Why America can’t rely solely on individuals to stop Covid-19

Americans have spent much of the Covid-19 pandemic blaming one another for the coronavirus’s spread.

Don’t go to that beach or park. Don’t go to that bar or restaurant. Don’t do anything for Thanksgiving or Christmas. Wear a mask! You don’t want to kill Grandma, do you?

Public officials have joined in. Increasingly, they are blaming private gatherings, not the restaurants and bars they insist on keeping open, for the spread of the disease. In some places, such as the Dakotas, framing Covid-19 prevention as an individual responsibility became the core of the strategy to fight Covid-19. As cases and deaths climbed to among the highest rates in the world, South Dakota’s leaders preached “personal responsibility” and refused to require masks, much less stricter measures. Ian Fury, a spokesperson for Gov. Kristi Noem (R), told me his boss gave citizens “up-to-date science, facts, and data, and then trusted them to make the best decisions for themselves and their loved ones.”

It’s true that individuals have an important role in fighting Covid-19. Everyone should wear a mask, and, unfortunately, everyone should reconsider big family gatherings this holiday season. But relying on individual action to fight a deadly virus — an approach that the US has leveraged for problems ranging from the opioid crisis to global warming — simply hasn’t worked.

Today, America is among the worst performers at fighting Covid-19. Despite recent surges in Europe and Israel, the US remains within the top 20 percent for most coronavirus deaths per person among developed nations, with more than twice the death rate as the median developed country. If the US managed the same Covid-19 death rate as Canada, more than 190,000 Americans would likely be alive today.

There are many reasons for that, not least President Donald Trump’s awful leadership. But part of it, experts say, is America’s inability to address structural problems, instead relying on demanding more from individuals. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, highlighted this problem when he remarked that the “independent spirit in the United States of people not wanting to comply with public health measures has certainly hurt us a bit.”

That was clear in much of the public’s response to lockdowns starting in the spring. With “Don’t Tread on Me” flags hoisted in the background, protesters often took to statehouses to demand the end of government-mandated closures. At the demonstrations, attendees claimed they could take care of themselves and didn’t need the government to tell them what to do.

It’s also been apparent in the government responses. The emphasis on individualism helps explain why Trump and his conservative allies, like Noem, have resisted more government mandates on masks and stay-at-home orders in lieu of letting people deal with the virus for themselves.

But it’s not just Trump and friends. Every state in the country, Democratic or Republican, has at some point reopened restaurants or bars, allowing people to congregate in indoor areas that experts widely agree are breeding grounds for Covid-19. While resisting shutting down such places, local and state officials have argued that it’s on people to wear masks, cancel private gatherings for the holidays, and avoid nonessential activities — while leaving room for people to not follow at least some of those guidelines. Every state in the country has also, subsequently, seen surges in the coronavirus this fall.

New York Gov. Andrew Cuomo exemplified the failure of this approach. In the lead-up to Thanksgiving, he said, “My personal advice is you don’t have family gatherings — even for Thanksgiving.” Days later, it came out that Cuomo was planning to host a family gathering with his 89-year-old mother and two of his three adult daughters. He only canceled after a public backlash. Even Cuomo wasn’t planning on following his own advice. (Cuomo’s office argued his comments were misinterpreted.)

Meanwhile, much less attention has gone to addressing Covid-19 from a truly structural perspective. The coronavirus has revealed America’s pathetic public health infrastructure — there’s still no national testing-and-tracing program, and no state has an adequate contact tracing program, if they have such a program at all. Businesses and workers have been left to fend for themselves, as Congress failed to pass an economic relief bill before the last one started to expire. For all the talk about outdoor activities being safer during the coronavirus pandemic, there’s been next to no action in most of the country on getting people outside — at times, governments have even eliminated outdoor venues by closing parks or beaches.

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“It’s a structural issue,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. “Systemic challenges in the United States — that predate the pandemic but have gotten worse [during the pandemic] — lead to the situation we’re in.”

It’s easy to yell at people over their Covid-19 failures — simply log on to Twitter and blast away. It’s costless for a governor to tell people that it’s on them to stop the spread of the coronavirus by voluntarily giving up things they love, especially if the same governor doesn’t even plan on following his own advice.

So rather than do anything about it, Americans are stuck blaming each other for Covid-19. But until we truly realize this is a collective failure, not an individual one, the problems will linger.

Structural problems are really to blame here

Since the start of America’s epidemic, experts have warned that indoor dining and bars are among the worst places for the spread of Covid-19: People are in poorly ventilated indoor areas where the virus spreads more easily sit close for possibly hours, can’t wear masks as they eat or drink, and spew germs at each other as they shout, sing, and laugh.

So many experts have called on governments to close bars and restaurants. Acknowledging the economic toll of this, economists and public health experts have also asked for a bailout of the industry to make employers and their workers whole until the pandemic resides.

None of that happened. Instead, America started to reopen before Covid-19 cases were under control — at the US’s best point in the spring and summer, it still had more than 60 times the daily new cases of Australia, New Zealand, and South Korea — with bars and restaurants reopening in every state by the fall. Public officials acknowledged the risks but merely moved to limit capacity and called on everyone to be responsible by physical distancing, wearing a mask, and limiting contact with people from other households.

This has not gone well. Coronavirus cases have shot up across much of the country, with the US in the middle of its third and biggest surge of Covid-19 yet. At the same time, we’ve gotten more data showing how dangerous bars and restaurants can be for the spread of Covid-19: A study published in the Journal of Korean Medical Science found that a person in South Korea may have been infected with Covid-19 in a restaurant in as little as five minutes. Another study in Nature found, “Reopening full-service restaurants was associated with a particularly high risk.”

Despite that, officials across the country have by and large resisted shutting down again. Many of them, instead, have cited another culprit for Covid-19 spread: private gatherings. New York, for example, put out a PSA to stop “living room spread,” and the state published data suggesting households and private gatherings are driving 74 percent of coronavirus spread.

It’s true private gatherings and households are driving some transmission. Most experts agree Thanksgiving dinners likely led to a surge on top of a surge, and similar Christmas and New Year’s events likely will too.

But that’s why at least some experts believe there’s a need for more focus on systemic action, not the individualistic approach. “People, in general, are horrendous risk assessors — we’re awful at assessing risk,” Daniel Goldberg, a medical historian and public health ethicist at the University of Colorado, told me. “I hate to say people can’t be trusted, but.”

There are other problems with this framing. For one, the New York data doesn’t separate within-household transmissions from social gatherings — so the 74 percent figure includes someone spreading Covid-19 to the husband he lives with (not as avoidable) and someone spreading the virus to someone he invited over for drinks one night (very avoidable). This also only includes the cases that New York could actually contact trace, and it’s much easier to trace transmission between family and friends in a household than strangers in a bar.

The big problem, though, is that there’s nothing unusual about Covid-19 spreading among people who live together. It’s typical for the bulk, even the majority, of the transmission of any disease to happen within households. If you’re infected, the people you live with or come into close contact with at home are simply likely to get it too. That’s how pathogens work. What matters most, though, is where that virus originated from in the first place.

To put it another way: People couldn’t infect others in their homes if they hadn’t picked up the coronavirus in bars, restaurants, or other public spaces. So if these places weren’t open, individual choices to gather — including over Thanksgiving and Christmas — would be of far less concern. There would simply be much less virus out there jumping from person to person.

So it largely comes down to the lack of systemic action, not solely the individual choice.

It’s not just bars and restaurants. If officials want people to wear masks, they can mandate masks and actually enforce those mandates. If they want more adults to stay home, they can replace any income individuals might lose by not going into work, or take steps to make work-from-home life more bearable, like deeming schools “essential” or subsidizing day care. If they want people to stay outdoors and not indoors, they can do things that can encourage people to go outside instead of congregating inside — like offering free outdoor activities like ice skating or art installations, or even just places to eat (with some heating during the winter) — rather than shutting down parks. If they want to address racial disparities for Covid-19, they need to address systemic racial disparities across society and health care.

Otherwise, we’re going to be stuck with relying on people to make decisions — almost always against their own social, cultural, and economic interests — to do the right thing. So far, that just isn’t working.

It’s easier to blame individuals than fix big problems

Public leaders and government officials face their own structural forces too.

Brown University School of Public Health dean Ashish Jha told me of a recent conversation with a governor. Jha argued that risky indoor spaces like bars and restaurants should be closed, or hospitals will soon overflow. The governor responded that such closures would require money to support affected businesses and their employees, and the state simply doesn’t have that money. The governor added, “Maybe I should spend a little bit of money and try to campaign for people to be more careful” — a pivot to an individualistic approach.

“I came to appreciate that, ultimately, the problem wasn’t this governor,” Jha said. He later added, “The right answer is not we need better governors — the right answer is we need a different structure and a better federal government.”

Structural issues are, almost by definition, much harder to fix than simply asking people to do the right thing. It’s easy and cheap to yell at people for getting together for Christmas — especially when they really shouldn’t be doing it. Closing down bars and supporting them economically, in turn, requires both political and financial capital.

In some cases, governments legitimately can’t do what they would prefer. Local and state officials, unlike the federal government, can’t print money and usually have to balance their budgets. Given that reality, a governor might decide that she has to keep bars open simply because she can’t bail them out — the economic cost is so high, and, who knows, maybe the state might get lucky and avoid an outbreak anyway. States, counties, and cities face a structural barrier in the federal government’s inaction.

There’s a cultural component, too. Americans pride themselves on their individualistic and libertarian qualities — what Fauci described as an “independent spirit in the United States.” That creates an innate resistance, among the public and its leaders, to look at problems in a collective over an individual manner. So with Covid-19, we yell at people for not distancing or wearing masks in bars, but not as much at public officials for allowing that bar to open in the first place.

The truth, as Covid-19 has shown us, is this individualistic approach doesn’t work well for public health (even if it does serve us well in other areas). The alternative to not taking collective action is more death. The countries that have done the best against Covid-19 — including Australia, New Zealand, South Korea, and, to a now lesser degree, Germany — all approached the issue collectively, leveraging government aid and public health systems to let people stay home without losing as much income or health insurance, to test and trace infections, and, when necessary, to close down to stop the spread.

In fact, America’s best — and perhaps only — success against Covid-19 so far came about with the power of collective action. The vaccines that are now being shot into the arms of health care workers and people in nursing homes came about with the strong support of various governments, which funded research or, at the very least, paid for tens of millions of doses before the vaccines were even proven to work. Crucially, this came about by acknowledging the structural risks involved in developing a vaccine, particularly that drug companies might be reluctant to gamble on the medications if they may not pan out, and mitigated those risks.

The problem runs deeper than what America did and can do about Covid-19 alone. One advantage that other countries had as the pandemic began is stronger social safety nets, which guaranteed people would retain some income and health care even if a lockdown was needed. The US has no such guarantees — the programs that do exist are notoriously underfunded (hence Congress needing to boost unemployment insurance in its economic relief bills), and far from universal. So while British and German workers could rely on some significant government support even if they lost their jobs, Americans could claim no such certainty.

We see that today. Even as Congress nears a deal on economic relief, the truth is it’s already too late for many Americans. With much of the previous stimulus measure expiring, people who lost their jobs have languished for months with little to no support. And even if the new deal passes Congress (which is still uncertain), there will likely be a lag in actually rolling out those benefits to the people who need them, leading to more prolonged suffering. It could have been avoided if these kinds of benefits were permanent, or kicked in automatically if the economy begins to weaken, as government programs in other developed countries do.

That’s just one example. From building up the social safety net to actually funding public health infrastructure to reforming government so it’s more responsive, there’s a lot of work America could do to make sure it’s better equipped to handle crises as they come up. That won’t completely end the need for leadership in troubled times — European countries with large social safety nets have still passed additional economic relief measures — but it would put the US in a much better place.

It won’t be easy. It means committing to a more hands-on governing structure, costing us more in dollars and cents and forcing many Americans to rethink how they view the role of government.

But if Covid-19 has taught us anything, those changes are worth the cost. It begins with taking a structural, rather than individualistic, view of the problems facing the US today.