May 2020


The ministry of pandemics

By Richard Cooke
Image of Press conference at Parliament House, March 24, 2020.

Press conference at Parliament House, March 24, 2020. © Alex Ellinghausen / Fairfax Images

How the spread of the virus revealed our leaders to us

Green waters, blue hills, all idle in vain
When a great doctor [Hua Tuo] stands helpless before such a tiny creature!
— Mao Zedong, “Expel the Plague Spirit”

China has linked infection with governance since ancient times. In the celestial bureaucracy of Chinese mythology, there are special ministries for pandemics, whole departments of dedicated plague gods employed in the seasonal dissemination of disease. Once, at the beginning of the Han Dynasty, in a mortality-marked year even by pre-modern standards, Emperor Gaozu asked a trusted adviser what could be done to stop these infestations. “Nothing,” the sage replied. “Epidemics are sent by Heaven.”

There is an echo of this ancient inevitability in modern science. Recombinant viruses are always among us. In a symptomless state, scientists call them “indolent”, suggesting laziness before deadly work begins. The source of the next pandemic is probably infecting humans already, and a more benign form of this current, world-halting pathogen may have infected humans for decades. This is why the terminology of “patient zero”, only briefly in vogue, has been abandoned. It was a mistake from the beginning (someone mistook a letter for a number on the chart of an early AIDS patient), and suggests a certainty of origin, and a taint of original sin, that health authorities find unhelpful.

Instead they employ a more suffuse vocabulary: “superspreaders” and “supershedders”, “index cases” and “primary cases”. Even the virus’s name is hedged: when it was christened by the World Health Organization on February 11, the virus and the disease it causes were given different names, neither elegant. The virus is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the disease is called coronavirus disease (COVID-19).

Strangely, in its communications the WHO chose to eschew the official name it devised. Instead it used a Prince-like formulation – “the virus responsible for COVID-19” – so it could avoid saying the SARS part out loud. This, according to the technical guidance, was to avoid “unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia”. It was a quaint concern that has been overtaken: COVID-19 carries enough of its own dread to make other sources of “unnecessary fear” a triviality.

I am writing this from isolation, you’re likely reading it from isolation too. Every friend and acquaintance of mine on every continent is confined to quarters, separated from all but their immediate households. At the same time, they are somehow together in the same condition of enforced quarantine. The streets of nearly every major city in the world are still, their businesses defunct, in hibernation or limping. Each news bulletin begins with a death toll, and all of the segments of the news, from the finance to the non-existent sports report, are monopolised.

The study of coronaviruses, until the 21st century a virus class considered harmless in humans, was one chiefly of interest to veterinary science rather than medicine. The standard textbook Virology used to rate their study as “obscure”. They are now guaranteed the fame that comes with making world history, alongside the pathogens responsible for the Spanish Flu and Black Death. The death toll is not as monumental, but in exchange, COVID-19 has exacted an enormous price.

Before the virus was named, it had already killed a thousand people, and frozen the second-largest economy in the world. In the first season of what looks to be its first plague year, it put almost 3 billion people into lockdown, sickened 1.7 million and killed more than 100,000. In the United States alone, it destroyed at least 6.6 million livelihoods in a single week. Its financial cost may be incalculable, though early estimates run into multiple trillions.

What’s more, this pandemic was predictable. Since the SARS outbreak of 2002 and the MERS outbreak of 2012, infectious disease specialists have feared the spread of a novel coronavirus, of zoonotic origin, transmitted through human–animal contact, likely originating in China. A study titled “Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection”, published in 2007, described the exact nature of this pathogenesis.

“Coronaviruses are well known to undergo genetic recombination, which may lead to new genotypes and outbreaks,” the paper said, noting that “the presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb”. It warned of “the possibility of the re-emergence of SARS and other novel viruses from animals or laboratories” and that “therefore the need for preparedness should not be ignored”.

The WHO was first alerted on New Year’s Eve, 2019. Cases of a SARS-like pneumonia were linked to the Huanan Seafood Market, a now infamous “wet market” in Wuhan. This unsavoury-sounding name designates only the selling of meat and other perishables, and the Huanan market’s selection of exotica – wolves, bamboo rats, bats and the like – tends to be eaten for novelty, therapy or good fortune rather than sustenance. These habits, never widespread, are slowly falling out of favour in mainland China.

Ironically, the animal believed to be the transmission link between horseshoe bats and humans, a pangolin, was probably eaten to promote healing. This shy native species of South-East Asia has become the world’s most trafficked mammal, and its proficiency at digging informs an element of sympathetic magic in Chinese traditional medicine. Its scales are thought to break through blockages and occlusions, to make blood (or mother’s milk) flow again.

There is a temptation to see a chaos theory–style event in this happenstance: a butterfly beats its wings and a chain of reaction ends in a hurricane; a man eats a pangolin in Wuhan, and Washington comes to a standstill. But while the virus, or something like it, may have been unstoppable, this chaos was not. It comes from a string of human failings that are political rather than medical. COVID-19’s virulence is made doubly dangerous by our ill-prepared condition.

It demonstrated not only how little we learnt from SARS (although the rapid response of some Asian countries was due to this recent scare), but also the pandemics that preceded it. While memory of the Spanish Flu has dwindled almost to a footnote after a hundred years, many follies and errors in response to COVID-19 are the same. Conspiracy theories about bioweapons, countries blaming each other for the outbreak, insistence that a deadly illness is “just the flu”, misplaced defiance preventing an early lockdown: in some ways we fail now as we failed a century ago.

Other countries have made their own distinct mistakes. In China, an initial cover-up showed Chinese authoritarianism at its worst. Communist Party authorities decided embarrassment was an outcome worse than death, and that vanity cost others vital time in responding. Then, after a disastrous Iranian response in the interim, it was the West’s turn, displaying its hollowed-out institutions and underfunded public-health systems, along with the collective action problems fed by atomisation and malaise.

These complexities may not be understood for years, but in the meantime commentators will rummage for clues and try to trace the cultural faultlines that exacerbated catastrophe. Mask-wearing countries, cheek-kissing countries, nations of scofflaws or the obedient; these just-so stories have quickly become parables in which the plague is a divine punishment for the sins of nations. There are few paradigms of success, although South Korea, Australia and New Zealand, through rapid action and late-mover advantage, have so far tamped down the infection rate.

Limitless implications open up an invitation to speculate. Already globalisation, populism, expertise, the Trump presidency and the Biden candidacy have each been tallied as casualties of COVID-19, and yet they live. The readership for virus news was insatiable (and often otherwise unoccupied) and kept being fed headlines. Among the things they promised would or could change “forever” were work, galleries, “the things we touch”, handshakes, the international order (Henry Kissinger said that), IT, hospitals, leadership, dating, travel, the economy, online wine purchasing, book publishing and the world of fine watches.

Sentiments were bullish on working from home and hard borders, and bearish on local newspapers, just-in-time supply chains and US–China relations. One verified casualty was small-government conservatism: leaders right and left have been almost indistinguishable in their fiscal response, and conservatives, even those previously critical of stimulus, were compelled into massive Keynesian largesse. The US declared it would give US$1200 to most eligible adults. Japan spent US$1 trillion immediately. In Australia, a party that had just six years ago announced the end of the age of entitlement, inaugurated the golden age of entitlement.

Curiously, it was communist China that was most restrained, perhaps gun-shy about its already heavy indebtedness, and elsewhere China hawks tried to make the system and the sickness synonymous. It was called the “China virus”, the “Wuhan virus”; the “CCP virus” (for Communist Party of China) at a stretch. These coinages did not stick, outside some far-out corners of conservative media, but a widespread feeling of unease and alarm over China’s actions was commonplace. It came in tandem with an inability to learn from China’s own actions and missteps.

Mattia Ferraresi, an Italian journalist, wrote a piece for The Boston Globe titled “A coronavirus cautionary tale from Italy: Don’t do what we did”. He detailed how Italy had ignored China’s own cautionary tale. Europe seemed to imagine the continent distinct and separate from the Far East, and comfort created complacency. “I lacked what you might call ‘moral knowledge’ of the problem,” Ferraresi wrote. “I knew about the virus, but the issue was not affecting me in a significant, personal way.” The US, the target of his warning, promptly did what the Italians did: waited until it was too late.

For anyone who has spent time in China, the imagery coming out in the wake of COVID-19 was sufficient to cause alarm. Even mid-sized Chinese cities (and on the mainland, mid-sized means more populous than London) operate on a scale too big to perceive, where taxi ranks stretch to the horizon, and bullet trains are flanked by an unceasing skyline for hundreds of kilometres. Bigger is different, and these machines of commerce have a lack of sentimentality that strays into ruthlessness. Traffic seldom parts for an ambulance. They are never quiet, and airborne pollution shows a live indicator of the balance between industry and safety. For industry to cease, the danger must be apocalyptic.

Wuhan’s local governance is considered stubborn even by CCP apparatchik standards, and the response was stymied by tensions between local and central governments. The first rash of cases threatened to impede the Spring Festival celebrations – one planned banquet had tickets already allocated for more than 40,000 people – and a major political meet in the city on January 15. Beijing informed the WHO about the suspicious pneumonia patients; travel into and out of affected regions continued unknowingly. Part of the rationale may have been economic: Spring Festival tourists are an important driver of China’s economy.

In the midst of this, an ophthalmologist at Wuhan Central Hospital, Li Wenliang, sent a warning to fellow physicians as early as December 30. Li had seen seven patients presenting with SARS-like symptoms and urged others to take protective measures when seeing patients. Instead, his private group message was reported, and he was taken to a police station and forced to sign an official reprimand for “spreading false rumours”.

The rumours were, of course, true. Doctors were already seeing an ominous sign they knew from SARS: a radiological finding called “ground glass opacities”, where the lungs are so replete with nodules or infiltrates they make a CT scan look like a frosted windowpane. This degree of disease can progress rapidly to acute respiratory distress syndrome, the most severe form of acute lung injury, where the alveoli are drowned with fluid and become incapable of oxygen exchange. Patients choke on pink froth as their lungs destroy themselves, and intubation is no guarantee of reprieve.

On January 22, though the death toll was still only 17, the implications were unmistakable: the virus had been out of control for some time. A renegade journalist named Michael Anti (  Jing Zhao), described officials as “acting on behalf of the virus, not on behalf of humans”. The same day, an announcement was made: 11 million people would be prevented from leaving Wuhan. To avoid panic, the movement ban started the following morning, and many fled overnight. By January 24, construction on a massive new temporary hospital had begun, anticipating an influx of the infected.

Other cities followed suit into lockdown, though under less severe conditions. It was difficult – a record number of couples would file for divorce – but many Chinese citizens responded with creativity and good humour. New hospitals’ construction was live-streamed to tens of millions, and a mini-subculture of fandom and jokes developed among these “online overseers”. Industrial cement mixers dubbed “Big White Rabbit” or “The Cement King” starred in digital artworks.

Construction crews worked to the point of collapse, and sometimes beyond it. Factory workers producing personal protective equipment worked endless shifts, and a spirit of sacrifice was promoted. In Shandong province, a 68-year-old sanitation worker donated his life savings at a local police station with a letter reading “To cheer on the brave medical workers, a token of my appreciation”, then ran away before he could be thanked. Doctors, anonymised by masks and goggles, drew cartoons on each other’s protective suits for identification, and danced with each other on shift-changes, trying to buoy morale. The threat was also personal: by March 1, more than 3300 of China’s 78,800 cases were medical workers.

One of them was Dr Li Wenliang. He had returned to work and contracted coronavirus. So had his parents. Before he became ill, Li told The New York Times that “if the officials had disclosed information about the epidemic earlier I think it would have been a lot better”, and there were rumours this outspokenness resulted in a delay in his treatment, as a punitive measure. A confused official account of his subsequent death, where the announcement was mysteriously delayed, seemed to partly confirm this. He left behind a son, and a wife pregnant with his second child.

Discontent rippled across the Chinese internet – it was not unusual to see entire news feeds devoted to tributes to Dr Li, many referencing censorship, his status as a whistleblower, or even outright rebellion. The character with which the doctor had signed his official reprimand – meaning “understand” – became inverted into a motto of open defiance: “we don’t understand”. China-watchers called the eruption “a nationwide howl of rage and mourning” (Financial Times) or “an online revolt” (The New York Times), and even usually apolitical Chinese citizens voiced their dissatisfaction. Whether the relatively free discussion was a partial concession by Beijing or simply a sign of the system being overwhelmed was unclear. By contrast, President Xi Jinping remained largely out of sight.Regardless, critics were still impressed by the pace, scale and acumen of the Chinese response to the virus, as though a macabre public-health Olympics was taking place. William Haseltine, head of the health think tank ACCESS Health International, called it a “sad day” when “China is outperforming the US in terms of public health”. Building hospitals overnight was difficult in a free country, he said, but a Western version of China’s testing and tracking program required only will and competence to implement. “It’s just a matter of whether the government takes action.” These words would turn out to be unpleasantly prescient.

The virus began its overseas travel in January, when a case was registered in Thailand. The Thai response was imperfect, and stymied by corruption, but a combination of tracking, testing, travel bans and body-temperature screening kept the caseload low. In the first wave, Thailand experienced 38 deaths, a fraction of what was to come elsewhere.

The varied fates of different countries were hard to parse. Singapore, Japan, Taiwan and Hong Kong dampened initial flare-ups successfully – was East Asian compliance to be thanked for that? Did Italy succumb harder because of its older population, or because of young people living at home? What separated Croatia (scarcely affected) and Belgium (ravaged)? The light imprint on India and the heavy per capita toll in Switzerland offered little information that could shape a universal response.

The virus did punish hubris. Iran was hardest hit after China, and it pioneered failure in response. The country was already in susceptible condition, after months of violent protests, and a year in which its sanctions-wracked economy had contracted by 9 per cent. The first cases were identified in the holy city of Qom in February: a merchant from Wuhan was clocked as an index case (the first documented patient within a population), though speculation extended to Chinese students in Shia seminaries. It was a bad time and a bad place for preventative measures, right before imminent parliamentary elections, and in the midst of spring festival celebrations leading up to the Persian new year. Authorities were reluctant to suspend the voting, and devotees demonstrated their divine confidence by licking the doors of Qom’s shrines.

Iranian hardliners set the tone for reactionaries the world over, composing a volatile compound of paranoia and defiance. (Graft may have played a role here as well – Mahan Air, a private, Revolutionary Guard–linked airline, was one of the last carriers anywhere to cease direct flights to China.) In the eyes of Iranian leadership, COVID-19 was at the same time a manufactured bioweapon, aided by a conspiracy of external and internal enemies, but also nothing to worry about. President Hassan Rouhani assured his people that normalcy would return by the end of February. By the end of March, the disease was killing one Iranian every 10 minutes, and Iran had spread it to at least seven other countries. Satellite photos of Qom showed fresh, lime-lined mass graves ready to receive their hecatomb.

Rumours spread in Iran that illegal alcohol might offer protection; instead, hundreds died from methanol poisoning, possibly because ethanol was in high demand for manufacturing hand sanitiser. The deputy health minister, Iraj Harirchi, soft-pedalled the threat in a press conference, during which he coughed continuously. “Quarantines belong to the Stone Age,” Harirchi insisted, sweating so visibly that aides rushed the podium with tissues. The next day he was quarantined himself, corona-positive. Eight per cent of Iranian MPs would test positive for the virus, and the former ambassador to the Vatican died.

Italy was next to be hit hard. There was no compelling reason why; instead, a lackadaisical attitude, an intimate social culture that struggled with distancing and the Chinese-operated rag trade in the north of the country seemed to conspire the circumstances. In Lombardy hospitals, anaesthesiologists were seen weeping in the corridors as they made impossible triage decisions. Mayors excoriated their dog-walking citizens in online videos; apartment blocks enjoyed a capella concerts, improvised from the balconies (this method of forbearance would be copied in Britain, where health workers were applauded nightly).

Still, the seriousness was not universally acknowledged. In the French commune of Landerneau, near Brest, at least 3500 people dressed as Smurfs gathered to try to break a world record. “There’s no risk – we’re Smurfs!” one attendee told Agence France-Presse. “Yes, we’re going to Smurfise the coronavirus.” Patrick Leclerc, Landerneau’s mayor, refused to apologise for the festival, and claimed it was “chance to say we are alive”. The next day, the French government banned crowds of more than 1000 people. Politico Europe thought the event emblematic of an “incompetence pandemic”, where politicians across the continent had failed to gauge the gravity of the situation.

No known cases have yet been traced to the Smurf festival, but other gatherings, small and large, acted as clusters. In South Korea, a millenarian church called Shincheonji maintained its services. It was here that “Patient 31”, a 61-year-old female congregant who displayed symptoms but refused testing, may have infected as many as 1300 other churchgoers (there was speculation the woman may have been trying to hasten the End Times).

Other sites of mass infection were less apocalyptic. The funeral of a popular retired janitor in the small American city of Albany, Georgia, seeded an outbreak that spread to 490 people. Nine members of one Hong Kong family tested positive after sharing a hotpot. Forty-four guests at a single Uruguayan wedding contracted the virus.

Spain succumbed as Italy did, until soldiers found the corpses of nursing-home residents abandoned in their beds. Other European countries adopted a mask-wearing culture almost overnight. The president of Slovakia, Zuzana Čaputová, wore a fuchsia outfit with matching face-covering to swear in a new cabinet, abiding by a decree that made wearing masks mandatory. In the Czech Republic, fashion students at the Academy of Arts, Architecture and Design in Prague sewed masks by the thousands. In some areas “mask-trees” cropped up on street corners, so volunteers could leave their homemade efforts hanging for volunteers. Their efficacy in stopping the virus was debatable – WHO guidelines did not recommend them, though this was contentious – but they worked well enough as a symbol of solidarity.

After witnessing the calamities in Southern Europe, most European countries rapidly instituted stringent contagion controls. There were three exceptions: the United Kingdom, the Netherlands and Sweden. The UK acted late, relative to its death count, and was said to be considering a mitigation-based, “herd immunity” approach. Prime Minister Boris Johnson ordered bars and restaurants closed on March 20, but outlined the quarantining only of the elderly and other at-risk groups. Over the weekend, the spring sun shone, and a pandemic is not enough to keep the Brits out of parks. Sir Patrick Vallance, England’s chief scientific adviser, rejected describing the aim as herd immunity. This would only be a by-product, he told the BBC. The true aim, he said, was to “broaden the peak” of the epidemic, “not suppress it completely”.

This risky gambit enjoyed high-level support. Dominic Cummings, an influential Downing Street adviser with a contrarian bent – he had helped author Brexit – enthused over this new departure from the continent, and it was not until March 24 that the UK instituted stricter curbs, after Imperial College modelling showed a “broadened peak” translated into 250,000 deaths. Shortly afterward, both Johnson and Cummings contracted COVID-19. The prime minister had visited hospitals and insisted on shaking hands with coronavirus patients, and, by April, he had been admitted to an intensive care unit with breathing difficulty. He recovered; by then, nearly 10,000 Britons had not.

As Britain baulked at their “blended” strategy of gradual exposure for the less vulnerable, it continued in Sweden. Sweden was one of the only states in the world to eschew lockdown (Brazil’s president Jair Bolsonaro had tried a similar, machismo-inspired approach, until he was stared down by his health minister and a coterie of generals). In Stockholm the decision was equal parts political and medical, and characteristically for the Swedes, it rested on human rights: the Swedish constitution allows for no declaration of emergency during peacetime. Instead Prime Minister Stefan Löfven emphasised personal responsibility, and streets in Stockholm remained sparsely peopled. Citizens were seen as compliant and sensible enough to look after themselves.

Criticism was vociferous. Fredrik Elgh, a virology professor at Umeå University, told the Swedish state broadcaster that the state was “almost the only country in the world not doing everything we can to curb the infection”, and that this was “bloody serious”. A prominent mathematician accused the government of playing Russian roulette with the lives of 10 million people. As infections climbed – per capita they were more than triple that of neighbouring Norway – the government sought additional powers, without turning half-measures into full measures. The death rate among the infected peaked at nearly 8 per cent, a failure second only to Iran.

Worldwide, panicked shoppers cleared stores of toilet paper, leading The New York Times to publish some old-school psychoanalysis: “psychologists say it’s more than a little Freudian, what with the anal personality being tied to a need for order, hoarding and fear of contamination”. (Most psychologists disagreed.) Stockpiling of hand sanitiser, cleaning agents, milk, eggs, rice, pasta, flour and cheese led to international supply shortages: supermarkets in Australia reported a 76 per cent increase in sales of these items over the year before. Fruit and vegetables rotted in fields without workers to harvest, and in March the US experienced a massive oversupply of chicken wings. There was no college basketball to watch while eating them.

Workers, working from home, met their colleagues over Skype or Zoom, and socialised the same way in “quarantini hours”. Yeast went gangbusters as well, and social media was full of proud parents displaying their sourdough starters, as Westerners uncovered a Depression-era folk memory of baking and drinking too much.

Those were not the only things to make a comeback: no longer repulsed by noise pollution, animals had the run of shuttered streets. Spanish bucks strolled around Catalonia and wild boars descended from the hills around Barcelona. In the Japanese city of Nara, deer accustomed to a rice-cake diet administered by sightseers had to leave their parks, and ate hedges outside the train station. Night-time curfew in Santiago, Chile, was broken by a wild puma. A dolphin swimming in the newly clear waters of Venice’s Grand Canal turned out to be a hoax. A tiger in the Bronx Zoo testing positive to COVID-19? That was real.

It was also an ill omen. The tests of public health, mutual responsibility and political competence posed an especially ominous challenge for the US. America’s dismal treatment of the uninsured, deracinated public institutions, partisan paranoia and myopic president made it uniquely vulnerable. Donald Trump did not call the virus itself a hoax, but he did say that about Democratic criticisms of his poor preparation. Privately, Fox News host Tucker Carlson made a personal mercy dash to Florida, to implore the president to take the threat more seriously.

Trump’s hometown, New York City, was doubly exposed. After the attacks of September 11, the city had celebrated the simple resistance of “living life”. Post-terrorism, this raised morale. Mid-pandemic, it raised infection rates. New York state’s number of confirmed cases would soon surpass Italy’s.

In Las Vegas, a city full of empty hotel rooms, a homeless shelter evacuated into a car park painted with white lines to enforce social distancing. Republican politicians in their autumn years declared themselves ready to die for the economy. Texas’s lieutenant governor Dan Patrick told Tucker Carlson that he had made his peace. “You know, Tucker, no one reached out to me and said, ‘As a senior citizen, are you willing to take a chance on your survival in exchange for keeping the America that all America loves for your children and grandchildren?’” he said. “And if that’s the exchange, I’m all in.” There were lots of grandparents who agreed with him, he said. Twenty thousand deaths did not alter these positions.

It was not so different from the bargain America accepted in other, less exceptional circumstances. The US was still the world’s richest country, but in the hospitals of New York, the nurses were wearing garbage bags for protection. A field hospital was set up in Central Park (the evangelical organisation running it made volunteers sign an anti-gay marriage statement before attending patients), and refrigerator trucks prepared for morgues to overflow. On Hart Island, where the unclaimed bodies of New York City are buried, workers put coffins side by side in trenches; previously they had averaged 25 a week. The harvest of coronavirus was 25 a day.

Prisons were especially hellish. Testing was rare everywhere, but the incarcerated could not even access bars of soap. An outbreak in a Chicago prison infected at least 450 inmates and staff. In the Rikers Island jail complex in New York City, felons spat in the faces of staff to infect them deliberately. At Brooklyn Supreme Court, a lawyer asked Judge Johnny Lee Baynes about the lack of social distancing in his crowded courtroom. “If you don’t like it, you can leave,” the judge retorted. Two weeks later he was dead from complications of COVID-19.

On the high seas, confinement incubated illness. US Navy captain Brett Crozier, the commanding officer of the USS Theodore Roosevelt, an aircraft carrier stationed at the Pacific island of Guam, emailed a request to evacuate his ship in desperation. The email was leaked, and Crozier was fired. Acting Secretary of the Navy Thomas Modly expended US$243,000 flying to Guam to relieve the captain of his command, called him “stupid”, and then resigned himself. Crozier’s crew chanted their former skipper’s name as he disembarked; more than 550 of them would test positive for the virus.

The presumptive Democratic nominee, Joe Biden, appeared increasingly confused and tongue-tied, and had absented himself from the airwaves as the crisis intensified. New polling showed a majority of Democratic voters preferred New York governor Andrew Cuomo as a presidential nominee.

Polling showed Fox News viewers and climate-change sceptics especially unlikely to practise social distancing. It also showed 43 per cent of registered voters supported the president, even as the federal government funnelled medical supplies away from the Democratic-voting states, which needed them most. Only Florida received the masks and ventilators that it asked for from the national stockpile.

US states competed for personal protective equipment but were outbid by the federal government, which then disseminated the stockpile through private contractors. Circumventing the agencies supposed to be helping them needed creativity: the Massachusetts governor borrowed a plane from the New England Patriots football team and sent it to China to pick up masks. An Illinois comptroller drove at speed to meet a middleman, before handing him a US$3.4 million cheque in a McDonald’s parking lot.

While Trump pushed to “re-open the country”, experts said the crisis could last until 2021, or until 90 per cent of the population was infected. Trump also recommended an old anti-malarial medication, hydroxychloroquine, which was promising but unproven. A man died after he and his wife drank a poisonous fish-tank cleaner with a similar-sounding ingredient. Only preventative measures – social distancing and quarantine – were truly efficacious. Their side effect was incredible economic damage. Some 16.8 million Americans applied for unemployment benefits in just three weeks.

Where treatment of patients is most intimate and vital – in the wards and rooms and makeshift hospitals – no visitors are allowed. The doctors wear masks, so these spaces are largely silent, apart from the sound of the ventilators. Each day a patient remains on a ventilator, the less likely it is they will survive. Here the cost/benefit curves that play out politically also play out personally, in miniature. In the UK, doctors have developed a triaging process called the Covid-19 Decision Support Tool, where patients are given a score – those over 70 years old with co-morbidities are treated palliatively, not curatively. At Italy’s worst point, that cut-off became 65.

In South Korea and China, some patients who had recovered from the virus were found to be re-infected. Some researchers already predict the virus will recur annually, like the flu. If that happens, there will be no normal to return to.

Richard Cooke

Richard Cooke is The Monthlys contributing editor. 


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