20 UnitedStates TheEconomistMarch12th 2022
University Medical Centre in Tennessee.
Publichealth officials are urging the
government to prepare for the next wave.
“This is a lull. A moment to prepare so we
are never caught again,” says Megan Ran
ney, a physician and dean at Brown Univer
sity’s School of Public Health.
On March 2nd the White House re
leased its National Covid19 Preparedness
Plan. It has four parts: protect and treat co
vid, prepare for new variants, prevent eco
nomic and educational lockdowns, and
continue to vaccinate the world. The plan
includes a onestop testtotreat initiative:
Americans can get a test for covid and, if
they test positive, get a prescription for an
antiviral drug free at pharmacybased clin
ics and other health facilities. During the
last covid surge, antivirals were hard to
find, says Dr Balser. He hopes this plan will
increase their availability.
The programme outlines better meth
ods to detect new strains. It aims for more
efficient data collection, wastewater sur
veillance (to detect prevalence of covid)
and virus sequencing. It includes a “surge
response playbook” to provide guidance
for setting up mass vaccination and testing
sites, deploying medical workers, expand
ing hospitals and providing supplies.
“It is a lovely plan. Everything I would
focus on is here,” says Dr Ranney. But she
fears that the administration will not re
ceive adequate funding. The plan requires
money from Congress, and Mr Biden’s last
coronavirus package for $1.9trn passed
along party lines. “It’s not a typical Ameri
can thing to say that we’re going to commit
resources ahead of time,” says Dr Ranney.
“I hope we have learned our lesson.”
Preparedness might be only part of the
answer. According to Howard Koh, former
assistant secretary for health in the Obama
administration, America’s overall health
could be to blame. “Covid is a fast pandem
ic fuelled by a slower pandemic of prevent
able chronic conditions,” explains Dr Koh.
He points to America’s rate of illness. It is
the fattest country in the oecd, a club of
mostly rich countries. Almost half ofAmericanshavehighbloodpressure.Heart
diseaseaccountsforone infourdeaths.
Aboutoneintenhastype2 diabetes.These
conditionsworsentheeffectsofcovid.
Dr Kohcallsformore investment in
publichealthinfrastructure,bothtopre
pareforcovidsurgesandtodealwithlong
standing health concerns. What seems
clearisthatamultiprongedapproachis
needed.AsDrRanneynotes:“Thereisvery
rarelya singlemagicbullet.” nTwo years of tragedy
Covid-Sources:TheEconomist’s excess-deathsmodel;OurWorldinData *AsdefinedbytheWorldBank†ToMar6th ‡To Mar 8thEstimatedcumulativeexcessdeaths
Per100,000people
4003002001000
2020 21 22 †UnitedStates9%confidenceintervalHigh-income*
countryaverage1007550250
01 ‡UAEBritainJapanShare of population fully vaccinated
%S. KoreaUnited StatesCalifornia’shousingshortageNo home runs
C
alifornia’snimbycrowdscoreda vic
tory this month when the state’s Su
preme Court declined to lift an enrolment
freeze for the University of California,
Berkeley. A local group, Save Berkeley’s
Neighbourhoods, sued the university in
2019 to force it to redo an environmental
impact report which showed that admit
ting more students would have little effect.
Thousands of students who would have
been accepted to one of America’s finest
public universities will now be turned
away. The decision is a potent example of
the cunning use of the California Environ
mental Quality Act (ceqa) by antigrowth
activists to limit development.
ceqa, signed in 1970, mandates costly
studies. It has spawned “a whole industry”
to litigate and redo studies on things like
how a housing project might alter a neigh
bourhood’s racial mix, notes Nolan Gray of
the University of California, Los Angeles.
ceqalawsuits can freeze projects for years.
That has allowed it to be “weaponised” for
extortion, says Ann Sewill, general manag
er of the Los Angeles Housing Department.
Gavin Newsom, California’s Democratic governor, has signed 17 bills that restrain
ceqa. The law retains strong support
among his base, including unions and
greens. But opposition grows as perverse
decisions such as the one in Berkeley re
verberate, and yimby(yes in my backyard)
groups counter their nimbynemeses.
California’s failures on housing go well
beyond ceqa. Half of America’s unshel
tered homeless population lives in Califor
nia. The number of unhoused Californians
has surged, by some estimates, by more
than a third in the past five years, com
pared with a rise of less than 6% nationally.
Housing has become astonishingly ex
pensive. Zillow, a property website, calcu
lates a typical California home value of
$745,200—more than double the figure for
the country. The Bay Area Economic Insti
tute, a thinktank, reckons California’s me
dian rents are America’s highest. Several
academic studies equate every 1% rise in an
area’s median rent with a similar increase
in the homeless population. The California
Housing Partnership, a research outfit, es
timates a shortfall of 2.65m dwellings.
Mr Newsom has signed, by some reck
onings, more new housing laws than any
predecessor. A law that in effect eliminated
singlefamily zoning will help owners turn
their houses into several units. Applica
tions to build granny flats in backyards
have also spiked: a report from ucBerke
ley’s Centre for Community Innovation
found that 15,000 units were permitted in
2019, up from almost 6,000 in 2018. Such
progress is welcome, but it is not enough.
A “crushing” bureaucracy is also to
blame, says Ron Galperin, the Los Angeles
city controller: permitting and other pro
cesses can cost nearly four times as much
as the land itself. London Breed, the mayor
of San Francisco, has tried but failed to
ditch a cumbersome review process. Her
spokesman says it adds between $1.5m and
$6m to development projects.
The Council of Economic Advisers esti
mated in 2019 that removing unnecessary
rules would slash homelessness in Los An
geles and San Francisco by 40% and 54%,
respectively. By contrast, New York City’s
homelessness would drop by 23%. The
Government Accountability Office has said
that a federal scheme called the LowIn
come Housing Tax Credit produced the
least bang per buck in California.
Officials hope throwing money at the
problem will help. The two most recent
state budgets would allocate $26bn for
housing and easing homelessness. Even
so, Adam Summers of the Independent In
stitute, a thinktank based in Oakland, ex
pects the crisis to drag on until voters de
mand far fewer impediments to building.
Mr Summers recently moved to Arizona.
Many of the people streamingoutof Cali
fornia are precisely those whowould be in
clined to vote for such change.nS ANTA BARBARA
The Golden State’s efforts to house
more people have mostly fallen short