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All in This Together?

Grappling with the unequal effects of COVID-19.

One of the most maddening aspects of the novel coronavirus—and there are many—is how heavily its effects land on some and how lightly on others. Many, including me, have said that we are all in this together. It's becoming increasingly, distressingly clear that we really aren't.

Taylor Wright/Unsplash
It's becoming clear we are not all in the same boat.
Source: Taylor Wright/Unsplash

Some are working grueling 20-hour days with their lives at risk. Others are checking out the homes of favorite TV personalities and re-arranging sock drawers. In between, there are one million variations. Social distancing is a privilege, as Dr. Jagamish Hiremath has detailed in a long Twitter thread that went viral. Working from home poses challenges, to be sure, but they pale in comparison to what is happening in a growing number of U.S. hospitals.

If your life path has turned you toward health care, production or distribution of essential goods and services, or maintenance of the safety and cleanliness of common spaces (to name a few), this virus is hitting you squarely on the jaw. The rest of us owe you an enormous debt for risking your health to stay on the job.

Amidst the growing recognition of these stark realities, I've noticed a mini-trend on social media. Interspersed with well-intended advice about how to stay productive when working at home, some productivity zealot momentarily forgets how disparately and desperately the virus emergency is affecting others. They post something categorical like: If you haven't used this time to start that new business or learn a new skill, what are you even here for? Inevitably, these comments get countered by someone struggling to homeschool a 9-year-old while responding to a demanding virtual boss. (While those struggling the most aren't even on social media in the first place.)

But our human impulse to judge is not helpful. If ever there was a time for perspective-taking and empathy, it is now. Is it possible to imagine ourselves in others' shoes before we judge? Or better yet, not to judge at all?

We may all be on the same (virus-infected) boat, but some are enjoying the view from the Lido deck, and others are working in the engine room. The people whose functions matter most in an emergency have the least job security, the least flexibility, and rely upon the thinnest of cushions.

As ruthless as this virus has been in propagating, it has been equally ruthless in exposing terminal weaknesses in our most essential systems. A surgeon friend dashed off these lines to me with the terseness of someone who is between a 12-hour day and an exhausted sleep: "People are complaining about our health care system. We don't have a health care system."

As it turns out, there are quite a few other systems we don't have:

1. We don't have a sufficient and well-maintained stockpile of medical equipment. (California receives "170 broken ventilators" from Feds, Time Magazine)

2. We don't have a reliable system—sealed off from politics—for allocating scarce goods. (Hunt For Medical Supplies Creates Marketplace of Desperation, PBS News)

3. We don't have a way to ensure a consistent public health message. Misinformation is rampant. TV personalities who command large audiences, like Dr. Drew Pinsky, have made public apologies for disseminating misleading information, and there is talk of lawsuits against networks that downplayed the threat in the early days.

4. We don't have an emergency workforce that can be quickly outfitted and sent into "battle," and we don't have a way to ensure these people are protected and paid. For the most part, this is up to individual employers, and protests and strikes have begun at Instagram and Amazon. If this were a military emergency, we would be all set. We could send in the cavalry. But we don't have cavalry for civil emergencies.

5. We don't have emergency supply and distribution lines. We are relying on a fairly small cluster of private, profit-making entities to keep a whole country in essential goods. A few headlines that speak volumes: "Amazon auditions to be the new Red Cross" and "Scared UPS workers desperately hunt for safety supplies."

6. And of course, we don't have a system for ensuring access to health care. For decades, we have tied health insurance to employment, for antiquated reasons. Layoffs are coming at us fast. Some of the newly laid-off can take advantage of COBRA to continue their health insurance, but it is expensive and time-limited. And what about the more than 27 million Americans who didn't have health insurance to start with?

Some of these shortcomings are management challenges—the likes of which we have taken on before and can envision doing competently again. Yet others expose deep societal fissures. (This has happened in other countries as well; a recent Financial Times editorial outlined the UK experience and called, quite uncharacteristically, for "radical reforms" to the social contract.)

Here in the U.S., we have allowed profound structural inequality to creep into and persist in our most important systems. Much of our social infrastructure, notably health care and education, has upper tiers that have and attract money and attention—leaving lower, accessible-to-everyone tiers gasping for air.

This is the state of affairs we have tacitly accepted for several decades. Those with access to the upper deck have little need to wonder what is happening in the engine room. In turn, those below are simply too busy surviving to fight for something better. The most vulnerable and the most heroic are forced to rely on a patchwork of ad hoc responses.

In just a few (albeit very long) weeks, COVID-19 has turned our world on its head and widened existing cracks in all of our systems. But maybe we can see a little daylight through those cracks. This moment is the reason that societies need systems, infrastructure, and policies that are not warped by politics or profits.

When it's time to put our world back together, let's hope we can build in the fairness that we have let slide. In the meantime, let's simply start with empathy. Productivity can wait.

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