Coronavirus and Our Existential Threats This Presidential Season

Pandemics, climate change and presidential vision have significant consequences for the future as we address our existential threats. There are stark differences being presented in our current presidential campaign from incremental movement forward to bold proposals necessary to address the scope of the problems we face in an interconnected world.

The Covid-19 pandemic challenging our nation and world is simply the latest crisis and certainly not the last. Following prior coronavirus outbreaks of SARS in 2002 and MERS in 2012 this represents simply the latest global health threat that comes at the interface of human health, animal health and the environment. This evolving crisis currently in its early stages will take months before its ultimate impact on our world is known. We find ourselves woefully behind as we react to the daily exponential spread of this virus that knows no sexual, racial, economic, temperate, political or geographic boundaries, racing to get ahead of its scourge. Certainly the most vulnerable among us including elderly, poor and those with preexisting conditions are the ones most at risk. I will not even attempt to cover the potential shortage of hospital and critical care beds the nation faces, most of which are filled at any given time even before the pandemic, let alone ventilators for mechanical ventilation should this crisis reach its full potential.

In the U.S. those who survive the current pandemic will be left to rely on our existing healthcare system. Our current patchwork of piecemeal health coverage leaves people to gamble with the outcomes of their diagnoses and their economic future.

Many are losing their jobs as a result of this crisis. How many of them will lose their health insurance as well? And how many will be left bankrupt from this illness or any other health crisis? The reality is that all of us may find ourselves one illness or injury or job loss away from bankruptcy. Four in five Americans who have suffered bankruptcy due to medical bills and illness had health insurance when they became ill. So in addition to being a health crisis, we find ourselves in an economic crisis as well, without sick leave, a living wage and income guarantees during our time of need. And when this pandemic passes, without systemic change there will remain 90 million or more with the resultant job losses in this country who have either no insurance or who are under insured. And we will return to the reality that approximately 70,000 people die in this country each year prematurely due to lack of health insurance.

We must recognize the interconnectedness of the health of our nation and planet to the economic security of our citizens. Unless we make the connection, our future is in doubt.

For the cynics in our nation, it should now be obvious that it is in our own self-interest to want everyone in our community to be healthy to protect ourselves. As a community, nation and world we are, in the words of Senator Sanders, "...only as safe as our least insured person."

What is called for is a systemic shift from a reactive response to a prospective approach to health with universal healthcare that covers every American - Medicare for All, integrated with a fully funded public health and global pandemic planning office as we prepare for the next inevitable pandemic. And rest assured, there will be another and another pandemic as our world responds to the Anthropocene. In the end, this is not a political choice, it is a survival choice. Yet we have allowed all medical choices to become political choices in how we choose to allocate our treasure in taking care of the most vulnerable.

The global crisis of climate change demands an equally bold action and is also presenting a health crisis around the world that effects every medical specialty and organ system on a daily basis. It especially effects women, most notably pregnant women and women of childbearing age, children and the elderly. The last five years have been the hottest five years on record. The Intergovernmental Panel on Climate Change (IPCC) report identifies that we have from 8 to 10 years to dramatically alter our use of fossil fuels to curtail catastrophic climate change averting disastrous outcomes. In the United States, the Green New Deal sets forth the necessary aggressive campaign that we must undertake in order to avert such calamity moving to a carbon free economy by 2050. Only one candidate understands the gravity of the situation and is willing to take on the root cause of the problem while putting into place the solutions necessary to match the change in course that the scientists tell us is necessary.

Rather than address the severity and urgency of the problems we face, an attempt to protect the economics of the fossil fuel industry and confuse and frighten those less versed in the crisis, the response has been framed as posing "a revolution versus incremental progress." This attitude was seen in previous bold societal initiatives such as ending slavery and giving women the right to vote labeled as radical ideas that needed to wait their time in history rather than recognizing the sentinel moment in history that each of these challenges represented to our nation and world.

Finally, the ultimate existential threat is the threat of nuclear war. Interestingly, the existential threats of climate change and associated pandemics are not disconnected from nuclear risks and war as each one results in conflict from resource depletion to global economic crises. When these crises bring nuclear nations into conflict, nuclear war is an option. As a physician dedicated to raising awareness about the dangers of nuclear war, I must state that there is no effective medical or public health response to nuclear war, no matter how small and prevention is the only response. Even a "suitcase" nuclear device detonated in one of our major metropolitan areas would overwhelm our entire national health and critical care system. Such a device in a city like Los Angeles would cause tens of thousands of severe burns requiring round the clock intensive burn bed care, yet the entire U.S. has less than 2,000 burn beds. Any nuclear war, by intent, accident, or cyber-attack would be far worse potentially ending civilization. The only way to prevent this scenario is by the complete abolition of nuclear weapons. Such a global movement banning nuclear weapons is underway around the world as nations are ratifying the Treaty on the Prohibition of Nuclear Weapons. Senator Sanders has said time and time again, "Maybe instead of spending $1.8 trillion a year globally on weapons of destruction... money to kill each other, maybe we pool our resources and fight our common enemy, which is climate change."

These bold ideas throughout history have been criticized as being "too much too soon". The same is being said of the current proposals to provide universal healthcare through a Medicare for All program or boldly addressing the climate threats taking on a global leadership role through the Green New Deal while guaranteeing the economic wellbeing and safety of our people, and yes abolishing nuclear weapons, when in reality the future generation may decry we did "too little too late".

This is indeed a sentinel moment in our world. The status quo is not acceptable. We must recognize the interconnectedness of the health of our nation and planet to the economic security of our citizens. Unless we make the connection, our future is in doubt. We must wake up to the reality that we are one human family and this is not about one man or one idea. This movement is real and it is unstoppable. If there ARE future generations, when your children's children look back and ask, when the planet was threatened, what did you do? What will you say? It's about us, ALL of US! #NotMeUs