With over 6 million people infected and nearly 400,000 dead, the COVID-19 pandemic is a catastrophe. What is less immediately clear, however, is how and why it is such a catastrophe – that is, how we got to this point. Due to differences in measurement techniques and complications caused by a slew of other causes, the exact mortality rate of the virus is unclear, with reported percentages ranging from 0.09% to 16.42%. Even if we take the frightening but likely unrepresentative high end of this spectrum, it still does not stand out as extraordinary in contrast to other such diseases in the past decades – the average mortality rate for Ebola is more than twice that at 50%. Though these kinds of comparisons did tend to be brought up by contrarians in the early days of the pandemic, they still need to be considered when asking what went so wrong. And while other epidemiological concerns like infection rates, etc., add towards the answer, another part of that answer lies not in the virus, but in the response to it.
This is seen most clearly not in the broad trends, but in the differences that emerge from the details. Germany, for example, has managed to keep its number of deaths below 10,000 despite having its first outbreak as early as January; the U.S., on the other hand, is more than ten times that. This divergence is nowhere more clear than in Italy however, one of the surprise protagonists of the coronavirus saga. A country thousands of kilometers from the virus’ origin in Wuhan, it nevertheless became one of the first to be hit hard and subsequently go into lockdown – it in fact surpassed China in the number of deaths as early as March.
What is even more interesting about the Italian case is how the pandemic was divided within the country: it was not the poorer and less-developed regions of its south, but the wealthy northern provinces that were hit the hardest. While Italy’s richest province Lombardy has been the worst hit with over 16,000 deaths so far, poorer provinces like Campania still remain in the low hundreds. Both the severity of the pandemic in Italy as a whole and Lombardy specifically is puzzling, considering the supposed strength of their healthcare systems. In a 2014 report the OECD called Italy’s healthcare system “uniformly impressive”, and Lombardy’s private/public partnership was considered a paragon of smart healthcare management.
Writing in the New Statesman, Ben Munster argues that the reason for this strange set of divergences was what privatization meant for the structure of healthcare in Lombardy. He writes that while on individual treatment the private hospitals and clinics were technically excellent, the incentives in a privately managed system meant that where and how they applied this excellent service varied. Seeking profit, the clinics cut costs by preferring to treat more profitable patients, thus providing less coverage but diverting more government funds away from public hospitals. When the pandemic hit, not only did the profit-motive make it such that these private clinics avoided accepting COVID patients until forcible requisitions by the government, but the lean management methods meant that they had little capacity to help even when forced to.
This example highlights an important priority in questions of management: resilience. Profit-based management incentivizes cutting costs to maximize profits, but this reduces the buffer available for when crises hit. This is true in many industries worldwide, which in the last decades have switched to the “just-in-time” model of management, organizing supply chains so that everything arrives just in time, with no slack or waste. This lack of “waste” is also a lack of space, however, and the disruption of the coronavirus has demonstrated the fragility of industries operating on this model – particularly when they rely on global supply lines.
All this should give us a broader perspective on the question of sustainability, and highlight the role of resilience in relation to it. Since things nearly never go all as planned, that a system can deliver results and grow, even indefinitely, if all goes as planned is not enough to call it sustainable. To achieve longevity, a system must be capable of responding to unforeseen shocks as well as functioning under normal conditions. A 2019 issue of Nature Sustainability highlighted this relation in an editorial, giving as an example of how the increasing connectedness and productivity of global agriculture “is actually eroding its resilience.” This erosion of resilience goes even deeper than human structures, as loss of biodiversity can lead to the fragility of entire ecosystems worldwide.
In other words, what COVID demonstrates is that the challenge of sustainability is neither a test to find the most efficient arrangement, nor a rumbling beneath the earth, set to emerge on some day of reckoning. It is a series of crises that we must be able to face, and which the most helpless among us are already facing. A system that cuts costs and heightens inequality merely increases the precarity of more and more people, inviting their ruination at the hands of the next crisis. As larger and larger sections of society are left vulnerable to such events, however, they leave the system hollow, threatening its collapse. The only other option is change.
Image courtesy of Flickr. Originally published by S&S on June 10, 2020.