely, we can try to avoid a big spike in infections, so that hospitals won’t be overwhelmed and fewer people will die. It makes sense, and it’s something all of us can help to do. When we do it—if we do it—it will be a civilizational achievement: a new thing that our scientific, educated, high-tech species is capable of doing. Knowing that we can act in concert when necessary is another thing that will change us.

People who study climate change talk about “the tragedy of the horizon.” The tragedy is that we don’t care enough about those future people, our descendants, who will have to fix, or just survive on, the planet we’re now wrecking. We like to think that they’ll be richer and smarter than we are and so able to handle their own problems in their own time. But we’re creating problems that they’ll be unable to solve. You can’t fix extinctions, or ocean acidification, or melted permafrost, no matter how rich or smart you are. The fact that these problems will occur in the future lets us take a magical view of them. We go on exacerbating them, thinking—not that we think this, but the notion seems to underlie our thinking—that we will be dead before it gets too serious. The tragedy of the horizon is often something we encounter, without knowing it, when we buy and sell. The market is wrong; the prices are too low. Our way of life has environmental costs that aren’t included in what we pay, and those costs will be borne by our descendents. We are operating a multigenerational Ponzi scheme.

We’ve decided to sacrifice over these months so that, in the future, people won’t suffer as much as they would otherwise. In this case, the time horizon is so short that we are the future people.

Amid the tragedy and death, this is one source of pleasure. Even though our economic system ignores reality, we can act when we have to. At the very least, we are all freaking out together. To my mind, this new sense of solidarity is one of the few reassuring things to have happened in this century. If we can find it in this crisis, to save ourselves, then maybe we can find it in the big crisis, to save our children and theirs.

Thatcher said that “there is no such thing as society,” and Ronald Reagan said that “government is not the solution to our problem; government is the problem.” These stupid slogans marked the turn away from the postwar period of reconstruction and underpin much of the bullshit of the past forty years

We are individuals first, yes, just as bees are, but we exist in a larger social body. Society is not only real; it’s fundamental. We can’t live without it. And now we’re beginning to understand that this “we” includes many other creatures and societies in our biosphere and even in ourselves. Even as an individual, you are a biome, an ecosystem, much like a forest or a swamp or a coral reef. Your skin holds inside it all kinds of unlikely coöperations, and to survive you depend on any number of interspecies operations going on within you all at once. We are societies made of societies; there are nothing but societies. This is shocking news—it demands a whole new world view.

It’s as if the reality of citizenship has smacked us in the face.

The neoliberal structure of feeling totters. What might a post-capitalist response to this crisis include? Maybe rent and debt relief; unemployment aid for all those laid off; government hiring for contact tracing and the manufacture of necessary health equipment; the world’s militaries used to support health care; the rapid construction of hospitals.

If the project of civilization—including science, economics, politics, and all the rest of it—were to bring all eight billion of us into a long-term balance with Earth’s biosphere, we could do it. By contrast, when the project of civilization is to create profit—which, by definition, goes to only a few—much of what we do is actively harmful to the long-term prospects of our species.

Economics is a system for optimizing resources, and, if it were trying to calculate ways to optimize a sustainable civilization in balance with the biosphere, it could be a helpful tool. When it’s used to optimize profit, however, it encourages us to live within a system of destructive falsehoods. We need a new political economy by which to make our calculations. Now, acutely, we feel that need.

We’ll remember this even if we pretend not to. History is happening now, and it will have happened. So what will we do with that?

How we feel is shaped by what we value, and vice versa. Food, water, shelter, clothing, education, health care: maybe now we value these things more, along with the people whose work creates them. To survive the next century, we need to start valuing the planet more, too, since it’s our only home.

In a review of Covid-19 social response programmes, cash transfer programmes were found to be: Short-term in their duration – lasting just over three months on average Small in value – an average of $6 (£4.30) per capita in low-income countries Limited in scope – with many in need remaining uncovered

The world’s food systems endured numerous shocks in 2020, from economic impacts on producers and consumers to desert locust swarms and erratic weather. All indicators suggest that this may be the new normal. The ecosystems we rely on for water, air and food supply are under threat. Zoonotic diseases are on the rise owing to growing demographic and economic pressures on land, animals and wildlife.

A warming planet is contributing to costlier and more frequent extreme weather events. And as people pack into low-quality housing in urban slums or vulnerable coastal areas, more are living in the path of disease and climate disaster.

We need sustained financing for approaches that prioritise human, animal and planetary health; restore landscapes and diversify crops to improve nutrition; reduce food loss and waste; strengthen agricultural value chains to create jobs and recover lost incomes; and deploy effective climate-smart agriculture techniques on a much greater scale.

Focusing on food security would address a basic injustice: almost one in 10 people live in chronic hunger in an age of food waste and plenty. This focus would also strengthen our collective ability to weather the next storm, flood, drought, or pandemic – with safe and nutritious food for all.

In South Africa, one of the hardest-hit countries on the continent by the pandemic, a mutated and more transmissible variant of the virus emerged less than two months ago, leading to a massive spike in both the number of cases and deaths.

Experts and humanitarian workers fear that even as high-income countries in the developed world get a handle on cases and begin distributing vaccines, poorer and developing countries in Africa will be left behind.

Data from the Africa Centres for Disease Control and Prevention released on Tuesday shows that the African continent has tracked more than 3.6 million COVID-19 cases and some 91,500 deaths. That number is expected to increase further in the coming weeks.

Last month, then-U.S. Ambassador to South Africa Lana Marks announced that she had spent 10 days in an intensive care unit after developing COVID-19 in late December. Marks, a luxury handbag designer and Trump political appointee, drew fire from embassy staff last March when she returned to the country and did not self-isolate after attending an event at the former president’s Mar-a-Lago resort despite some attendees later testing positive for COVID-19. 

South Africa has a highly developed health care system, but in poorer countries in the region embassies are relying on medical evacuation to deal with severe cases. One official in the region said medical evacuations have been taking 48 to 72 hours, adding, “In terms of COVID, that could be a death sentence.”

According to an internal USAID memo, patients in Eswatini, which borders South Africa, were dying due to a lack of oxygen supplies

greater awareness of the potential impact of natural as well as man-made shocks will accelerate tendencies not toward deglobalization but rather toward reglobalization: a reshuffling of supply chains and at least a partial reduction in the concentration of capacity inside China

The disruption caused by the pandemic creates an opportunity for U.S. policymakers to reassess and recalibrate their generally laissez-faire approach to globalization.

Another reason for attempting to shift existing supply chains and, in particular, for trying to preserve and expand domestic manufacturing capacity is that doing so could help boost the overall productivity, international competitiveness, and long-term growth prospects of the U.S. economy. That, in turn, would generate more of the aggregate resources necessary to sustain a protracted strategic competition with China, while at the same time enhancing the well-being of many American workers.

Even if the value-added from the final assembly of consumer goods is relatively small, from a strategic standpoint it would be preferable if the resulting gains accrued to the economies of U.S. friends and allies rather than to China. The physical relocation of some portion of existing supply chains could also help slow China’s efforts to extract sensitive technology through industrial espionage or coerced joint ventures.

Even a largely market-driven dispersion of supply chains and a lesser degree of concentration in China should help to reduce risks and increase resilience.

To the extent feasible, the United States should seek to source imports of critical goods from a trusted production network of facilities in friendly or allied countries, at least some of them located far from China.

During World War II and the opening stages of the Cold War, the federal government used the tax code in a focused fashion, extending the so-called rapid tax amortization privilege to promote expansion in sectors where resource requirement calculations revealed gaps that could stall defense mobilization. In the 1950s, federal agencies also used procurement guarantees to encourage the maintenance of capacity above anticipated market demand for certain minerals and machine tools by promising to buy a portion of the resulting output. Some of these were then placed in stockpiles for possible future use.

The U.S. government could use similar tools today if, for example, it wanted to expand the nation’s ability to manufacture personal protective equipment and ventilators, items that might be needed to combat the next pandemic.

Globalization is not an unstoppable natural force, propelled solely by technological progress and autonomous market forces; instead it is a man-made phenomenon with contours shaped by the choices of states as well as firms.

China’s emergence as an irresistibly attractive manufacturing platform was partly due to the sheer size of its working-age population and the falling costs of communication and transportation, but also due to deliberate government policies designed to aid in the acquisition of foreign intellectual property while keeping the cost of land, labor, and capital low and exchange rates favorable.

the migration of manufacturing capacity from the advanced industrial countries reflected not only the profit and loss calculations of individual companies but also the permissive policies of Western governments that concluded in effect (in the U.S. case) that what was good for Apple or 3M was good for the United States.

if it results in excessive dependence, an addiction to low costs can create serious commercial and strategic risks

There are obvious dangers here. Sharpened tools of trade and industrial policy can be abused by irresponsible leaders seeking to pander to voters and pay off supporters, or they may be captured and exploited by special interests.

more likely that the regime of Syrian President Bashar al-Assad has a hand in producing Captagon, reaping a profit that it can invest into its armed campaigns against civilians and damaging the health of many Syrians who are now addicted to amphetamines after years of war

“When Syria invaded Lebanon in the ’90s there were many reports showing the Syrian military were aiding and abetting hashish and opium production in the Bekaa Valley,”

Captagon production flourished in Syria after 2013, when a crackdown in neighboring Lebanon likely forced Hezbollah to relocate its drug production operations next door. The shift came at an opportune time for the Syrian regime, as it needed money to fund its military campaign against rebel groups

The majority of Syria’s Captagon production sites are in regime-held areas, according to Abu Ja’far, a former truck driver who worked between Homs, Rif-Dimashq, and Aleppo. “You only need some deserted homes and a few workers supervised by someone with strong connections,”

International organizations are unable to conduct research on the ground, meaning there is no concrete evidence linking the Assad regime to the Captagon trade. But sources say that strong protection would be required to produce, sell, and export the drugs from regime-held areas. “It was always possible in a country at war that those best placed to safely manufacture a drug in large quantities would be people in the regime … or in areas the regime were guaranteeing security,”

Last year, more than 33 million Captagon pills were seized in Greece after being shipped from regime-held Latakia. And in April this year, Saudi customs seized more than 44 million pills hidden in tea packaging from a company close to the Assad family.

At the height of its territorial control, the Islamic State was involved in the black market, trading looted antiquities, arms, and oil. But there is little evidence that the group ever produced Captagon—even if individual fighters used the drug on the battlefield. It would not have been sanctioned at the institutional level because of the group’s Salafism: Islamic State leaders punished people caught smoking or selling tobacco, making it unlikely they condoned the manufacturing of amphetamines.

Saudi Arabia has long been the No. 1 consumer of Captagon, which is popular among young and affluent partygoers. As conflict drags on in Libya, it is also possible the large shipment was destined for the port of Benghazi, with Europe as a transit point.

While much of the Captagon produced in Syria is destined for overseas markets, Syrians themselves suffer some of the worst damage from the trade. The worst-quality Captagon tablets are sold within Syria for as cheap as $1 per pill

Captagon is known to inhibit tiredness, hunger, and fear. But its use is now common among all demographics in Syria, not just fighters. The most common side effects include extreme depression, insomnia, malnutrition, and heart and blood toxicity

with the United States only starting to grapple with climate-induced retreat, the notion that it will bring about a unique set of mental health issues is barely on the map

"we have not turned adaptation (to climate change) into a trauma-informed field"

The new and growing category of professionals whose work involves planning for and dealing with worsening natural disasters as a result of climate change will face their own trauma

About 80% of Americans who assist climate-vulnerable coastal and urban communities in dealing with growing threats say they have experienced burnout in their work

The sergeant major for one unit at Camp Pendleton, California, told Marines and sailors that they still had to report to work even though their children’s schools had been closed.“We had to ‘figure it the fuck out,’” a source told Task & Purpose, who added the sergeant major also told the Marines and sailors that it was their fault if having children at home was a problem for them.

While top defense leaders have stressed the need for troops to telework and stay at home, several reporters have found numerous examples of commanders who have done precisely the opposite

While there is much about the military to admire, the coronavirus outbreak lays bare the military’s sadistic streak.

if we want a decent shot at climate stability, high-income nations will have to shift to post-growth economic principles

Post-growth thinking is starting to trickle into policy, too. Jacinda Ardern, the prime minister of New Zealand, captured headlines in 2019

Economists have long assumed that we need growth to improve people’s lives. But it turns out there’s no empirical evidence for this argument. Beyond a certain point, which high-income countries have long since surpassed, the relationship between GDP and human wellbeing completely breaks down.

dozens of countries beat the US in life expectancy with only a fraction of the income

universal public services are significantly more cost-efficient than their private counterparts. Spain spends $2,300 per person on healthcare,

The reason that GDP growth tends not to deliver the outcomes that we might expect is because the vast majority of it goes straight into the pockets of the rich. They are the real beneficiaries of growth. In the United States, the incomes of the richest 1% have more than tripled since the 1970s,

growthism

We can accomplish our social goals right now, without any growth at all, simply by sharing what we already have more fairly, and by investing in generous public goods. It turns out justice is the antidote to the growth imperative – and key to solving the climate crisis.

The less energy we use, the easier it is to accomplish a rapid transition to renewables. This is perhaps the single most important lesson that climate science has taught us in the past few years.

Think of all the energy that’s needed to extract and produce and transport all of the material commodities that the economy churns out each year. Think of the mining, the logging, the factories, the packaging, the container ships, the warehouses, the retail outlets and the waste disposal facilities. The material economy is a giant energy-sucking machine. By reducing the material "throughput" of our economy – the amount of stuff we produce and consume – we can reduce our energy demand. 

The key thing to grasp is that a huge chunk of material production in our economy is intended, literally, to be wasted. Firms desperate to overcome the limits of saturated markets resort to all sorts of devious tactics to artificially increase turnover. Take planned obsolescence, for example. The lifespan of household appliances like refrigerators and washing machines has plummeted over the past few decades.

Research by US sociologists has revealed that advertising expenditures have a direct impact

We like to think of capitalism as a system that’s rational and efficient when it comes to meeting human needs. But in some respects, it’s exactly the opposite. In pursuit of constant growth, firms resort to intentional inefficiencies. This might be rational from the perspective of profits, but from the perspective of human need, and from the perspective of ecology, it is a kind of madness. It is madness in terms of human labour, too. Think about the millions of hours that are poured into producing stuff that’s designed to break down, or that people don’t actually need in the first place.

We can legislate for long-term warranties, rights to repair, and mandatory take-back schemes. We can regulate marketing expenditures, and we can liberate public spaces from ads telling us to buy even more – both offline and online. The gains from this could be enormous. Think about it: if clothes and refrigerators and smartphones last twice as long, we will consume half as many. That’s half the extraction, half the shipping, half the warehouses, half the transport, half the waste – and half the energy it takes to power it all. 

There are also a number of other steps we can take. We can shift from private cars to public transport. We can ban food waste by supermarkets and farms. We can cut single-use packaging. And we can choose to scale down ecologically destructive and socially less necessary industries, such as SUVs,

But, you might ask, what about jobs? As we scale down unnecessary industrial activity, won’t that cause unemployment to rise? Under normal circumstances, yes. But ecological economists have a surprisingly simple solution to this: shorten the working week. Add a job guarantee to the mix (a policy that happens to be resoundingly popular)

What’s exciting about this move is that it has a substantial positive impact on wellbeing. Studies in the US have found that people who work shorter hours are happier than those who work longer hours, even when controlling for income. And it has a big impact on energy demand, too. If the United States were to reduce its working hours to the levels of western Europe, its energy use would decline by a staggering 20%. 

Public interest in post-growth economics has soared over the past year as the climate crisis worsens. With fires blazing through Australia and the Amazon, floods swamping northern England, droughts driving migration, and record heatwaves searing across Antarctica, people realise that the status quo has us hurtling toward disaster, and they’re increasingly open to new ideas. In the 2020s, we can expect that the climate movement will rally around the Green New Deal and a vision for a completely new economy. 

the hype around the disarmament of Colombia’s largest guerrilla group was short-lived. The government couldn’t effectively occupy the territories where former fighters operated, providing combatants with another opportunity to join dissident groups or create new groups with the aim of taking over illegal trades.

Residents of the western department of Chocó are particularly vulnerable to displacement by armed groups. Deserted jungles and a network of rivers running to the Pacific Ocean make it a profitable region for illegal trades such as mining and drug trafficking, and a hotbed of conflict between armed groups including the ELN and the Gaitanista Self-Defence Forces of Colombia.

The statements by armed groups apparently siding with the government and threatening to enforce the curfew not only intimidate residents, but also compromise the credibility of the authorities. “They are trying to supplant the authorities,” said Col. Henry Galán of the Chocó police department

Cauca is a remote and mountainous region on Colombia’s Pacific coast with limited state presence, where ethnic Indigenous communities have a long history of organizing themselves. “Everyone knows that if that disease reaches us, there is no possibility of survival because there is no medical infrastructure,” said Lisifrey Ararat, a leader from the town of Suárez. For Ararat and other leaders, the lack of hospitals, telecommunications, roads, and infrastructure in their region puts their communities at higher risk—forcing them to make difficult decisions such as placing biosecurity checkpoints and sealing off outsiders. Such measures have increased tensions with armed groups which fight to control the region, and further isolated the communities from basic health services and food supplies.