Universal systems like Britain’s National Health Service should find it easier to mobilise resources and adapt rules and practices than fragmented, private ones that have to worry about who pays whom and who is liable for what. The United States, despite its wealth and the excellence of its medical science, faces hurdles. Its private system is optimised for fee-paying treatments. America’s 28m uninsured people, 11m illegal immigrants and an unknown number without sick pay all have reasons to avoid testing or isolation. Red tape and cuts have fatally delayed adequate testing.
Uncertainty will be a drag on the third factor—trust. Trust gives leaders licence to take difficult decisions about quarantines and social-distancing, including school closures. In Iran the government, which has long been unpopular, is widely suspected of covering up deaths and cases. That is one reason rebellious clerics could refuse to shut shrines, even though they spread infection.
Nothing stokes rumour and fear more than the suspicion that politicians are hiding the truth. When they downplay the threat in a misguided attempt to avoid panic, they end up sowing confusion and costing lives. Yet leaders have struggled to come to terms with the pandemic and how to talk about it. President Donald Trump, in particular, has veered from unfounded optimism to attacking his foes. This week he announced a 30-day ban on most travel from Europe that will do little to slow a disease which is already circulating in America. As people witness the death of friends and relatives, he will find that the pandemic cannot be palmed off as a conspiracy by foreigners, Democrats and CNN.