Friday, July 30, 2021

About Systems Failures and a Pandemic

I’m annoyed.  Really annoyed.  I live in a community where, as of today, 92.3% of the population, 12 and older received at least one dose of a COVID-19 vaccine.  That’s the highest vaccination rate in our county.  We have an incredible volunteer medical and emergency response corps who put together a vaccination campaign that even attracted folks from outside the community to come here and be vaccinated.  Our small, independent pharmacy took a leading role in becoming a hub for vaccinations, and even my dentist’s office purchased a specialized freezer to become a vaccination site.  This is all one outcome of living in a community where large numbers of medical professionals and talented organizers live.  It’s an older population with a median age of 54 where a lot of experienced professionals – many of them retired – are available to organize and participate in making all this happen.  I’m grateful to these people.  My wife and I didn’t move here 24 years ago with the intention of someday living in a secure bubble that protected us from a pandemic.  We came for the forests and connection to the waters that surround us.  But, as it turns out, living here gives us resources that we couldn’t have anticipated – that’s confirmed by our community having the lowest COVID-19 infection rate in the region.  So why am I annoyed?


I’m annoyed because these privileges stop at the community’s edge.  The more ethnically/racially and economically diverse communities in my county have higher infection rates and lower vaccination rates than my community.  These other areas also don’t have a large cadre of volunteer medical professionals at the ready to educate them and to organize the medical services that a community like mine can muster.  It’s the same problem that the nation has always had.  Medical service has historically been available to those with resources.  Even in a pandemic where the impacts of no medical service cross geographic lines, the privileged get more services.  In truth, though, I am no more safe from the pandemic than the neighboring communities are.  In truth, I can’t live in a bubble.  When I have an appointment in a neighboring community, when I shop in another community, when someone in those neighboring communities comes to mine – we are all exposed to each other.  The effect of that borderless exposure becomes more real with reports of “breakthrough cases” among the already vaccinated like me – even if my risk for being infected is small.  It’s clear that the folly of the well-resourced being served and others continuing without those resources doesn’t serve anyone well.  That’s always been the case, and a pandemic just makes the interdependence more apparent. 


I’m also annoyed because of how the politicization of this pandemic has ensured that some areas of the state and nation choose not to take caution.  We have counties in our state where significant numbers of people see public health precautions as a political issue.  Significant numbers of people in these communities are convinced that putting on a mask, social distancing, avoiding crowds, and, ultimately, getting vaccinated are actions that that somehow connect to their personal liberty.  Certain politicians, television networks, religious leaders, and online media outlets fuel these ideas.  As a result, their followers choose to remain defiant to the virus, or they choose to remain ignorant of its impact; or they believe themselves protected from it; or they believe unreasoned conspiracies about vaccines, masks, and social distancing.  These people ignore the warnings of health professionals and the unfolding facts as over 600,000 of our citizens died and over 35 million were infected.  All of the current data suggest that these folks being convinced to be intransigent contributes to the pandemic’s spread and impact on all of us – as do the inequity of resources and the politicization of public health measures.  Seems to me that I have a right to be annoyed by this as much as I’m annoyed by the inequitable medical system that favors people who live in communities like mine. 


Finally, I’m annoyed that economic and political pressures forced an early end to public health and safety measures that were limiting the pandemic’s effect.  Those pressures have supported an anti-science approach where political and economic considerations have equal or more authority as scientific ones.  During a December, 2020 NPR interview, Dr. Fauci said, "I would say 50% would have to get vaccinated before you start to see an impact.  But I would say 75 to 85% would have to get vaccinated if you want to have that blanket of herd immunity."  Throughout December through February, as the vaccines were just starting to be reviewed for use, Dr. Fauci and other epidemiologists noted the importance of getting 75 to 85% of the population vaccinated.  The current federal administration and state administrations lowered that to a more pragmatic goal of 70% when it became clear that people were hesitant to be vaccinated.  Science gets put aside as leaders set about mollifying anti-science believers or their voting base or those with economic interests.  Now we’re being warned about another surge in cases.  I understand the economic forces, and I understand the political forces, but understanding doesn’t lessen my annoyance.


So is this just a rant, or do I have an idea of substance to offer here?  Maybe a little of both.  On the other side of this pandemic, when it does end, I like to hope that the lessons of an inequitable health system, the dangers of politicization of matters of social good, and the discounting of science will offer lessons for how we handle the next crisis.  I have this hope, but it’s a dim hope.  Given the issues above, I hear few people, and almost no leaders, discussing the fundamental flaws that led to the problems.  Instead, I hear conversations about the need for technical fixes to existing systems – like providing funding for one short-term solution or other – not the systemic causes we should be discussing. 


We’re faced, in this pandemic, with broken economic and political systems that created divisions and favoritism for some.  These systems poorly serve all but the very few who benefit from them.  These systems are intended to ensure their own perpetuity, yet they can’t continue in the models of failure that is their hallmark.  We’re also reaping the rewards of a decades-long anti-intellectualism that generated skepticism for even the most common-sense measures.  All of this is leading to a clash between perceptions and reality.  This clash will either reshape the fundamental ways in which the society operates, or it will generate little change that will eventually lead to a future clash. 


What to do?  It seems to me that the first task is to be aware that the failures during the pandemic were systemic.  If your car’s motor stops working, and you notice that the lights aren’t working, changing the headlights isn’t going to get the car moving again.  A dead motor is a system that needs to be fixed.  We need to look beyond what’s immediately visible to get at root causes.  In addressing the post-pandemic future, now is the time to discuss the systems that failed us.  What in our systems allows significant numbers of people in ethnic/racial groups and within certain economic groups to be less well served?  What in our political and social processes allows leaders to lie and manipulate their followers with impunity?  What caused suspicion of science to become so widespread?  These are the questions we should be discussing now as we examine the struggles of the past 18 months.  Answering these questions will determine the nation’s future.  Creating piecemeal technical fixes to those systems isn’t enough to ensure we can address the next crisis.

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