AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, broadcasting from the epicenter of the pandemic in New York; co-hosting, Juan González, broadcasting from his home in New Brunswick, New Jersey, to stop community spread.

Monday marked the deadliest day of the pandemic in the United States with more than 500 deaths reported. The total death toll in the United States has now passed 3,100 — a number that’s tripled since just Thursday. Medical workers are bracing for that number to soar in the coming weeks. In New York state, the current epicenter of the pandemic, the peak of the crisis is expected to come around April 10th, when one study estimates 827 people will die of the virus in a single day. More than 1,200 people here in New York have already died.

In Michigan, a growing hot spot for the virus, the death toll is expected to peak a day after New York, with 164 deaths on April 11. Nearly 200 people have died already in Michigan as the city of Detroit prepares for a swell of cases. Michigan state Representative Isaac Robinson died of the virus in a Detroit medical center Sunday. He was only 44 years old. Detroit’s police commissioner has tested positive for the virus, and 500 officers are in quarantine. Detroit’s hospital system is already overwhelmed. The city has high rates of asthma and chronic illness. Meanwhile, President Trump has repeatedly attacked Michigan Governor Gretchen Whitmer, who is calling on the federal government to offer more medical supplies and who is expected to shutter the state’s schools for the remainder of the school year by the end of this week. They’re already closed, but to announce they would be closed for good for this semester.

Well, for more, we are joined by the former director of the Detroit Health Department, recent candidate for governor of Michigan, Abdul El-Sayed. He’s a physician, an epidemiologist. He’s the author of Healing Politics: A Doctor’s Journey into the Heart of Our Political Epidemic, the book just out today, his recent piece in The Guardian headlined “Coronavirus is exploiting an underlying condition: our epidemic of insecurity.”

And thanks so much for joining us, Doctor, from your home, again, to protect your family, yourself and community spread. How critical this is. Can you talk, overall — I mean, every time I see President Trump talking about “that woman,” meaning the governor of Michigan, saying he told Vice President Pence not to call her, because he doesn’t like her, also talked about the governor of Washington state, as well, talking about him as a “terrible person,” and yet your governor continues to say things like — they had just gotten a federal shipment, and she said, “This shipment is not enough for one shift at one hospital in my state.” Talk about the state of Michigan, Dr. Abdul El-Sayed.

DR. ABDUL EL-SAYED: Well, let me tell you, first of all, thank you for having me today. What we’re seeing here is just an utter lapse in federal leadership. It’s clear that the individual in the White House sees himself more as the head of a political party whose job it is to divide the country between himself and leaders in other states, while you’ve got governors in places like Michigan or Washington or New York who realize the depth of their responsibility right now. Michigan is a state with 10 million people. It’s one of the most diverse states in the country. But also we’ve had this very devastating history of what has been a level of leadership that has taken from communities like Detroit to pass tax cuts for major corporations across the state.

And when you think about the movement of a pathogen like coronavirus, it’s easy to just focus on the pathogen. But epidemiologists think not just about the pathogen, but also about the host and about the environment. And what we’ve seen is an interplay between the host and the environment that’s left people in communities like Detroit fundamentally vulnerable to this disease. And that’s why we’re seeing the spikes that we’re seeing now. And in the absence of federal leadership to coordinate the response, we’re seeing suffering that didn’t have to happen.

JUAN GONZÁLEZ: And, Dr. El-Sayed, you’ve talked often that this is not just a question of the epidemic of COVID-19 itself, but that there is also an epidemic of insecurity in the country. Could you expand on that?

DR. ABDUL EL-SAYED: That’s right. I spent 18 months touring my state. And I had thought that when I walked into my campaign, that the challenges that people faced in places like Detroit or Flint had to be different than the ones they face in places like Petoskey or Kalkaska. And then I toured the state. And as an epidemiologist, my job is to understand patterns in disease, how disease moves between people. And one of the most interesting but also inspiring things that I found was that people were talking about the same set of issues — why water is so expensive in a state that’s defined by its fresh water, while corporations like Nestlé can bottle unlimited amounts of water for $400 a year; why our education system is being corporatized and profiteered off of by people like Betsy DeVos; why it is that people still can’t get healthcare in the richest, most powerful country in the world.

And what I realized is that all of us are living in this system that has moved more of the means of wealth off to the very top, leaving all the rest of us, whether it’s because of healthcare or housing or an insecure gig job in a gig economy or the porous barrier between corporations and government — have left us fundamentally insecure, and that insecurity has consequences for all of us in some pretty profound ways. It’s what’s left us so vulnerable as a society to this. You know, when we talk in the United States, when we say we’re number one, usually we mean that to be a good thing, but it shouldn’t mean that we’re number one in the case burden of a global pandemic. And that’s what we’re seeing right now. And unfortunately, that was written for us well before this pandemic hit, because if it wasn’t this, it might have been a climate event. And we are, as a society, ill-prepared for these things, because our people are unfortunately living at the slippery edge of our economy and because we have torn our public service and our public infrastructure apart to sell it to the highest bidder.

JUAN GONZÁLEZ: And I wanted to ask you — you mentioned President Trump, and we’ve been watching now, day after day, as the president has his daily press briefings in the evening, just before the 6:00 news is getting ready to start. And he brings a parade of corporate CEOs, one after another, calling them all by first names. I don’t know if that’s because he’s on a first name basis with all of them or he just can’t remember their last names. But he brings them up one after another, yet we’ve seen very few health professionals, the people — you’re a doctor yourself, a public health professional. None of the — except for the top people at NIH and at the Centers for Disease Control, we’re not seeing any of the doctors and nurses and people who are on the frontlines fighting this disease. I’m wondering what your reaction to that is.

DR. ABDUL EL-SAYED: Yeah. We are suffering a public health emergency, not a private health emergency. But it’s rather clear that this is part and parcel of the kind of leadership that, unfortunately, conservatives and Republicans have offered for a very long time, which is to say that the best way to respond to a public crisis is not to empower the government infrastructure that’s intended to solve it, like, say, the CDC or HHS or any of the infrastructure that’s focused on public health, but instead to bring in corporate CEOs as private solutions to the problem, almost to point at government and say, “Well, that’s why we failed, is because we failed to privatize and sell.”

Fact of the matter is, though, is that the reason we are suffering where we are — right? — is because we have gutted the public health infrastructure in this country. If you look at the state and local level, we’ve seen a 45% drop in public health funding over the past 15 years. The CDC has had its budget cut — its budgets proposed to be cut every year of the Trump presidency. In fact, they were proposing to cut the 2021 budget, which they’re negotiating right now in the middle of this pandemic. We need a public response. And what Donald Trump is saying is that he doesn’t believe in the government that he leads to solve it. And meanwhile, because of the failure of federal leadership across the country, you’ve got governors and mayors competing against each other for resources we should have had stockpiled. We should have been ready for this.

And one last point about this. When you look at a pandemic, it’s not like a hurricane. It’s not like when it forms, you can’t do anything about it, and you’ve just got to be ready. The thing about a pandemic is that it starts small. And it’s almost like a fire. If you put it out when it’s in your toaster, you won’t be fighting it when it’s in your house. And if you put it out when it’s in your house, you won’t be fighting it when it’s taken over the neighborhood. Unfortunately, right now it’s almost like we’ve taken the battery out of the fire alarms. We have told all the firehouses to go home. And then, when this thing is raging in our neighborhoods, we’re wondering why it’s happening, and everybody is left to themselves to try and put out their own fire. And that’s why we’ve seen such a massive failure in the response federally.

AMY GOODMAN: [inaudible] like a few weeks ago, and other newspapers, of course, as well, that running water will be temporarily restored to thousands of poor Detroit residents disconnected due to unpaid bills, disconnected to the water supply of Detroit amidst an outcry about the public health threat posed by the pandemic. At least 141,000 Detroit households were disconnected since 2014 as part of a widely condemned debt collection program, according to records obtained by The Bridge news magazine. Just last year, taps were turned off in more than 23,000 homes, three-fifths of which were still without water by mid-January. So, can you talk about the significance of saying they’re temporarily being rehooked up? Because you so well describe in your book the way this pandemic has exposed the fissures of inequality and health inequality in this country.

DR. ABDUL EL-SAYED: Yeah, when you look at communities that are suffering the most, they’re communities on which environmental injustice, structural racism, and their implications on poverty, have already softened the space for the incoming of this virus to devastate people. You know, you think about something like water. The fact that a mayor or a governor have to be thinking about turning water back on suggests that they’re already playing from the back foot, because water should already be on. It should never have been turned off. It’s one of the most frustrating things about the system of corporate capitalism in communities like Michigan, because what we do is we, in effect, ask poor people to pay exorbitant rates for basic things like water to pay off debts that governments well before them incurred.

You know, look at the situation in Detroit. The reason that people had their water shut off is because during the municipal bankruptcy in the city of Detroit, which, by the way, had a lot more to do with white flight and the resulting loss of a tax base — during that municipal bankruptcy, it was agreed upon that Detroit had to pay debts for their water authority, that, in effect, had actually purified water for the entire region. So they were literally — Detroiters were literally having to pay back the debt that the entire region incurred because Detroit was the single utility purifying water for everybody. And then they just raised rates. And when people couldn’t pay them, they just shut off people’s water. You think about the logic of this — right? — and the realization that water should just be a human right for people, it should just be there for people, and then you fast-forward, and you think about the incoming pandemic, and we’re telling people to wash their hands with warm, soapy water for 20 seconds. Well, if you don’t have water in your house, you can’t do that.

All of those — all of that is seeded by decisions that have been made, that have been patterned around race and patterned around wealth for a very long time. And that’s why I talk about this epidemic of insecurity as being what laid the groundwork for the incoming pandemic. And if it wasn’t a pandemic like this, it might have been a climate event. But we are not well situated to be able to handle these challenging circumstances that we’re going to see pitched at us. And it’s the reason why we have to build a robust federal government that can take these things on and prevent them when they’re small, and, more importantly, build the kind of social infrastructure for people, the kind of social safety net, that says that you’re not going to be evicted if something bad happens to you, that you’re not going to lose your water simply because you can’t pay exorbitant rates, that your kid is not going to have to take hundreds of thousands of dollars in loans to go to college, that you can get healthcare if and when you’re sick.

JUAN GONZÁLEZ: Dr. El-Sayed, I’d like to ask you about that last point, healthcare when you’re sick. We just played a headline earlier of Joe Biden talking about why Medicare for All would not have been a solution to the current problem. But the reality is that our healthcare system is this Byzantine world of for-profit hospitals, nonprofit hospitals, some community hospitals, some huge so-called nonprofit chains where the executives make multimillion-dollar salaries, and they’re all now competing for resources. If there was a single-payer system with some rationale or planning to a process of responding to an epidemic like this, would the situation have been easier to deal with?

DR. ABDUL EL-SAYED: Absolutely, there’s no doubt. And I just want to explain a couple reasons why. Number one, the idea that 10% of your population doesn’t have healthcare at all, or another 50% on top of that have a deductible that’s so high that they’ve learned to ignore symptoms like a fever and a dry cough — which, by the way, are the symptoms of COVID-19 — because they know that if they do go and seek medical care for those symptoms, that they’ll be hit with a bill on the back end, that’s a really dangerous state of affairs when you’ve got an incoming global pandemic.

But even beyond that, I just want you to think about the structure of our health system. Hospitals make money in this system on elective surgeries. That’s how they get reimbursed from insurance companies. But if you’ve got a global endemic that’s about to hit your hospital, what’s the first thing you cancel? Elective surgeries. And so, now you’ve got hospitals that not only are trying to staff up and be ready for one of the most serious public health crises of our time, but they’re also battling bankruptcy on the back end because they’ve lost their main source of pay. All of that is because the system is run for profit.

Here’s the other part. We keep hearing about doctors going without PPE, personal protective equipment. And part of the reason why is because they’ve talked to business consultants who told them that the best way to supply your hospital is what we call “just-in-time” supplying, meaning you don’t want to have a bunch of stuff laying around, because you don’t know when you’re going to use it. That’s all overhead you can strip away. But here’s the problem. Well, when you’re hit with a pandemic, just in time doesn’t work, because all of a sudden everybody is trying to get the resources that they need. Just in time is a classic page out of a business consulting manual. When you run hospitals like a business, you forget the fact that they’re actually supposed to be there to save lives.

And the third point is this. There is no incentive for prevention in our system. Why? Because our system makes money on people getting sick, right? You can’t actually bill something if somebody does not get sick, so that you can bill them for the care. And so, if you look at just the way the system is set up, there’s very little incentive to talk about prevention. And that’s why we keep seeing budgets get cut for institutions like the CDC or local health departments or state health departments, because it just doesn’t fit within the incentive structure of our health system. Imagine we had a system that actually rewarded keeping people healthy rather than taking care of them after they get sick. That’s what Medicare for All would have done.

And one last point. We keep hearing this comparison between us and Italy. And like, since when did we start comparing ourselves with Italy? When was that the comparison? The fact of the matter is, Italy is a far smaller country. And even then, even then, we just surpassed them in terms of the number of COVID cases, and it’s looking like, over the long term, our cases are going to skyrocket well beyond what Italy experienced. We have a responsibility to learn from this moment and realize that we’ve got to guarantee everybody in this country healthcare. And if we don’t, we will continue to be vulnerable to these kinds of massive public health crises.

AMY GOODMAN: Dr. Abdul El-Sayed, we want to thank you so much for being with us. We hope to talk with you at a future point more about your book and your work as an epidemiologist, a physician, former director of the Detroit Health Department. His new book is out today, Healing Politics: A Doctor’s Journey into the Heart of Our Political Epidemic.

When we come back, an exclusive Democracy Now! TV/radio broadcast. We speak with Tara Reade about her allegations against Joe Biden. She says he sexually assaulted her in 1993 when he was a senator and she was his staff assistant. Stay with us.