In my home state of New Jersey and across the river in New York, where COVID-19 has been under control for the last two months, there's a deep sense of foreboding that the failure of so many other states to learn from our painful experience, and the MIA status of the Federal government, will lead to another mass casualty event.
As Gov. Andrew Cuomo has observed from the beginning, we have been behind the curve of this scourge, in a purely reactive mode. We're like a person on fire running to escape the flames.
Gov. Phil Murphy of New Jersey has already sounded the alarm that our state is seeing a significant uptick in new cases. On Friday, state health authorities reported 699 new cases, up dramatically from 261 the day before.
Experts now project we could have 250,000 dead Americans by Election Day.
But these publicized numbers, which are supposed to act as our collective dashboard and define our risk-threat matrix, don't really capture what's actually going on — or the role the Trump administration is playing in undermining our ability to combat this virus.
The bigger picture
According to research published by the CDC and the peer-reviewed journal JAMA Internal Medicine, the nation's COVID-19 infection rate is likely 10 times higher than what's being reported. The findings are based on tests that flagged the presence of COVID-19 antibodies in 19,000 routine blood tests that included individuals who had likely never been tested for the virus nor displayed obvious symptoms.
Yet, even if we extrapolate this data and assume that 20 million Americans are now infected, that means the vast majority of Americans are still vulnerable to the deadly virus.
The wider prevalence of the virus comes as research is still inconclusive on whether the presence of the antibodies provides the carrier with an immunity, and if it does, for how long.
Dr. Fiona Havers, a member of the CDC seroprevalence task force, told NBC News: "We don't know if antibodies represent protection from the virus. And there may be some suggestion [of] antibodies waning over time, so we don't know if herd immunity is achievable."
And that's not the worst of it in terms of the widening gap between reality and our popular understanding of the collective threat we all face, which is vulnerable to manipulation by economic and political forces with their own self-serving agenda.
Riding the herd
To this very day, it is the presumed possibility of herd immunity has informed the Trump administration's cynical ploy of pitting the 50 states against one another while simultaneously promoting the spread of the virus by trying to forcing schools to open and the nation's meat plants to keep working, no matter how high the body count.
Just as the Trump administration's lack of a national response to the virus accelerates its spread, the failure of the Republican Senate majority to extend the $600 a week supplemental unemployment benefit puts tens of millions of Americans at risk for eviction, when they need to shelter in place.
We face a multi-faceted crisis which requires an economic strategy that reinforces the essential national public health response.
In New Jersey, more than 1.3 million people, out of a workforce of 4.3 million, have filed for unemployment since the start of the COVID-19 crisis. That statistic doesn't include the impact of the pandemic on the hundreds of thousands of workers who work off the books or are self-employed
On Thursday, the Commerce Department announced that in the second quarter the nation's GDP shrunk at an annualized rate of 32.9 percent, the most severe contraction on record.
Senate MIA as families struggle
Yet Washington continues to dither about what if anything it should do to backstop the local, county and state governments drowning in red ink as they face unanticipated pandemic costs and a dramatic drop-off of tax revenues, all while the nation sinks deeper into the clutches of the virus.
"We don't have a federal government — it's in collapse," said Hetty Rosenstein, New Jersey state director for the Communications Workers of America. "You can't leave people in this circumstance. No responsible government would do that. This federal government is creating this crisis by not offering an effective integrated public health response."
For hundreds of thousands of New Jersey families the CARES Act's $600 in additional unemployment helped them make ends meet in a state notorious for some of the highest housing costs in the nation.
"I hear every day from our constituents whose very lives depend on the $600 unemployment insurance benefits passed by the House," wrote Rep. Bill Pascrell Jr, a New Jersey Democrat. "Their backgrounds are diverse, their stories are compelling, and their needs are heart-wrenching…. I want to share the stories of my constituents who are just some of the people devastated by Republicans' cruel dereliction."
One of those constituents was Joe from Teaneck, who worked at a Broadway theatre.
"My industry has been drastically affected, with the unfortunate news that we will not be returning to live theatre on Broadway until the earliest in January 2021," Joe wrote. "The stimulus and unemployment add up to a percentage of what was my weekly income, hence to say if the stimulus were to end, it most definitely would have a drastic impact on my financial realities."
Joe is also an active member of my hometown Ambulance Corps, which was at the heart of the initial outbreak in Bergen County.
"Our hospital and our Township were ground zero in the early days of the pandemic," he wrote. "It is with great pride, honor and respect for my fellow members, the men and women of our organization that answered the calls during that most difficult period and served our community."
Many were hurting before the pandemic
It is impossible to grasp just how precarious our national circumstance is if you don't have the context of understanding just how many American families were struggling before the pandemic.
For decades, demographers and economists have documented how inadequate a gauge the U.S. poverty rate is, in terms of capturing the lived experience of vast swaths of our country where wages have failed to keep pace with escalating costs for shelter and basic living expenses.
More than a decade ago, the United Way of Northern New Jersey was perplexed by the volume of calls they got from families struggling economically who lived in zip codes with some of the lowest official poverty rates in the nation.
In 2009, working with researchers from Rutgers, they developed a way to track the actual local costs of living and wages and in the process discovered a cohort of families that were not living below the official poverty line, but still struggled week to week.
That same project has been replicated with state surveys across the country.
Dr. Stephanie Hoopes, the national director of United For ALICE, has written that "40% of US households were ALICE — Asset Limited, Income Constrained, Employed — struggling paycheck to paycheck before the pandemic":
Closed and partially open businesses have meant lost income for these families — reduced hours or unemployment. For these households, even one unemployed person can push the family over the edge. Without outside help, many will be forced to choose between their home, their car, their parent's medication, or their child's next meal.
While consumer spending has improved since Covid-19 restrictions have eased, low-wage workers' hours and earning have not rebounded the same way. What little savings ALICE families had has been used up. They have no cushion to absorb gaps in benefits. Unless these families get relief quickly, there will be a huge uptick in evictions and foreclosures, utility cutoffs, lapses in car and student loan payments, and increases in medical debt; and lines at food banks will continue to grow.
Before the pandemic, according to the Federal Reserve, 40 percent of American households would have had to resort to borrowing to cover something like an unanticipated $400 car repair or medical bill.
On the edge of a COVID abyss
In addition to letting the $600 supplemental unemployment payment lapse, Congress failed to renew the federal moratorium on evictions, which covers more than 12 million tenant households, roughly 30 percent of those who rent their homes. At the same, time state and local moratoriums are expiring.
"Frightening does not adequately describe what's coming ahead," said Larry Hamm, longtime Newark civil rights activist and former state coordinator for the Bernie Sanders campaign. "I know people whose federal subsidized unemployment is running out and they don't know what they are going to do. They are going to be homeless."
He continued. "Remember: the eviction moratorium Murphy put in place was not forgiveness of the rent but simply a suspension of eviction. I don't know what made people think that if folks were behind in the rent before, that now they can come up with three or four months."
The importance of keeping people in their homes, particularly in communities of color where we know COVID is taking the heaviest toll, can't be overstated.
The next crisis
In typical mass media reductionism informed by our limited binary thinking, we frame COVID-19 as either something that kills you outright or as a disease you survive with an immunity that will protect you.
The grim reality that should be informing our actions, both individually and as a state and nation, is that you can survive COVID with disabling consequences that could take years to fully manifest.
We have to study and become conversant with the underlying science ourselves. If this virus doesn't outright kill you, it can do serious damage to your respiratory, coronary and central nervous systems.
Studies have flagged that COVID creates scarring on the lungs for those who have survived a bout with the virus, including individuals who were asymptomatic.
"One thing we didn't anticipate was that the virus seems to accelerate a great deal of scarring in the lungs," wrote Dr. John Swartzberg, of the UC Berkeley-UCSF Joint Medical Program. "And if lung tissue is replaced with scar tissue, it is no longer functional as regular pulmonary tissue, which translates to poor gas exchange."
He continues. "What we really fear is long-term shortness of breath that could extend anywhere from being very mild to severely limiting. There is also a disturbing report looking at computerized tomography (CT) scans of asymptomatic people that found they were left with some scar tissue. So, this could even be happening on a subclinical level."
In the same analysis, Swartzberg notes that "the virus can directly attack heart muscle cells, and there's also evidence that the cytokine storm that the virus triggers in the body not only damages the lungs but can damage the heart. We don't know what the long-term effects of that may be, but it could be that we will have a population of people who survive COVID-19 only to go on and have chronic cardiac problems."
And that's not all.
"The third organ system that we're now pretty clear about is the central nervous system," he writes. "There is evidence of direct involvement of the virus with neurons, and also the cytokine storm and inflammatory mediators can cause damage to the central nervous system. "
He warns that in addition to "neurologic clinical findings," attending physicians are "seeing patients post-discharge struggling with psychological challenges, almost like PTSD. And, we're also seeing some cognitive defects in some people that are very disturbing."
As previously reported, COVID-19 infections can cause "abnormal clotting of the blood in some people. This has led to pulmonary emboli, which are blood clots that travel to and damage the lungs, and strokes, which are blood clots in the vascular system of the brain. Both pulmonary emboli and strokes may have long-term consequences for these two organs."
So, yeah, as too many Republicans have been saying, it's just like the flu.
Still not getting it
Our more enlightened policy-makers, who are still in their "flattening the curve" phase, need to also prepare for addressing these long-term health consequences from COVID-19.
Yet, as Hamm points out, the response from some in Congress has been to use the cover of the pandemic to sneak in $1.75 billion for a new FBI building and $686 million for the F-35 combat aircraft.
"All of what is happening now is just a logical extrapolation of what has been going on for decades," Hamm said. "The bad situation may come quickly, but it is the consequence of myriad of actions that we have taken before."
For a generation, particularly in the aftermath of 9/11, we spent hundreds of billions of dollars of borrowed money on the military so we could project force anywhere in the world.
At the same time, we defunded public health, closed hospitals in inner cities and in rural America — and for three years in a row Americans' life expectancy declined, fueled by a spike in opioid addiction and suicides.
As President Trump and his partisans press to open schools in the fall, the reality is that the existing health infrastructure in our schools has long been inadequate, with thousands of them lacking something as basic as a school nurse.
Door-to-door healing
Donna Mazyck, executive director of the National Association of School Nurses, recently told NPR that one in four U.S. schools have no nurse, while 40 percent only have "a nurse only part of the day — a nurse who's shared among several schools."
The only way to successfully combat COVID is in the community where it is spreading. All too often, by the time people get to the hospital it's too late, and in the process they infect their co-workers, friends and family.
In Cuba, where there are 8.19 physicians per 1,000 people, the government sent thousands of doctors and health professionals to canvas every home for COVID-19 cases. So far, the island of 11.3 million has recorded 2,608 cases, with 87 deaths.
"There's no other country in the hemisphere that does anything approaching this," William Leogrande, professor of government at American University in Washington, told the Guardian. "The whole organization of their healthcare system is to be in close touch with the population, identify health problems as they emerge, and deal with them immediately."
He continued. "We know scientifically that quick identification of cases, contact tracing and quarantine are the only way to contain the virus in the absence of a vaccine — and because it begins with prevention, the Cuban health system is perfectly suited to carry out that containment strategy."
We need emergency universal health care coverage now. For too long greed and scarcity have throttled our health care system, which by the way has only 2.59 physicians per 1,000 people.
Our politics and our imaginations are failing us.
We are underestimating the scale of the problems we face and the long-term consequences of failing to effectively address them. Our current system of rationing health care based on the ability to pay leaves too much of the population exposed to a deadly and disabling virus that anyone can catch.
We need to think bigger — much bigger.
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