XR,

You were surprised by the level of response in the U.S. public health system. You seemed to feel the U.S. is on a decline at least in public healthcare. Well, there might be strengths to the U.S. system but today I want to focus on the negative side. Essentially, U.S. healthcare system has always been horribly expensive, inefficient, fragmented, and dominated by private, commercial entities. Therefore, for decades, the low-income residents (African Americans, poor immigrants etc) have suffered from wholly inadequate healthcare. There’s no decline – it has always been this bad for decades.

Public healthcare provision is worse in the U.S. than most rich countries.

Healthcare should not always be profit-driven but for decades, it has been this way in the U.S. for decades.

Pandemic response requires strong central government, but U.S. political system is decentralized. Many state governments have a lot of autonomy and limited trust in the federal government. I think some state governments are more effective than the white house.

This March 2020 TheAtlantic article in my blog offers good insight into the U.S. public health infrastructure issues.

https://www.channelnewsasia.com/news/commentary/us-cannot-handle-covid-19-poor-response-capitalism-trump-12796618 is similar but shorter.

— 7-point score card .. https://bintanvictor.files.wordpress.com/2021/09/covidhandling7indicator.pdf is a 7-poipnt scorecard developed by international experts to evaluate a country’s coping strategy, track record, public policies against covid19, and readiness to lift lockdown. This new scorecard addresses limitations of two existing assessments:

1. Existing scorecard — Some countries – among them the United States and Britain – had ranked highly under old scorecards such as the Global Health Security Index (GHSI), an annual assessment of how ready countries are to deal with infectious disease outbreaks, this did not reflect their actualpandemic preparedness. So GHSI proves to be an inaccurate scorecard.
2. Case numbers — are dependent on a country’s testing strategy and capacity, and the extent to which individuals go for testing. It also neglects how effectively clusters have been contained and virus transmission suppressed.

Even though the 7 criteria are not developed by Asian experts, these criteria seem to show that the strongest countries ( except New Zealand ) are all in east Asia such as Vietnam, Taiwan and South Korea. I think China scores high on most of these 7 criteria.

My damning assessment of the U.S. public health system:

• vulnerable and neglected groups — not well protected in the U.S. Many nursing homes and low-income black/Latino communities suffer a disproportionate number of deaths.
• contact tracing — can contain clusters and stop their exponential expansion, but I don’t know if U.S. governments give it any priority. The percentage of cases detected through contact tracing (as percentage of all cases) is high in SG, Korea, Germany, China. I doubt the U.S. percentage is comparable. See https://www.scientificamerican.com/article/contact-tracing-a-key-way-to-slow-covid-19-is-badly-underused-by-the-u-s/
• proactive cluster management — is center stage in SG, Vietnam, China, NewZealand, SouthKorea ,,, partly because these countries have low case numbers and can focus on clusters. I don’t know about the cluster management in low-infection cities of the U.S. I believe NY and NJ governments are not paying enough attention to clusters taking shape and exploding. This is reactive management, not proactive.
  • Actually, Singapore has had very high case numbers per 1 million population, but the government took decisive actions to identify and contain more than a hundred large clusters and many smaller clusters. Therefore, enduring high case number is not an excuse for neglecting the tough job of cluster management and contact tracing. “亡羊补牢”，而不是  “破罐子破摔”
• protection of frontline workers — a serious concern in the U.S. but I don’t know how it compares with other countries. Singapore frontline workers always have adequate protective equipment, even though Singapore doesn’t manufacture any. Planning and coordination seems to be the key.
• testing capacity — not as good as China, S.Korea etc, despite the technological advantage and economic power of the U.S.
• death rate — per 1 million population is very high in the U.S. compared to China, Korea, Taiwan, NewZealand, Vietnam etc. Singapore has one of the lowest death rates (27 in a 5.6 million population)