The preexisting conditions of the coronavirus pandemic

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Those same people are also more likely to have the chronic conditions that the Global Burden of Disease singles out—because of poverty, lack of universal health care, lack of access to higher-quality food, and a public health system defunded, by some calculations, to the tune of $4.5 billion before COVID-19 was even a twinkle in a bat’s eye. “Your risk of dying if you have no underlying comorbidity is less than 0.1 percent,” Galea says. “People with lower socioeconomic position and people of color had more risk. In some respects, it’s that simple.”

To paraphrase a famous book, that is one hell of a catch. The virus that causes COVID-19 would always have been a deadly one. But fewer people in poverty, fewer people with the conditions that turned out to be dangerous comorbidities, and a better health care system that focused on prevention rather than magic-bullet cures would have meant that the same deadly virus would have killed fewer people. “Why did COVID become the problem it did to begin with?” Galea asks. “One, we have historically underinvested in the public health systems needed to actually keep us healthy. And two, we have underinvested in the social and economic conditions that create a healthy world.”

And the catch gets catchier. Earlier this week in an article in the Journal of the American Medical Association, two economists at Harvard calculated that all the deaths and illnesses from COVID-19 so far, and those likely to happen before mid-2021, combined with losses to the economy, mental anguish, and lost output, will sum up to one astounding number: $16 trillion. That’s about 90 percent of the US annual gross domestic product. “For a family of four, the estimated loss would be nearly $200,000,” the economists write. “Approximately half of this amount is the lost income from the COVID-19–induced recession; the remainder is the economic effects of shorter and less healthy life.”

Even that burden is shared unfairly. “By shutting down the economy, we hurt poor people and people of color more, economically, than by keeping it open,” says Alan Krupnick, an economist and senior fellow at Resources for the Future. “But you can’t open up the economy until people have a reasonable expectation that they’re going to be safe when they go to a restaurant or bar, or go to work. The disease needs to get taken care of first so that the economy can blossom.” That’s an income effect, and it creates a feedback loop. Trying to deal with the effects of the pandemic after it has already swallowed the economy makes the economic effects worse on the most vulnerable… which means that to survive financially, they have to expose themselves to more risk… which makes their comorbidities potentially more dangerous.

Some researchers have described COVID-19 as not a pandemic but a “syndemic”—a synergistic epidemic of related, overlapping problems, each one making the others worse. That’s bad. But on the bright(-ish) side, syndemics offer more targets of opportunity. Expensive drugs and accelerated vaccine trials are the kinds of long shots you only have to bet on if you (or your government) hasn’t put in the boring, population-scale public health work on the front end. The Global Burden of Disease report quietly hints that it’s not too late. For COVID-19 specifically, that’d be messaging on wearing masks, figuring out how to deploy wide-scale improvements in ventilation systems, and getting people aid so they can stay home. That all worked in Singapore, Taiwan, South Korea, and even Wuhan. It can work here. But the GBD numbers show how to build a system that can deal with all kinds of other problems, including infectious surprises like SARS-CoV-2. And that same system will make for a happier, healthier world—one that’s tough enough to shake off a SARS-CoV-3 someday, too.

This story originally appeared on wired.com.

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