Health Infrastructure & Security: COVID-19 Viral Outbreak

The ongoing novel coronavirus pandemic, known scientifically as SARS-CoV-2, or colloquially as COVID-19, has caused untold damage to both global economies and societies, as well as caused hundreds of thousands of deaths, which continue to rise in number every day. The global response to this health crisis has been chaotic. Some countries, such as Taiwan or Iceland, have shown the capability to meet the challenge and protect domestic interests, while others, such as the United States (US) or Brazil, have shown an impressive capability not to handle the threat.1 Any global pandemic requires a multifaceted approach that involves stakeholders from all parts of society, including civil, private, public and military, as well as relies on data-proven techniques to both track, quarantine and eradicate the virus. The American government appeared unfazed by early warnings and failed to take advantage of the opportunity gained from timely shutdowns to prepare national stockpiles, strengthen existing infrastructure systems and ensure that the country’s health sector was resilient enough to handle the upsurge in intensive care unit (ICU) admissions for COVID patients demanding comprehensive treatment. This failure to act meant that critical security sectors outside of healthcare became detrimentally affected by both the consequences and responses to this crisis. The COVID-19 disaster could have been mostly avoided had national policies strategically identified hotspots, implemented testing procedures and protection practices, and then quarantined and treated infected individuals, since this would have made communities more resilient, as well as allow healthcare facilities to avoid overcapacity enabling society to potentially avoid a complete shutdown of economic or communal activity.

Current research suggests that COVID-19 originated from the Wuhan region in China and the epicenter was likely one of the country’s infamous ‘wet-markets,’ where live animals of varying species are illegally sold, eaten and traded.2 The current pandemic is believed to have probably come from one of the many bat species that were bartered at these often sanitarily insecure marketplaces where health procedures and guidelines are virtually non-existent.3 The index case, which refers to the first person affected with a vector-borne disease, would become infected by the coronavirus at one of these markets. After the disease incubated long enough, the index case then would inadvertently cause the virus to spread rapidly throughout mainland China, where it quickly progressed from just a concern for the Chinese government (CCP) to a catastrophe for the entire international community.

Initially, the CCP would attempt to downplay the virus’s spread and threat, even silencing several whistleblowers in an attempt to cover up the incident.4 Unfortunately, due to COVID-19’s high infection rate and ability to spread via several vectors, it became impossible for the CCP to stop the virus’s spread, as well as avoid global embarrassment.5 The US would first learn of this pandemic on December 31, 2019, when the Centers for Disease Control (CDC) and the World Health Organization (WHO) reported on a cluster of cases of pneumonia-like symptoms spreading in central China.6 American high command, however, was only formally warned of the disease on January 3, 2020, when the CDC director received a call from his Chinese counterpart who informed him about a mysterious respiratory illness that was spreading through his country.7 Despite these early and apprehensive warnings, it would be months before the federal government acted decisively and implemented either preparation, mitigation or safety recommendations,

It would take roughly 70 days for the US government to take the coronavirus threat seriously, by which point COVID-19 was no longer a distant threat and harmless to the American public, and instead was clearly rampant in the States and no longer under control.8 By mid-February, the virus was lethally spreading from community-to-community, outflanking American’s health defenses and putting the death count on track to potentially kill millions.9 Despite the federal government’s travel ban on China, which was announced on February 2, 2020, COVID-19 had likely already entered the US, making the ban ultimately ineffective because both many travelers still entered the country from China after the ban and at this point the disease’s transmission into the US was predominantly coming from Europe, not Asia.10 Recent genomic analyses have indicated that the vast majority of US cases began to circulate in the country by mid-February, weeks before the first confirmed US infection, and that travelers brought in the virus mainly from continental Europe.11 Thus, even if the ban had been enacted earlier, it seems unlikely that the US would be spared the worst health, economic and social issues that the US currently faces. The reason being that the disease is believed to have been quickly transmitted to Europe from its initial outbreak in China where it then travelled into the Americas, at which point the virus had reached nearly every country in the world.12 The federal government eventually banned travel to Europe, but the policy was disastrously rolled out in mid-March and created immense complications for millions of people stranded abroad.13 In hindsight, this decision was made too late since the virus had already likely infected people in the States, invaded their cellular machinery and forced those infected to unwillingly spread the coronavirus throughout American communities.14

In an attempt to slow the virus’s spread, nearly every US State would implement some form of stay-at-home order that required citizens stay indoors and requested all businesses to shut down save for those deemed essential, such as hospitals, supermarkets or the post office.15 Due to the incoherent leadership coming from either the Federal or Legislative branches, however, no universal strategy was put forward, meaning State’s stay-at-home orders were implemented and followed to varying degrees. This created a patchwork of rules and regulations that enabled the virus to keep spreading across State borders, threatening regions outside of a hotspot as people began traveling to areas with less restrictions than others.16,17 This could have been avoided had the federal government developed a coherent comprehensive framework strategy that gave guidance and recommendations on best practices for States to follow, as well as established risk-informed mechanisms to adhere to, so as to ensure the safe reopening of businesses and other parts of society. The federal government would eventually release basic guidelines to handle the virus, but the details were limited, leaving much of the decision-making to State Governors who typically lacked the resources to manage a transnational pandemic.18 Furthermore, later reports would suggest that much of the prepared recommendations were shelved, since they were viewed as being too perspective.19 Despite the government’s reluctance, many health and epidemiological experts would go on to inform the public about the most tried-and-true strategies to stopping the virus’s spread. These procedures included social distancing, protecting oneself with protective gear like masks and gloves, as well as avoiding unnecessary contact with people who might be unknowingly spreading the disease.20 Once deemed safe, experts recommended that society cautiously reopen non-essential businesses, such as sports arenas, gyms or restaurants, and begin to return to some sense of normal operating function.21

In a normal operating environment, hospital systems and society can quickly admit, respond to and quarantine an individual that was infected with either a new disease or suffers from an extreme pulmonary-related virus, such as a variant strain of influenza. These healthcare infrastructure systems typically have adequate supplies and capacity to treat a handful of novel cases, but in the case of COVID-19, these systems found themselves overwhelmed and responding to a deluge of patients. The lack of clear policy directives meant that the healthcare infrastructure system, which normally are resilient and can withstand above-average hospitalization rates, found that normal operating procedures were ineffective and vital resources, such as drugs, testing kits, ventilators, trained healthcare workers and personal protective equipment (PPE) were in short supply.22 This meant that much of the healthcare infrastructure could not adequately respond to the disaster and in some extreme cases hospitals did not possess enough ICU beds for all the COVID patients that were rapidly entering their doors and unable to breathe.

Many local hospitals were pushed to breaking points and required local, state and federal support to both distribute materials and coordinate regional responses between healthcare facilities.23,24 In many instances, overcrowded hospitals were forced to transport patients to other facilities that possessed additional ICU capacity, but if this was not possible, a hospital was forced to make the impossible decision of determining who should receive certain medical resources over others, meaning doctors at times were choosing who lives and who might die.25,26 Luckily, public health industries have advanced considerably throughout the years, enabling health systems to better respond, track and treat at-risk populations, which in turn, has allowed many private industries to discover vaccines and advanced therapies, such as remdesivir, which provide for better public treatment procedures to be deployed, lessening the burden on the entire health infrastructure system.27

While many countries are experiencing precipitous drops in economic activity as a result of these virus protection protocols, not all countries are experiencing the level of mass unemployment seen in the US, which has proven incapable of adapting critical infrastructure and security systems to the pandemic’s threat. Countries that performed vigilant monitoring and early intervention, such as Taiwan, were able to quickly respond to reports of infection and immediately treat those infected, as well as use contract tracing to track down those who may have been in contact with the infected preventing further community spread.28 These methods were not embraced by the American government and as a result, nearly 36 million Americans have filed jobless claims and to date nearly 90,000 people have died in the US.29,30 These tragedies are unprecedented, but could have been avoided had the US prepared hospital systems better for over-capacity and made critical health-related transport networks more secure by procuring supplies in advance. In certain situations, that efficiency would have been the difference between life and death, as seen in the early necessity to procure ventilators for those affected by COVID-19.31

Although the immediate pain of these actions would be dramatic for both the national economy and individual Americans across the country, these temporary, yet critical protocols have assisted in ‘flattening the curve’ by preventing widespread contamination, as well as allowed the health system to not become overwhelmed with coronavirus. These data-proven strategies lower the peak demand for health services, while simultaneously raising the availability of these health-related resources that were in short supply.32 With these life-saving resources made more widely available it would have been easier for stakeholders to acquire and direct those resources toward hotspots that experienced upsurges, whereas now States appear to be reflexively responding to virus flare-ups and competing for vital goods in bidding wars.33,34 The lack of sustained investment in public health infrastructure and personnel is evident and it is a key reason that many of these healthcare facilities were woefully unprepared and had initial deficiencies in the necessary resources to handle the influx of COVID-19 patients.35 That being said, even now as testing appears to be ramping up and States begin to reopen as overall case rates trend downward, all the protections and preparation could be in vain if people are still too afraid to even go outside their house to get tested and reenter society.36 This crisis has clearly created a major health emergency, but without comprehensive security measures that protect all other critical infrastructure systems, society is not likely to return to a sense of normalcy any time soon.

This pandemic has impacted many other significant critical infrastructures, exposing weaknesses in economic, food, transportation and energy systems that are beset by the consequences of a world defined by SARS-CoV-2. Besides the distressing loss of life, this virus has specifically put the economic livelihoods of many people at risk. Already, normal economic activity has been severely disrupted, as seen in the uptick in business closures, continued loss of jobs, and the number of States requiring financial relief due to budgetary shortfalls and lost revenue as a consequence of coronavirus expenses.37 Furthermore, the cost of food has gone up significantly. According to the Bureau of Labor Statistics, slowdowns in the food chain has meant that basic goods have gone up in price sharply, with eggs costing nearly 16% more than last month and protein-based foods rising at least 3% in average price.38 These price increases have further downstream impacts on at-risk communities that already suffer from poverty or food insecurity, and is symbolized by the massive increase in people requiring food banks to feed them and their families.39 Furthermore, these economic and food threats are highlighted even more when taken in the context of recent statements from Federal Reserve Chairman Jerome Powell, who noted that “while [everyone is] affected [by COIVD-19], the burden has fallen most heavily on those least able to bear it,” referring to the mounting evidence that this virus affects communities and populations deemed most insecure, including minorities, children and the elderly.40

From a societal perspective, people who are marginalized, including those mentioned above, increasingly find themselves particularly susceptible to the downstream risks of COVID-19. Recent data from the CDC has shown that COVID-19 has had a clear racial disparity, where nearly 1 in 3 people who became sick enough to require hospitalization were African American, despite only accounting for 13% of the total US population.41 This data points to another difficult truth about American society, where minorities often suffer from chronic underlying medical conditions and are more likely to be in areas without adequate healthcare services.42 These problems are compounded when we examine children and the elderly.

Despite initial evidence showing children were relatively safe from the coronavirus, the CDC recently issued a warning for children, saying that some may suffer from a COVID-related immune over-response with some individuals developing a condition that mimics a rare inflammatory illness called Kawasaki disease.43 On top of all this, this virus has clearly affected the older generations more so than any other demographic, where fatality and infection rates are significantly higher for those aged 65 and older.44 This has made many nursing homes ground zero for many COVID cases and meant that the elderly have shared an out-sized burden of the virus’s lethal effects.

Some other notable problems caused by this virus can be quickly summed up and present ideal case studies for how health crises create significant problems for other areas of society. As mentioned, this global pandemic has placed the food system at risk and many frontline meat workers are rapidly becoming infected due to working in close proximity with each other and handling meat products together. As a result, many meat producers are being forced to kill their livestock versus bringing them to market for sale, which means that producers are losing income and society is letting viable food go to waste during a time of immense need for these resources.45,46 In the entertainment sector, the crisis has deepened so dramatically into normal functions that even independent concert promoters, musicians and venue operators have done the unthinkable by banding together to lobby the US government for federal aid, since they believe that they will be among the last industries to open up in a post-COVID society.47 Additionally, prisons have risen to notoriety as numerous correctional facilities emerge as major hotspots due to the requirement of prisoners to live in tight quarters and interact with each other regularly.48

Other critical infrastructure systems that have been affected by the pandemic include the energy and transportation networks that have come to define globalization. For example, US oil markets went negative for the first time in history, as demand dried up and stranded assets were being paid by producers to take oil off their hands over storage capacity fears.49 Additionally, COVID-19 has likely accelerated the decline of the US coal industry, since lower energy demands placed many coal plants on the margins of regional energy markets, lowering electricity prices and making natural gas or renewable technologies more attractive and profitable.50 Alongside this, COVID-19 has disrupted many transport infrastructures, as seen in the decline of plane usage and general decrease in population movement, as measured by cellular data.51,52 Transportation networks have been identified as one of our biggest weaknesses during this pandemic, since they enabled the virus to spread much more rapidly than it normally might have, making average citizens afraid to participate in major travel plans.53 With that being said, health experts are still worried that many regions are opening up too quickly, and fear the emergence of a deadlier second wave, as more people venture out from their houses despite the fact that more than half of the US States lack enough COVID-19 testing or tracing capacity to warrant the lifting of certain coronavirus restrictions.54

Eliminating the health threats posed by COVID-19 will necessitate a new global paradigm based on cooperation and shared knowledge of the disease, yet these attempts at collaboration are made increasingly difficult when geopolitical concerns enter the fray and attempts at subterfuge or propaganda cast doubt on the wider health disaster.55,56,57 Furthermore, efforts will be hampered as many nations begin contending with a second wave of coronavirus outbreaks and turn their attention away from international cooperation and toward focusing on domestic health outbreaks that place strain on healthcare security infrastructure systems, as well as deplete financial resources.58 Additionally, science has yet to find evidence of how to accurately predict where and how bad this virus will affect a given state, region or country, making it abundantly harder to coordinate domestic and international efforts.59 Sadly, if governments fail to prepare, then we will continue to see countries reporting national stockpiles being quickly depleted and reports about essential workers needlessly dying on the front lines.60,61,62 This is abundantly true for the US, where the government failed to plan, prepare, and honestly assess or communicate the threat to the nation, which is what led to this ongoing disaster. The long term damage to the US’s international security and cooperative resilience will worsen and already many international relations experts are noting that the US’s global reputation is hitting rock bottom as a consequence of their inability to prepare for this pandemic disaster and that diplomatically speaking, the US is on life support.63

Although the devastation wrought by coronavirus is appalling, there is a silver lining in its spread. Climate change is benefiting from the reductions in industrial and economic activity, since collapsing demand for fossil fuels has meant less greenhouse gas emission, allowing for cleaner air and water quality.64 This is some comfort, since experts are sounding the alarm that continued exploitation of the planet will likely create more frequent and deadly pandemics, since we unintentionally create more spillover of diseases from wildlife to people as we pursue development.65 That being said, governments should pursue sustainable development emulated off of the UN’s Sustainable Development Goals, since these will promote societal and economic growth, but not at the cost of environmental or health systems.66

Deadly pandemics have occurred throughout human history and decimated numerous civilizations, as seen in Medieval Europe when the Black Plague swept through or when smallpox wiped out the Aztecs and Incans in advance of the Spanish conquests in Latin America.67 COVID-19, however, presents a new challenge for humanity, since it is the first pandemic to affect every part of the globe and has caused massive worldwide disruptions across a variety of critical infrastructure systems. Modern healthcare systems and scientific discoveries, such as vaccines, will enable society to better prepare, mitigate and prevent future viruses, but indications suggest that things will get worse before they get better. Realistically, American society will not return to a sense of normalcy until everyone can feel safe from infection, which will not occur until a vaccine is developed and made accessible to the wider public. Thankfully, promising results from the biotech company Moderna suggests that a vaccine is forthcoming.68 That being said, any potential cure could still be a long ways away. Hopefully, governments recognize that they must place more emphasis on making critical health infrastructure more resilient to the susceptibility of the threats posed by a global pandemic. Protecting these systems enables the other critical sectors to avoid the worst impacts of a pandemic and global society will be better capable of adapting to the challenges that come from a novel virus by developing contingency plans that are comprehensive, context-specific and prevention-orientated, as well as based on data-proven techniques that guarantee the safety of the public’s health and wellbeing.69

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