In the early 20th century, the American South was ravaged by pellagra, a nasty disease that produced the “four Ds” — dermatitis, diarrhea, dementia and death. At first, pellagra’s nature was uncertain, but by 1915 Dr. Joseph Goldberger, a Hungarian immigrant employed by the federal government, had conclusively shown that it was caused by nutritional deficiencies associated with poverty, and especially with a corn-based diet.
However, for decades many Southern citizens and politicians refused to accept this diagnosis, declaring either that the epidemic was a fiction created by Northerners to insult the South or that the nutritional theory was an attack on Southern culture. And deaths from pellagra continued to climb.
We’ve known for months what it takes to bring COVID-19 under control. You need a period of severe lockdown to reduce the disease’s prevalence. Only then can you reopen the economy — while maintaining social distancing as needed — and even then you need a regime of widespread testing, tracing and isolation of potentially infected individuals to keep the virus suppressed.
Most advanced countries have gone down this route. A few countries, like New Zealand and South Korea, have largely or completely defeated the coronavirus. The European Union, comparable in population and diversity to the United States, continues to record new cases of COVID-19, but at a far slower rate than at the pandemic’s peak in late March and early April.
But the United States is exceptional, in a very bad way. Our rate of new cases never declined all that much, because falling infection rates in the New York area were offset by flat or rising infections in the South and the West. Now cases are on the rise nationally and surging in such states as Arizona, Texas and Florida.
And no, reported infections aren’t rising just because we’re doing more testing; contra Donald Trump, we can’t solve this problem just by testing less. Other indicators, like the percentage of tests coming back positive and hospitalization rates, show that the COVID-19 surge is real.
It’s true that deaths are still falling for the nation as a whole, although they’re rising in some states. This reflects some combination of the way that deaths lag infections, better precautions for the elderly, who are the most vulnerable, and better treatment as doctors learn more about the disease.
But we’re still losing around 600 Americans per day — that is, we’re experiencing the equivalent of six 9/11s every month. And many people who aren’t killed by COVID-19 are nonetheless debilitated by the illness, sometimes permanently.
Why are we doing so badly? A lot of the answer is that many state governments have rushed to return to business as usual even though only a handful of states meet federal criteria for even the initial phase of reopening. Epidemiologists warned that premature reopening would lead to a new wave of infections — and they were right.
Beyond that, in America, and only in America, basic health precautions have been caught up in a culture war. Most obviously, not wearing a face mask, and hence gratuitously endangering other people, has become a political symbol: Trump has suggested that some people wear masks only to signal disapproval of him, and many Americans have decided that requiring masks in indoor spaces is an assault on their freedom.
As a result, social distancing has become partisan: self-identified Republicans do less of it than self-identified Democrats. We all saw how this plays out in Tulsa, Oklahoma, where a large (if smaller than expected) crowd gathered, mostly without masks, in an indoor setting custom-designed to spread the coronavirus.
And the next Trump rally, on Tuesday, will take place in Arizona, where COVID-19 is exploding, but where the Republican governor not only refuses to require mask-wearing but refused until a few days ago to allow local governments to impose their own rules.
The moral of this story is that America’s uniquely poor response to the coronavirus isn’t just the result of bad leadership at the top — although tens of thousands of lives would have been saved if we had a president who would deal with problems instead of trying to wish them away.
We’re also doing badly because, as the example of pellagra shows, there’s a long-standing anti-science, anti-expertise streak in American culture — the same streak that makes us uniquely unwilling to accept the reality of evolution or acknowledge the threat of climate change.
We aren’t a nation of know-nothings; many, probably most Americans are willing to listen to experts and act responsibly. But there’s a belligerent faction within our society that refuses to acknowledge inconvenient or uncomfortable facts, preferring to believe that experts are somehow conspiring against them.
Trump hasn’t just failed to rise to the policy challenge posed by COVID-19. He has, with his words and actions — notably his refusal to wear a mask — encouraged and empowered America’s anti-rational streak.
And this rejection of expertise, science and responsibility in general is killing us.
Paul Krugman, Ph.D., winner of the Nobel Memorial Prize in Economic Science, is an Op-Ed columnist for The New York Times.