Scientists around the world have worked overtime to get a handle on Covid-19, yet one great unknown remains. We still don’t know for sure whether this is only a medical crisis, or also a medical system crisis.
The distinction matters for the novel coronavirus for the same reason it matters for other “natural disasters” that aren’t entirely natural. It is now widely understood that famines arise from local political failures in the trade and distribution of abundant global food supplies, not from local crop failures. Floods devastate communities not because the local rivers are unusually watery but because poor zoning and subsidized flood insurance encourage people to build homes in flood plains.
This is the context for a conspicuous feature of Covid-19: It is not untreatable, but many health systems are struggling to deliver effective treatment. Nowhere is this more so right now than in Italy, where nightmarish reports are emerging from hospitals in the hardest-hit areas.
Doctors in Italy know what to do to treat severe cases, such as using ventilators in intensive-care units. But hospitals lack the beds and equipment for the influx of patients and Italy doesn’t have enough doctors even to make the attempt. Ill patients languish in hospital corridors for want of beds, recovering patients are rushed out the door as quickly as possible, and exhausted (and sometimes sick) doctors and nurses can’t even muster the energy to throw up their hands in despair.
Is this more a result of the severity of Covid-19, or of long-term failures to invest in the Italian health-care system? One starts to suspect the latter.
Italy lags other large European countries in provision of acute-care hospital beds, furnishing 2.62 of them per 1,000 residents as of 2016, according to the Organization for Economic Cooperation and Development. In Germany it’s 6.06 and in France and the Netherlands it’s 3.15 and 3 respectively. That year, Italy devoted around $913 per capita to inpatient acute and rehabilitative care, compared with $1,338 in France, $1,506 in Germany, and $1,732 in the U.S.
U.K. policy makers understand what such analyses portend—because underinvestment in Britain’s creaking health-care system is even worse. The U.K. spent the princely sum of $901.70 per capita on acute care in 2016, according to the OECD. British data don’t distinguish acute-care beds, but a comparison of available beds overall isn’t any more favorable to the U.K. (or to Italy). In 2017, when Germany provided 8 beds per 1,000 residents and France offered 5.98, Italy managed 3.18 and the U.K. only 2.54.
Socialized, centralized medicine certainly plays a part.
But less known, Italian leather and shoe makers sold their manufacturing plants to the Chinese.
Those plants stayed in Italy but the Italian workers were all replaced by slave labor from Wuhan Province.
There were dedicated air transportation to and from Wuhan China into northern Italy until just recently.
I wonder if the loss of doctors to attrition due to Obamacare cutting fees for treatment will have an impact on our response? When they talk about the need for respirators I think of the tax on medical equipment Obamacare imposed. It was removed relatively quickly, but imagine what such short-sighted oppressive acts would have on our preparedness? Expensive equipment is not bought to warehouse just in case we need them.