Americans have spent much of the Covid-19 pandemic blaming one another for the coronavirus\u2019s spread. <\/p>\n
Don\u2019t go to that beach or park. Don\u2019t go to that bar or restaurant. Don\u2019t do anything for Thanksgiving or Christmas. Wear a mask! You don\u2019t want to kill Grandma, do you?<\/p>\n
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\u2019s leaders preached \u201cpersonal responsibility\u201d and refused to require masks, much less stricter measures. Ian Fury, a spokesperson for Gov. Kristi Noem (R), told me his boss gave citizens \u201cup-to-date science, facts, and data, and then trusted them to make the best decisions for themselves and their loved ones.\u201d<\/p>\n
It\u2019s 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 \u2014 an approach that the US has leveraged for problems ranging from the opioid crisis to global warming \u2014 simply hasn\u2019t worked.<\/p>\n
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.<\/p>\n
There are many reasons for that, not least President Donald Trump\u2019s awful leadership. But part of it, experts say, is America\u2019s 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 \u201cindependent spirit in the United States of people not wanting to comply with public health measures has certainly hurt us a bit.\u201d<\/p>\n
That was clear in much of the public\u2019s response to lockdowns starting in the spring. With \u201cDon\u2019t Tread on Me\u201d 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\u2019t need the government to tell them what to do.<\/p>\n
It\u2019s 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. <\/p>\n
But it\u2019s 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\u2019s on people to wear masks, cancel private gatherings for the holidays, and avoid nonessential activities \u2014 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.<\/p>\n
New York Gov. Andrew Cuomo exemplified the failure of this approach. In the lead-up to Thanksgiving, he said, \u201cMy personal advice is you don\u2019t have family gatherings \u2014 even for Thanksgiving.\u201d 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\u2019t planning on following his own advice. (Cuomo\u2019s office argued his comments were misinterpreted.)<\/p>\n
Meanwhile, much less attention has gone to addressing Covid-19 from a truly structural perspective. The coronavirus has revealed America\u2019s pathetic public health infrastructure \u2014 there\u2019s 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\u2019s been next to no action in most of the country on getting people outside \u2014 at times, governments have even eliminated outdoor venues by closing parks or beaches.<\/p>\n
\u201cIt\u2019s a structural issue,\u201d Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. \u201cSystemic challenges in the United States \u2014 that predate the pandemic but have gotten worse [during the pandemic] \u2014 lead to the situation we\u2019re in.\u201d<\/p>\n
It\u2019s easy to yell at people over their Covid-19 failures \u2014 simply log on to Twitter and blast away. It\u2019s costless for a governor to tell people that it\u2019s on them to stop the spread of the coronavirus by voluntarily giving up things they love, especially if the same governor doesn\u2019t even plan on following his own advice.<\/p>\n
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.<\/p>\n
Structural problems are really to blame here<\/p>\n
Since the start of America\u2019s 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\u2019t wear masks as they eat or drink, and spew germs at each other as they shout, sing, and laugh. <\/p>\n
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.<\/p>\n
None of that happened. Instead, America started to reopen before Covid-19 cases were under control \u2014 at the US\u2019s 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 \u2014 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.<\/p>\n
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\u2019ve 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<\/em> 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<\/em> found, \u201cReopening full-service restaurants was associated with a particularly high risk.\u201d<\/p>\n 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 \u201cliving room spread,\u201d and the state published data suggesting households and private gatherings are driving 74 percent of coronavirus spread.<\/p>\n It\u2019s 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\u2019s events likely will too.<\/p>\n But that\u2019s why at least some experts believe there\u2019s a need for more focus on systemic action, not the individualistic approach. \u201cPeople, in general, are horrendous risk assessors \u2014 we\u2019re awful at assessing risk,\u201d Daniel Goldberg, a medical historian and public health ethicist at the University of Colorado, told me. \u201cI hate to say people can\u2019t be trusted, but.\u201d<\/p>\n There are other problems with this framing. For one, the New York data doesn\u2019t separate within-household transmissions from social gatherings \u2014 so the 74 percent figure includes someone spreading Covid-19 to the husband he lives with (not as avoidable) and<\/em> 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\u2019s much easier to trace transmission between family and friends in a household than strangers in a bar.<\/p>\n The big problem, though, is that there\u2019s nothing unusual about Covid-19 spreading among people who live together. It\u2019s typical for the bulk, even the majority, of the transmission of any disease to happen within households. If you\u2019re infected, the people you live with or come into close contact with at home are simply likely to get it too. That\u2019s how pathogens work. What matters most, though, is where that virus originated from in the first place.<\/p>\n To put it another way: People couldn\u2019t infect others in their homes if they hadn\u2019t picked up the coronavirus in bars, restaurants, or other public spaces. So if these places weren\u2019t open, individual choices to gather \u2014 including over Thanksgiving and Christmas \u2014 would be of far less concern. There would simply be much less virus out there jumping from person to person.<\/p>\n So it largely comes down to the lack of systemic action, not solely the individual choice.<\/p>\n It\u2019s 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 \u201cessential\u201d 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 \u2014 like offering free outdoor activities like ice skating or art installations, or even just places to eat (with some heating during the winter) \u2014 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.<\/p>\n Otherwise, we\u2019re going to be stuck with relying on people to make decisions \u2014 almost always against their own social, cultural, and economic interests \u2014 to do the right thing. So far, that just isn\u2019t working.<\/p>\n It\u2019s easier to blame individuals than fix big problems<\/p>\n Public leaders and government officials face their own structural forces too. <\/p>\n 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\u2019t have that money. The governor added, \u201cMaybe I should spend a little bit of money and try to campaign for people to be more careful\u201d \u2014 a pivot to an individualistic approach. <\/p>\n