by Biodun Iginla, The Economist Intelligence Unit News Analyst
All governments will struggle. Some will struggle more than others
TO SEE WHAT
is to come look to Lombardy, the affluent Italian region at the heart
of the covid-19 outbreak in Europe. Its hospitals provide world-class
health care. Until last week they thought they would cope with the
disease—then waves of people began turning up with pneumonia. Having run
out of ventilators and oxygen, exhausted staff at some hospitals are
being forced to leave untreated patients to die.
The pandemic, as the World Health Organisation (WHO)
officially declared it this week, is spreading fast, with almost 45,000
cases and nearly 1,500 deaths in 112 countries outside China.
Epidemiologists reckon Italy is one or two weeks ahead of places like
Spain, France, America and Britain. Less-connected countries, such as
Egypt and India, are further behind, but not much. (For more coverage of
covid-19 see our coronavirus hub.)
Few
of today’s political leaders have ever faced anything like a pandemic
and its economic fallout—though some are evoking the financial crisis of
2007-09 (see article).
As they belatedly realise that health systems will buckle and deaths
mount, leaders are at last coming to terms with the fact that they will
have to weather the storm. Three factors will determine how they cope:
their attitude to uncertainty; the structure and competence of their
health systems; and, above all, whether they are trusted.
The uncertainty has many sources. One is that SARS-CoV-2 and the disease it causes, covid-19, are not fully understood (see article).
Another is over the status of the pandemic. In each region or country
it tends to proliferate rapidly undetected. By the time testing detects
cases in one place it will be spreading in many others, as it was in
Italy, Iran and South Korea. By the time governments shut schools and
ban crowds they may be too late.
China’s solution, endorsed by the WHO,
was to impose a brutal quarantine, bolstered by mass-testing and
contact tracing. That came at a high human and economic cost, but new
infections have dwindled. This week, in a victory lap, President Xi
Jinping visited Wuhan, where the pandemic first emerged (see article).
Yet uncertainty persists even in China, because nobody knows if a
second wave of infections will rise up as the quarantine eases.
In
democracies leaders have to judge if people will tolerate China’s harsh
regime of isolation and surveillance. Italy’s lockdown is largely
self-policed and does not heavily infringe people’s rights. But if it
proves leakier than China’s, it may be almost as expensive and a lot
less effective (see article).
Efficacy
also depends on the structure and competence of health-care systems.
There is immense scope for mixed messages and inconsistent instructions
about testing and when to stay isolated at home. Every health system
will be overwhelmed. Places where people receive very little health
care, including refugee camps and slums, will be the most vulnerable.
But even the best-resourced hospitals in rich countries will struggle.
Universal
systems like Britain’s National Health Service should find it easier to
mobilise resources and adapt rules and practices than fragmented,
private ones that have to worry about who pays whom and who is liable
for what (see article).
The United States, despite its wealth and the excellence of its medical
science, faces hurdles. Its private system is optimised for fee-paying
treatments. America’s 28m uninsured people, 11m illegal immigrants and
an unknown number without sick pay all have reasons to avoid testing or
isolation. Red tape and cuts have fatally delayed adequate testing (see article).
Uncertainty
will be a drag on the third factor—trust. Trust gives leaders licence
to take difficult decisions about quarantines and social-distancing,
including school closures. In Iran the government, which has long been
unpopular, is widely suspected of covering up deaths and cases. That is
one reason rebellious clerics could refuse to shut shrines, even though
they spread infection (see article).
Nothing
stokes rumour and fear more than the suspicion that politicians are
hiding the truth. When they downplay the threat in a misguided attempt
to avoid panic, they end up sowing confusion and costing lives. Yet
leaders have struggled to come to terms with the pandemic and how to
talk about it. President Donald Trump, in particular, has veered from
unfounded optimism to attacking his foes. This week he announced a
30-day ban on most travel from Europe that will do little to slow a
disease which is already circulating in America. As people witness the
death of friends and relatives, he will find that the pandemic cannot be
palmed off as a conspiracy by foreigners, Democrats and CNN.
What
should politicians do? Each country must strike its own balance between
the benefits of tracking the disease and the invasion of privacy, but
South Korea and China show the power of big data and mass-testing as a
way of identifying cases and limiting their spread. Governments also
need to anticipate the pandemic, because actions to slow its spread,
such as banning crowds, are more effective if they are early.
The
best example of how to respond is Singapore, which has had many fewer
cases than expected. Thanks to an efficient bureaucracy in a single
small territory, world-class universal health care and the well-learned
lesson of SARS, an epidemic of a related virus in 2003,
Singapore acted early. It has been able to make difficult trade-offs
with public consent because its message has been consistent,
science-based and trusted.
In the West
covid-19 is a challenge to the generation of politicians who have taken
power since the financial crisis. Many of them decry globalisation and
experts. They thrive on division and conflict. In some ways the pandemic
will play to their agenda. Countries may follow America and turn inward
and close their borders. In so far as shortages crimp the world
economy, industries may pull back from globalisation—though they would
gain more protection by diversifying their supply chains.
Yet
the pandemic also puts doctors, scientists and policy experts once
again at the heart of government. Pandemics are quintessentially global
affairs. Countries need to work together on treatment protocols,
therapeutics and, it is hoped, a vaccine. Worried voters may well have
less of an appetite for the theatrical wrestling match of partisan
politics. They need their governments to deal with the real problems
they are facing—which is what politics should have been about all along.
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