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I think the #coronavirus #COVID19outbreak is going to be particularly bad in the US. Below are some reasons why, based on my experience living in New York, which is now one of the top global epicenters of this crisis. My analysis is sociological, not medical 1/14
Lack of testing is a real danger. A family we know came back from a vacation in France a week ago and all started having immediate symptoms. They asked for a test and did not get one despite fitting many criteria. This alone is not catastrophic so read on. 2/14
Lack of testing should create "presumptive positive" behavior, but in this case, despite explaining to our friends that they have to "presume they are positive until they find out otherwise" they have continued going about their lives, going to parks, shops, etc. 3/14
Why are symptomatic people risking community spread when many asymptomatic people are self-isolating? It seems insane. Why's it happening? I think there are a few reasons, both cultural and structural. 4/14
Reason #1a: Too many voices, all throwing out slightly, or radically, different information, causing information fatigue. Federal. State. Pundits. Extended family members spreading false information from right-wing media. It makes it harder for people to know what to do. 5/14
Reason #1b. The erosion of trust in institutions means that the real experts who we should be listening to for practical advice have to compete for mind-space with a know-nothing punditry who are still pushing some agenda or other that has nothing to do with public health. 6/14
Reason #2: American definitions of freedom: the belief that Americans are free to do whatever feels right. This is powerful because people feel like they don't have to comply with government requests (absent enforcement and even then...) 7/14
Reason #3: Lack of community solidarity. The reason why you self-isolate when presumed positive for the virus is NOT so YOU won't get it (probably too late) but so that others won't get it. If you don't feel any responsibility towards your neighbors you won't self-isolate. 8/14
Reason #4: "I don't feel that bad" THIS right here is the killer about this thing, a lot of people don't get that sick (either at first or ever), so they don't understand that this could kill other people. A mild cough and fever? So what? I'm going about my day anyway. 9/14
Reason #5: American Exceptionalism. Due to various accidents of history (Lower 48 out of bomber range during WW2), Americans believe that the rules that apply to the world do not apply to them; many Americans feel that they are personally invulnerable. 10/14
Reason #6a: Lack of public health infrastructure. We have a very well funded health system, it's just not a public health system. What does this mean? It means that many individuals will receive excellent care but community-level management of the epidemic could be poor 11/14
Reason #6b What happens when you have excellent healthcare for individuals who can pay but poor community-level management? First the poor suffer, then private hospitals get overwhelmed by the sheer numbers. Better public health with "just OK" hospitals might be better 12/14
Reason #7 Poor social safety net. This means that the aftershocks of #covid19 are being felt immediately throughout society and could undermine community resiliency during a 12+ month "war on Covid". I do have some optimism here that action will be taken quickly 13/14
Reason #8 Optimism. I love Americans for their optimism. American optimism will be an asset as we all rebound from this thing, but it does tend to slow down the initial response when hours and days make a difference. "It couldn't happen here" makes people slow to catch on. 14/14
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