When something happens on a large scale that is preventable, and that harms the health of numerous people, that is a public health crisis.   Drinking water that infects a city with cholera; a popular pharmaceutical, but it includes a compound that causes cancer or birth defects; a common insulation and fireproofing material, made from a mineral found in nature, but it causes grave pulmonary diseases.

Before this worldwide catastrophe, we in the US have been living in an overlapping array of public health crises for years now. Free-range gun violence, soaring suicide rates, and widespread opioid addiction are just three examples.

Mix these with the systematic driving down of wages, our bizarre, extortionist private health insurance system, the demeaning of education, and the worship of the ruthless rich (and humiliation of everyone else), and you’ve cooked yourself quite a dish.  We are living within so many public health crises that we barely see them: they’ve become the matrix of our American life.

The thing that first got me thinking deeply about all of this was another outbreak that I see as a little prequel to the one we are facing today – the nationwide outbreak of Hepatitis A. That outbreak began in 2016 and it has only grown since then. It has infected almost 32,000 people, 61% of whom have had to be hospitalized, and 322 have died. These figures may all be higher due to variations in the way “outbreak-associated status” is reported across the states. It has hit major metropolitan areas, like San Diego, and small cities like Columbia, South Carolina, and right now it is fierce in places like Kentucky – hardest hit state of all, so far. Most victims are homeless, or in prison, or men who have sex with men.  But a significant chunk are people have been exposed inadvertently: for instance, diners exposed when they eat at a restaurant with an infected kitchen worker.

Hep A can be easily stopped.  Simple hand washing breaks the chain of transmission. And there is a perfectly useful vaccine that prevents it. But access to clean running water is not just a luxury but often an impossibility for Americans who are unhoused, and even more cruelly, affordable healthcare – the ability to just go off and get a life-saving vaccine when you need it – is a luxury for many Americans.

At a higher level, we are observing this outbreak marvelously. We can see it rolling across the country, the CDC has terrific statistics about it, but the next part, where national resources are brought to bear to halt the disease in its tracks and heal the problem at its roots….  well, what national resources?

That is, this was a sign, a big flashing sign, of two things: we really do not have a public health system; and we no longer believe even in the foundational idea of a public health system –- the idea that there is such a thing as public health; that it is a thing we should protect; that it is essential for the greater good; even that it is the greater good. It’s not that this whole concept is breaking down. It’s that it no longer exists. If you doubt that, think of all those thousands of gleeful spring breakers crowding the beaches of Florida this week, taking advantage of those $51 round trip airfares (thanks United!) and boasting about it online.

One good thing that I hope comes from this global catastrophe is that it may end our chilly indifference to public health. We don’t even seem to care when our children, our actual children, die of something vicious and stupidly, easily preventable. When all those children were slain at Sandy Hook and it made absolutely no difference to the national conscience, when not one single thing changed in the legislation or the regulations or the public discourse – if anything, in its wake, more nuts have more guns more openly – then I knew we were in for it. I knew it would take something unimaginably horrible to wake us to what we have become. And here we are.