Americans will need to agree on a “social compact” whereby individuals subject themselves to social separation for the common good, while the government meets their essential needs. People separated from society may be highly vulnerable, including persons who are elderly, disabled, or with chronic health conditions. The government will need to provide food, medicine, and support for the lonely, fearful, or depressed.

Inequity creates America’s biggest gap in preparedness. Nearly 28 million Americans are uninsured, and many millions more underinsured. Large migrant and undocumented populations have limited access to essential health services. Rural, disabled, and low-income populations face additional barriers. If the uninsured have reduced access to health care or fear deportation, they may stay away from hospitals even as they remain in the community, spreading COVID-19 and other viruses.

The answer to that challenge is to establish effective stopgap measures to ensure all costs related to COVID-19 are covered. Medicaid eligibility could be expanded for a limited duration, with a streamlined application process, a model employed by the Disaster Relief Medicaid program created in New York after 9/11. Or COVID-19 testing and treatment could be free of charge. Further, government should designate health facilities as enforcement-free zones for undocumented immigrants.