Abu Dhabi, UAEFriday 25 September 2020

Coronavirus has made me an American 'medical refugee' in France

Inequality in healthcare access in the US is particularly stark. I am luckier than most Americans

Medical personnel from the Robert Debre hospital wear masks to help curb the spread of the coronavirus stage a protest in Paris, June 11, 2020. French nurses and doctors demand better pay and a rethink of a once-renowned public health system that found itself quickly overwhelmed by tens of thousands of coronavirus patients. Michel Euler / AP
Medical personnel from the Robert Debre hospital wear masks to help curb the spread of the coronavirus stage a protest in Paris, June 11, 2020. French nurses and doctors demand better pay and a rethink of a once-renowned public health system that found itself quickly overwhelmed by tens of thousands of coronavirus patients. Michel Euler / AP

Last week I went to a socially distant dinner in Paris, celebrating the end of France’s strict lockdown.

“This is Janine,” my host announced, introducing me to the rest of the room. “She is a medical refugee in France.”

It was meant as a light-hearted joke and I laughed, but it is, in fact, true. The main reason I cannot return to my home in the US while the coronavirus pandemic is still raging and infection rates there remain high (the country has over 2 million cases, according to the Centres for Disease Control) is that I don’t have American medical insurance.

At the beginning of the pandemic, when everyone was struck by fear and uncertainty, one story that drew a lot of attention was that of a dying man in New York City. As he lay gasping for breath, he whispered to the nurse, Derrek Smith, who was about to place the ventilator in his lungs, “Who’s going to pay for this?”

Mr Smith was horrified. "(The patient) was in severe respiratory distress, had difficulty speaking, and yet still his main concern was who could pay for a procedure that would his extend his life," he told CNN.

I am luckier than most. My son and I will eventually have American insurance when the academic institution I work for reinstates my benefits in the next school year. But if we went back now and one of us got infected, I could be in debt for the rest of my life.

This is not a wild exaggeration. American Covid-19 patients have been getting big medical bills. US President Donald Trump has signed two legislative bills that together will make Covid-19 testing and treatment free for patients, insured and uninsured alike.

I am grateful to possess French nationality, and to carry the country’s treasured, green and yellow “carte vitale”, which allows holders to receive free medical treatment across most of Europe

But these changes will not happen swiftly. At the moment, there are cases of people spending 30 minutes in a triage tent and later receiving bills over $1000 in the post. Another man, Imad Khachan from New York City, has said he received a bill for nearly $50,000 after a three-night hospital stay.

When I read these stories, I am grateful to possess French nationality, and to carry the country’s treasured, green and yellow “carte vitale”, which allows holders to receive free medical treatment across most of Europe. In fact, however, even foreign visitors to France who have found themselves stranded in the country during lockdown are looked after by the state’s universal healthcare system.

A patient from a nursing home is transported to an emergency room at St Joseph's Hospital in Yonkers, New York, April 20. John Minchillo/ AP
A patient from a nursing home is transported to an emergency room at St Joseph's Hospital in Yonkers, New York, April 20. John Minchillo/ AP

Most countries have some degree of inequality in health care access, though in the US they are particularly stark. Excellent care exists for those who can afford it, but less so for the socioeconomically deprived.

But the pandemic has brought attention to a similar dynamic of medical inequality between countries, too. In addition to traditional concepts of the “developed world” versus the “developing world”, we might soon see the rise of a divide between “pandemic-safe countries” and “susceptible countries”.

According to a recent report by the Deep Knowledge Group, a consortium of entities working in “frontier technologies”, Switzerland is now the safest place on earth.

That may not be surprising, but it is not only a result of the country’s neutrality and remote alpine setting, or its wealth. It also managed the Covid-19 crisis with a sound medical infrastructure that was in place long before pandemic struck.

An Emergency Medical Technician dons personal protective equipment before going into Elmhurst Hospital during the outbreak of the coronavirus disease in Queens, New York, US, April 20. Lucas Jackson/ Reuters 
An Emergency Medical Technician dons personal protective equipment before going into Elmhurst Hospital during the outbreak of coronavirus, Queens, New York, US, April 20. Lucas Jackson/ Reuters

The Swiss banned gatherings of more than 1000 people immediately after discovering its first coronavirus case in late February. It took the US months to do the same, due to Mr Trump’s faltering.

Germany, where Chancellor Angela Merkel handled the pandemic with pragmatic, strategic calm – instigating community testing early on – is second on Deep Knowledge’s list.

Both countries take the first and second slots because of “the careful ways in which they are attempting to relax lockdown and economic freezing mandates in a fact and science-based manner, without sacrificing public health and safety," the study reported.

I am not surprised to find the United States ranked 58th – immediately below India and Romania.

What is consistent in the Deep Knowledge study is that all of the countries that succeeded in harnessing or at least controlling the spread of the coronavirus imposed strict practices early on.

So it makes me wonder about whether or not, in the future, we will begin to look at countries through a different prism: as “safe” and “unsafe”.

Here in France, my friends are planning their summer holidays to “safe” countries, with the definition of “safe” being tied directly to coronavirus policies.

French borders are not yet open to tourism, but many are already planning holidays to Italy – which suffered badly, but for now has managed to control infections – and Greece. However, if people start flocking to airports and ferries, will the pandemic jump again? Will the frontiers shut down a second time?

We are all living with the shadow of the dreaded “second wave” that many experts predict. And it is inevitable that if people move around in airports, trains and gather in large groups without masks, the virus will spread.

“Medical refugee” is a cavalier term, given my privilege of having French nationality. But the future for many might look something like this: countries re-aligning in new groupings, with people finding themselves moving in restricted regions that are not based on geography, but on policy and health care. “Safe” or “unsafe”.

In the meantime, I’m not moving anywhere. And I’m still wearing a mask.

Janine di Giovanni is a Senior Fellow at Yale’s Jackson Institute for Global Affairs and the author, most recently, of “The Morning they Came for Us: Dispatches from Syria”

Updated: June 14, 2020 06:33 PM

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