As I look back at the long bygone era before the coronavirus, I keep being reminded of my visit to Pompeii, whose people were wiped out in the first century by a violent volcanic eruption. There had been many warning signs, including a severe earthquake, tremors, springs and wells that dried up, dogs that ran away and birds that no longer sang. And then the most obvious warning sign: columns of smoke belching out of Mount Vesuvius before the volcano blew its top, burying the city and its inhabitants under sixty feet of ash and volcanic rock. But the warning signs had been dismissed as “not particularly alarming.”
There are plenty of echoes in our modern-day Vesuvius. I don’t just mean the reports and repeated warnings from health officials that the government failed to heed. For years, we have lived with — and largely ignored as “not particularly alarming” — continuous increases in chronic diseases, an accelerating mental health crisis and growing income inequalities — not to mention the escalating climate change crisis. These are our equivalents of tremors and belching smoke. And now, vulnerabilities in our physical and mental health and structural inequalities are disproportionately affecting our ability to slow the spread of the coronavirus.
So here are four curves — in addition to the curve of coronavirus infections — that we need to start flattening now:
1. Chronic Diseases: The pandemic has forced a reckoning around our failure to take action on chronic health conditions like diabetes, hypertension and obesity. According to the Centers for Disease Control and Prevention, six in 10 American adults have a chronic disease and four in 10 have two or more. The key drivers of chronic diseases are lifestyle related, from poor nutrition and tobacco use to lack of physical activity and excessive alcohol use. And part of the food supply that fuels obesity and diabetes is a gruesome factory farming system that creates breeding grounds for antibiotic-resistant bacteria and pathogens leading to human infections. A new study in the Journal of the American Medical Association of thousands of hospitalized coronavirus patients in New York City provides staggering data making the connection between underlying conditions and the severity of coronavirus infections: nearly all patients had at least one chronic condition and 88% had at least two. Only 6% had no chronic health conditions.
2. Mental Health: The pandemic has accelerated a pre-existing mental health crisis. Depression has for years been one of the world’s leading causes of disability. And every 40 seconds, someone takes their own life.
These conditions didn’t just pave the way for our current mental health crisis. They are likely to shape the continuing crisis amplified by the pandemic. A recent report published in The Lancet warned that the mental health effects of the pandemic could “exceed the consequences of the 2019-nCoV epidemic itself.” Congress passed trillions of dollars in emergency coronavirus funding, but only a tiny portion was earmarked for mental health. As Paul Gionfriddo, president of the advocacy group Mental Health America, puts it, “if we don’t do something about it now, people are going to be suffering from these mental health impacts for years to come.”
3. Structural Inequalities: Despite some claims that the virus is a great leveler, its ravages are occurring against a backdrop of deep structural inequalities. As Van Jones writes on Thrive, “this virus is especially lethal to African Americans because it is — in effect — a pandemic jumping on top of multiple, pre-existing epidemics that were already ravaging the black community.” As a result, counties with a disproportionate number of African American residents accounted for 52% of coronavirus diagnoses and 58% of deaths while also showing high levels of underlying conditions including diabetes and hypertension.
4. Climate Change: And of course there is climate change, which has impacted the coronavirus outbreak and has already contributed to the spread of diseases including malaria and the Zika and West Nile viruses. “As we change ecosystems and natural habitats, long-dormant diseases can emerge to which we have no immunity,” Fareed Zakaria writes in The Washington Post.
So the challenge before us is not merely to flatten the curve of coronavirus infections. If we are going to emerge from this crucible stronger, healthier and more resilient, we must also flatten the curves of chronic diseases, mental health problems, inequalities and climate change. And then, after we flatten the curves, we must start reversing them. Successfully navigating this pandemic doesn’t mean getting back to the status quo. It means addressing missed warning signs that defined the pre-Covid world, and creating a better one to take its place.
There’s no better time than now to begin this process. More than at any time in recent memory, these issues have our attention. There is widespread acknowledgment that these are changes — at both the collective and individual level — we can no longer postpone. So let’s take advantage of that.
Walking around Pompeii, my friends and I kept wondering: “How could they miss the birds not singing, the water not flowing, the earth trembling and the smoke billowing?” Future generations may similarly marvel at our own blindness to the warning signs before our eyes. But unlike the citizens of Pompeii, we are not yet buried under 60 feet of ash and volcanic rock. We have been shaken to our roots, but we still have a chance to imagine and build a better — much better — future.
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