This winter brings a bleak sense of déjà vu to the Boston-area ICU where I work. Once again, beds are increasingly occupied by critically ill patients with Covid-19. When I join Zoom calls with physicians from other hospitals to coordinate regional “load balancing” of ICU beds—exchanging patients between facilities to prevent overload—the tone is again tense.
They too, seem about to burst. Compared with our last big surge a year ago, things should be much better now. After all, we have highly effective vaccines. But in many ways, things feel worse, and not just because of Omicron.
Over the past two years, meaningful policy supports helped sustain us through the Covid pandemic. They were nowhere near sufficient, but nonetheless constituted a stronger and wider safety net than we had seen before the virus struck. Emergencies, it turns out, can focus our minds, steady our nerves, and promote cooperation, putting Margaret Thatcher’s infamous assertion that “there’s no such thing as society” to rest once and for all. Both the transmission of the virus and our means of fighting it have proved that we are tied together. And what people need during emergencies is also what they need throughout their lives.
We may not have gotten Medicare for All (or even Medicare for All Things Covid), but federal legislation did provide coverage of coronavirus testing and treatment for the uninsured, as well as federally procured Covid vaccines that were provided free at the point of use throughout the country. In a break with business as usual, providers were strictly prohibited from charging patients a dime for administering them. Even private insurers waived copays and deductibles for Covid care (though they still turned record profits). New policies incentivized states to keep people on Medicaid rolls and raised subsidies for private plans, driving a possible decline in the ranks of the uninsured in spite of massive job losses. And the government spent trillions on enhanced unemployment insurance, child tax credits, stimulus payments, and student loan deferments. These measures helped maintain most people’s standard of living, while keeping tens of millions safely out of the workplace, even achieving a remarkable drop in the poverty rate.
But now a new strain is upon us. In the space of just a month or so, we’ve already experienced mass death. The collective resolve that helped bring about a major expansion in social spending during this crisis is yielding to the threadbare austerity we are used to.
That means we’re facing Omicron with the federal eviction moratorium extinct, expanded child tax credits on the chopping block, and robust unemployment insurance a memory. Private insurers have reimposed copays and deductibles for Covid care. Lines for PCR testing wrap around blocks in some locales. Home rapid tests are not only unaffordable but also sold out almost everywhere. Student loan payments will soon restart. Who needs such measures when, as some claim, we face a pandemic of only the unvaccinated? The spirit of collectivity gives way to the kind of rugged individualism normally embraced only by free-market fanatics.
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It’s true that, on an individual level, most vaccinated people are at low risk for severe illness from Omicron. But we do live in a society, and that society still contains millions of vulnerable people. Most of my ICU patients with Covid in recent months have been unvaccinated. Many are no longer alive; some were relatively young. What some fail to realize is that such patients are the victims not only of disinformation but also of the societal inequities, ranging from inadequate treatment of substance-use disorders to exclusion from the health care system—to say nothing of policies that accelerate viral spread, like the mass reopening of nonessential workplaces.
The destructive capacity of the virus, it’s now a cliché to say, has been intensified by the social inequities of American society. In the ICU, I see just how true that is: All along, my patients have been disproportionately poor, immigrant, marginalized. As Omicron surges, they’re the ones who will once again bear the brunt of it, this time in a country that has lost the patience to install any safeguards to protect them.
Yet there is another, more hopeful truth here: The tools we need to fight this wave are the same ones we need to rectify the inequities that immiserate and sicken even outside of plague years. We already know what those are: decommodified health care, safe workplaces, strong social welfare programs, and more equitable education and housing policies. All of those things are still needed: If the pandemic has been a collective emergency, life is full of private ones that happen every day. We can better protect people against those too.
Emergencies can be terrible to live through, yet they can provoke action that both mitigates short-term harms and opens a window for long-term change. The collective experience of the Blitz in the United Kingdom during World War II—including the emergency medical response organized to meet it—is one historical example: It helped drive support for a future National Health Service, and perhaps the British welfare state itself.
The question before us now is whether the Omicron blitz can or will serve as such a catalyst for an invigorated and immediate public health response to the current Covid wave, for the urgently needed organization and rationalization of our medical services, and for an egalitarian reconstruction in the pandemic’s wake. Covid has exposed the structure of our society as not only unjust but untenable. Our work must now be to change it.
