In 1910, when a contagious pneumonic plague was ravaging northeastern China, a physician there concluded that the disease traveled through the air. So he adapted something he had seen in England. He began instructing doctors, nurses, patients and members of the public to wear gauze masks.
That pioneering of masks by Dr. Wu Lien-teh, a Cambridge-educated modernizer of Chinese medicine, is credited with saving the lives of those around him. A French physician working with Wu, however, rejected putting on a mask. He perished within days.
More than a century later, now that the new coronavirus has spread across the United States and claimed more than 16,000 lives, some scholars and health system experts are shaking their heads that lessons from other countries were not learned in time to help Americans reduce the toll of the pandemic within their borders.
“No matter how long I live, I don’t think I will ever get over how the U.S., with all its wealth and technological capability and academic prowess, sleepwalked into the disaster that is unfolding,” says Kai Kupferschmidt, a German science writer.
His comment came as the United States was surging past 100,000 confirmed cases of COVID-19, the illness caused by the virus, facing a critical lack of ventilators, masks and testing. Now it is more than 400,000. The Trump administration says its approach has been proactive and, thus far, effective, and has blamed others for any missteps.
South Korea, a country that had its first reported case of the illness at about the same time as the U.S., has had a much lower trajectory of the disease and deaths, numbered in the hundreds not thousands. The United States, on the other hand, has become the global epicenter.
Of course, the United States is a larger, more complex, more heterogeneous country than South Korea, Taiwan or Singapore, the three countries in Asia that seem so far to have managed the pandemic with better results. But when they were reacting quickly to the disease, the United States was acting as if the huge disruptions of life that had happened there would not happen here.
Should U.S. political leaders and the public have taken cues from other countries victimized by the disease much earlier - including China itself, which, after an initial period of secrecy and confusion, took rapid and draconian measures to slow the virus’s spread?
Those countries tested aggressively to identify and quarantine the first patients and then isolate anyone they might have had contact with. They used technology to trace at-risk groups. They implemented strict social quarantines and distancing - including closing off whole regions. They engaged their entire societies in the fight from the from the beginning, taking temperatures in public places, isolating carriers and adopting the near-universal wearing of face masks, emulating Wu’s still-relevant insight.
Having dealt with other dangerous epidemics including SARS, MERS and the H1N1 virus, the Asian nations arguably were better primed than the U.S. to respond rapidly and know what to do. In the case of China and Singapore, an autocratic system could respond with little concern for public debate and dissent.
To some experts, however, the reluctance of the United States to imitate other countries’ successful behavior reveals a blind spot evidenced by a reluctance to learn from other countries, believing that whatever needs doing can be done best following America’s own precepts.
“It’s as if these events are happening in a vacuum and Americans think none of these events outside our borders are relevant to them,” says Dr. Mical Raz, a physician and health policy expert at the University of Rochester in upstate New York. “When people were dying in China, it was hard for journalists to get anyone to pay attention. But what is happening here now is very similar to what happened in Wuhan.”
Even in an age of globalization, the slowness of nations to take on board the lessons of others could help to explain why so few in the United States started preparing for the disease outbreak after it blew up in January with lockdowns in China and several Asian countries.
Raz said she thinks such insularity can extend to attitudes inside the country. Inland states in the U.S. tended to view what was happening in New York and other coastal cities as irrelevant until the disease began arriving in their own places, she noted.
Kupferschmidt, who studied as a molecular biologist, said when German scientists developed a test to detect the virus in patients in January and gave it to the WHO, which offered it around the world, that was an opportunity for other countries to get a quick start on aggressive testing. He wonders why the United States did not follow suit.
Officials at the CDC headquarters in Atlanta decided to develop their own unique test instead, as they have in the past. That effort - delayed and, some say, bungled - cost the United States at least a month of testing. “So many missed opportunities,” Kupferschmidt said.
He sees a pattern with other global problems. “A lot of my colleagues who cover climate say, ‘Welcome to the club.’ Unless it impacts you personally, people just don’t see it.”
The United States might benefit from practicing “cultural humility,” says Daryl Van Tongeren, an associate professor of psychology at Michigan’s Hope College. “Cultural humility is this idea that we realize that our way is only one way of seeing the world, and we demonstrate curiosity to learn from others.”
In his view, “True innovation comes from being open-minded. Countries that become insular are the ones that fail to advance.”
“In the past, countries have looked at the discovery of cures and vaccinations as matters of national competition,” says William Johnston, a history professor at Wesleyan University who studies disease and medicine. “The competition between the French and the Germans during the late 19th century was especially marked, over any number of diseases,” he noted.
Sometimes the competition is harmful, he said, but it also can lead to better outcomes by spurring discoveries, such as when France and the United States both raced to discover HIV, the virus that causes AIDS.
National competition vs. cooperation in science waxes and wanes, he says, and right now he believes the world is in one of its more nationalistic periods.
But Johnston questions if American faltering in this crisis so far was actually about an unwillingness to learn from other countries, or if it flowed from another trend - a populist rejection of science and experts in general.
“My take of our failure goes to this bent of questioning science and going to the creation of doubt, starting with lung cancer, acid rain, ozone hole, and so on,” he says. “Whenever there is an economic hit, it has led to the creation of doubt.”
John Daniszewski, vice president and editor-at-large for standards at The Associated Press, is a veteran foreign correspondent who has been writing about world affairs for four decades. Follow him on Twitter at http://twitter.com/jdaniszewski
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