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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 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

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 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.

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.

“Trade barriers will create extreme volatility,” warned Torero. “[They] will make the situation worse. That’s what we observe in food crises.”

problems could start to be seen within weeks and intensify over the following two months as key fruit and vegetables come into season

“Fruit and vegetables are also very labour intensive, if the labour force is threatened because people can’t move then you have a problem.”

“We need to have policies in place so the labour force can keep doing their job. Protect people too, but we need the labour force. Major countries have yet to implement these sorts of policies to ensure that food can keep moving.”

Countries such as the UK, with a sinking currency and high level of imports, are also likely to see food price rises unless the government takes action or retailers absorb some of the costs

Individuals can also play an important role, by avoiding panic buying and hoarding of food, and cutting down on food waste. Buying too much fresh farm produce that then goes off before it can be eaten will just exacerbate food supply problems, he said. “Individuals should only buy what they need to avoid food waste.”

In the UK, some farming leaders have called for a “land army” of workers to replace a shortfall of workers that could reach 80,000, according to one estimate, if the 60,000 seasonal workers recruited from abroad in normal years are prevented from coming, and if some British workers fall ill.

Andre Laperriere, executive director of Global Open Data for Agriculture and Nutrition, which provides data on food and agriculture, said the government must make plans to ensure the food supply chain functioned smoothly.“Empty shelves in supermarkets should not be much of a concern,” he said. “It is not a supply problem – it is a logistics problem. There is enough supply for all, as long as everyone stays calm and stops hoarding. We may tend to waste food if we hoard more than required, and hoarding would also artificially increase food prices because of the pressure on the supply chain.”

“The food sector comes under the critical infrastructure sector, along with healthcare and emergency services,”

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. 

“A halt or a drastic slowdown in processing visas will have an immediate domino effect of the domestic food supply of this country,” said David Scaroni, vice president of Fresh Harvest, the country’s largest private contractor of H-2A workers. “No emergency declaration or short term provision will change this fact.”

“We believe because of what’s planted and what’s going to be harvested that we can meet the demand and maintain the continuity of the food supply,” Valadez said. “The question is the labor equation. The crops are going to be there. But what are we going to be able to do to get the crops out of the ground?”

labor contracting surges dramatically as produce shifts from the winter desert regions of California and Arizona and gets underway along the central coast. That region hosts the bulk of the state’s strawberry production and much of its spring and summer leafy greens, broccoli and cauliflower, among other crops.

Any shortfall or slowdown, however, would have a cascade effect across production, harvest, processing and distribution within weeks, Scaroni said. “Plants already in the ground do not know that there is a pandemic occurring. It is crucial to keep this process going as close to the prior normal to ensure a stable food supply for the coming months.”

deep, short-term dependency within crops and harvest areas

There is no evidence that contact with produce is contributing to the spread of coronavirus, federal health and safety agencies have said.

“Historically, farmworkers are so used to not having healthcare they just put up with being sick,” said Armando Elenes, secretary-treasurer of the United Farm Workers. “They’re going to go to work, and on the way to work, they’ll be in a car with four, five or six workers. So ‘social distancing’? Forget that.”

An agriculture industry source said operations dependent on food-service clients could suffer irreparable economic harm. The inability of the retail side to absorb the unused supply could leave a paradox of empty bins in grocery stores while food rots in the fields.

Rabobank Research predicts that effects of the pandemic will last several months. It already has affected parts of the food economy few think about, such as the boxes it’s packed in — cardboard production largely halted in China in January and February, driving up prices.

Wholesalers report that unusually heavy rains have created an “extreme” market for many produce items, including carrots, peppers, squash, potatoes and cauliflower. California’s citrus industry has had to slow or pause harvest during the prolonged rains of the last week, according to California Citrus Mutual. The industry had hoped to overcome most of the supply imbalances as it shifted production north and into additional states. Then the pandemic hit.

As rich countries have been allowed to maintain their level of agricultural subsidies – which are mostly handed out to large producers, not family farms – developing countries have not been allowed under WTO rules to subsidise food production for domestic consumption to guarantee food security, nor to protect their farmers from unfair dumping.

subsidies for the environmentally damaging production of oil and gas remain undisciplined, while countries have successfully sued each other in the WTO for directing subsidies towards greener fuels, especially if they try to create jobs at the same time.

The environment has suffered as countries use environmental exploitation as a comparative advantage, and trade is responsible for a growing percentage of the greenhouse gases that contribute to climate change.

supporters of the WTO were able to get developing countries to agree to a new round of trade talks only by claiming it would be a “development” round – ie, one that put the needs of developing countries at its heart.  Since then, unfortunately, developed countries have never delivered on their promises to address the constraints that bad WTO rules put on development

most developing countries that have gained from trade have done so by exporting to China, whose growth is usually attributed to its divergences from the WTO model. 

At a time when most conversations regarding Big Tech are around the need for stronger antitrust and tax enforcement, and how their model of surveillance capitalism should not be allowed to shape the contours of our media, democracy, human rights, education and social relationships – or even how to break them up – they are working through the WTO, without public debate, to gain a new constitution that will consolidate their power and profits.

the problem with the dispute system is that it adjudicates according to a set of rules guided by corporate interests

The crisis is that people around the world have suffered through nearly 25 years of a damaging pro-corporate trade model, encapsulated by the WTO, and the domestic policies of austerity that have led to uprisings on four continents, mass migrations, and the election of right-wing governments in many countries.

We all need a global economy that facilitates decent jobs, access to affordable medicines, healthy food, and a thriving environment. Nearly all governments agreed to this mandate through the Sustainable Development Goals (SDGs) and Agenda 2030 in 2015. The rules of the global economy should be shaped around ensuring that trade can help achieve these goals, but at the minimum, it should not constrain governments from doing so.

The solution to the current conflicts on trade policy is not a false nationalism that nonetheless expands corporate control, nor a defence of the current failed corporate system. We need a wholly different system than that embodied in the WTO, just as the protesters clamoured for in Seattle 20 years ago. That will require a multilateral vision of ecological stability, shared prosperity, and leadership committed to that vision. Until then, we can expect more crises. 

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.

degrowth has come under severe criticism from pundits, mainstream economists, and the jet-setting Davos elite

austerity is always imposed for the sake of growth. We have been convinced, for half a century now, that cutting public services is good for us because it will increase competitiveness, balance the budget, and eventually lead to growth. Degrowth, by contrast, is the argument that we can, and should, move away from an economy that exclusively depends on economic growth.

While austerity increases inequality by curbing public services and benefitting the rich through tax cuts and privatisation of government services, degrowth policies focus on democratising production, curbing the wealth and overconsumption of the rich, expanding public services, and increasing equality within and between societies.

Recessions make inequality worse, degrowth is about making sure everyone has their needs met. Recessions often cause bold policies for sustainability to be abandoned for the sake of restarting growth, while degrowth is explicitly for a rapid and decisive transformation.

Because profits are based on making labour and nature as cheap as possible, the very basis of profit is always at risk, for example, through labour shortages or supply bottlenecks. Thus, constant economic expansion will also see constant crises.

As argued by Naomi Klein in the book Shock Doctrine, crises are often taken advantage of by the owners of capital because they make it possible to thrash social and ecological legislation, thus lowering the costs of wages and resources, and further generating windfall profits through inflation.

infrastructure projects which will lock in fossil fuel use for decades continue to be built and expanded, while banks, energy companies and multinationals that are involved in polluting and carbon-intensive industries are bailed out with public money and given lucrative government contracts

A recent UN report found that nine out of 10 countries worldwide have fallen behind on life expectancy, education and living standards. For decades, international organisations have promised to fight global inequality and poverty with growth – but the results are anything but promising.

guarantee access to “universal basic services” like housing, food, healthcare, mobility, and childcare to the general population, by taking them out of the market.

Germany’s three-month experiment with a $9 monthly ticket for all regional and city public transport could serve as an example. It not only reduced carbon dioxide emissions by 1.8 million tonnes – equivalent to powering about 350,000 homes for a year – but it also helped mitigate the effects of high inflation rates, increased freedom of mobility for all, and was quite popular with the public.

a 2020 research paper on energy sufficiency found that it is possible to provide a decent life to the entire global population at 40 percent of current energy use, despite population growth until 2050.

reducing the excess energy and resource use of the rich and making designs more efficient within the framework of a truly circular economy have huge potential to reduce demand

many people would likely possess fewer material objects – but most would have access to better services and society would be more sustainable, just, convivial, and fulfilling