Here’s a scary thought from Ian Welsh:

Our society, as a whole, has no surge protection - no ability to take shocks. We have no excess beds, no excess equipment, no excess ability to produce vaccines or medicines, nothing. Everybody has worshiped at the altar of efficiency for so long that they don’t understand that if you don’t have extra capacity you have no ability to deal with unexpected events. And now some people are suing the Ontario government for their SARS handling, which I fear will perversely make the government less willing to do what needs to be done rather than more, when a crisis hits.

Public health care in a pandemic or epidemic is a triage operation. You isolate people and you shut things down deliberately, and people are going to die because of the decisions you make. If nurses and doctors decide that their own lives are more important than those of the sick, or if ordinary citizens decide to break quarantine or travel restrictions, then there could be complete disaster. The moment of the SARS outbreak that caused me the most fear was when there were reports of people fleeing Beijing. In a real pandemic situation all that would do is spread the disease further and kill even more people.

(emphasis mine)

To make matters scarier, as we have now seen with Hurricane Katrina, even if the capacity were there, the United States’ ability to manage and allocate that capacity is essentially non-existent. At this point in time, when evaluating the safeguards available to me as I look to manage the risk of a worst-case H5N1 outbreak, one safeguard I will not be counting on is a functioning national infrastructure. It’s no longer so much a question of if I will stockpile essentials like food, water, medicine and protective clothing as a question of how long will I expect my stash to last.

Efficiency and Robustness

People have been worrying about the ability of a tightly coupled world to withstand shocks - including Hurricane Katrina and SARS.

Ian Welsh seems to be a bit of an alarmist from the snippet you post.

The US economy is remarkably resilient to a wide variety of shocks (9/11 is a good example, as is Katrina) due to our horizontal integration rather than vertical. It is easy to look at history and see where colossal economic problems occurred - Soviet central planning, Nixonian gas price controls.

I’ve added some fairly extensive thoughts in another post