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Coronavirus for All

Photograph Source: 2C2K Photography – CC BY 2.0

“Someone once said that it is easier to imagine the end of the world than to imagine the end of capitalism.”

Frederic Jameson

OK, maybe it’s not the end of the world – but it’s the end of the world as we know it – and it will be upon us within the next few days. The author heads up coursehero.com. Still, I believe that he’s right. Michael Moore says that the public health-types in government tell him that he’s right.

In Boston, Biogen’s name will forever be mud. One of the high-flying executives of the successful biotech corporation contracted the coronavirus somewhere other than Boston. They then brought it to the hotel conference room and, afterward, to the restaurant/bar, where (through those handshakes and hugs), in a soon-to-be-famous superspreader event, billions of virions made the jump from Boston’s Patient Zero to a bunch of other managers and scientists. Then they turned in unison toward Patient Zero and chirped, “Hey, thanks for the ride, sucker!” (OK, I made up that last part.)

Those biotech executives then went to “Man’s Greatest Hospital” (Massachusetts General Hospital), where the doctors told them, no, we can’t test you for coronavirus because you don’t meet the criteria for testing according to the CDC protocol. And the executives thundered, “What? Are you stupid? Who do you think I am? I have a PhD in molecular biology and an MBA, too!” But they were turned away, and they went home fuming, but being very careful to cough into their elbows, responsible and civic-minded citizens that they are.

The smart-ass intern at the nurses’ station said into his EHR screen, “If you’re so smart, why don’t you make your own RT-PCR for SARS-CoV2?”

Certainly it’s true in the U.S.A. it is easier to imagine the end of the world than to imagine the end of capitalism. On the other hand, it’s also obvious that capitalist health care is going to faceplant in the face of the coronavirus. It’s going to be a choice between Medicare for All or Coronavirus for All.

But eventually, the coronavirus made its way into regular working people. And that fast food worker had to think, so I’m living paycheck to paycheck, and I’ve got this cough and this fever. Can I take time off from work? Can I afford to go to the doctor? For many who work for hourly wages – a day off from work means no pay for that day. While public health authorities may say, “Don’t go to work if you’re sick,” many who live paycheck to paycheck had to think that staying home meant having trouble paying for rent, food, water, electricity, or childcare.

The virus had an easy time infecting homeless people, who may not have homes, but do congregate in shelters. Nursing homes are also congregate living settings. What happened in old people’s homes in Wuhan? When we talk about a 14.8% case-fatality rate (CFR) among those 80 year-olds and older–it’s evident that Wuhan’s health system wasn’t ready for lots of old people in lung failure. Is the U.S. health system ready for that? Of course, the CFRs are related to the biology of the infecting organism: the coronavirus is much more virulent than, say, seasonal influenza. The CFR is, however, also related to the effectiveness of health systems. So, we can expect health systems to keep people from dying when they’re not overwhelmed – when health care workers in Wuhan or Lombardy are not having to decide whom to put on those scarce mechanical ventilators.

These days U.S. health system is run by health care executives, with their business smarts, their lean operations (except for their compensation packages), achieving just-in-time delivery. Until there was a nationwide shortage of IV bags of normal saline after Hurricane Maria, whoever knew that they were made in Puerto Rico? Until lots of losartan and ranitidine had to be taken off the shelves, whoever knew that they were made in China? The lax manufacturing practices of generic pharmaceutical corporations there contaminated the medications with NDMA. That’s what happens when you obtain your supplies from the cheapest sources on the planet. They’re the cheapest because they have the most lax environmental regulations and their labor is most exploited.

Until this past week, the only available option in for COVID-19 testing was your state laboratory, which was sending samples to the CDC. In order to obtain the COVID-19 test, it was required that the patient have a respiratory virus panel test done. This panel is a reverse transcription polymerase chain reaction (RT-PCR) test for a variety of viruses, including influenza and the run-of-the-mill coronaviruses that cause the common cold. From a diagnostic perspective, this makes some sense. If the patient’s symptoms can be explained by influenza, then it’s unlikely that they would have COVID-19. The respiratory virus panel test, however, costs $1479.90. Now for a very ill, hospitalized patient, such a cost would be buried within the cost of the entire hospitalization – and health insurance would likely pick up the cost. For the outpatient who is not about to die, however, it means a bill for $1479.90. It appeared unlikely that insurance will pay for a $1500 test to confirm a common cold – especially if we were to start testing larger numbers of patients. An uninsured patient would find such a cost unaffordable, meaning that unless one is deathly ill, an uninsured person cannot get tested for COVID-19. This has hampered our ability to who has the virus in the U.S. In Korea, you can get tested via a drive-through. In China, the authorities will find you, and they will test you – free of charge – and they’ll warehouse you in a re-purposed exhibition hall.

Anthony Fauci says that we’re now moving from containment, the notion that we’re going to track down any individual with the virus and isolate them – to mitigation, just trying to slow down the spread so that your local hospital doesn’t turn into The Central Hospital of Wuhan. In the mitigation phase, we’re social distancing. We’re staying six feet away from each other. We’re going to hole up and subsist on macaroni and cheese. Or the government could lock it down the way China did – where a man was quarantined, and his disabled son starved to death, where a boy was found with the body of his grandfather because he had told him not to venture out.

Our government will compensate the petroleum, airline, cruise ship, hotel, and sports and entertainment industries for their losses. Socialism for corporations is the first order of the day. But if we want to get through the coronavirus with grandma and grandpa alive, we must have Medicare for All. Or would you rather have Coronavirus for All?

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Seiji Yamada, a native of Hiroshima, is a family physician practicing and teaching in Hawaii.

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