COVID-19: A Primer: How to Think About the Coronavirus
This article was originally published in The American Scholar. Philip Alcabes will continue to blog about COVID-19 there in the coming weeks. Visit its homepage for updates.
Flights are canceled, airports are closed, conferences and conventions postponed, churches and mosques shuttered, soccer games played in stadiums empty of spectators. My university has called home the study-abroad students from Italy, Japan, South Korea, and China. It would be easy to look at the world in the face of the new coronavirus, COVID-19, and believe it is theater, penned by a playwright filled with xenophobia and fears of promiscuous mixing with other humans.
Every epidemic is theater, a drama written by the powerful for the sake of the unsuspecting. AIDS became a morality tale of innocence and sin. Outbreaks of Ebola became stories of strange tribal customs and feckless governments. Measles outbreaks become the fault of a delusional but highly organized “anti-vaxxer” movement. What’s unusual about the outbreak of COVID-19 is that the story isn’t being told by the powerful. The powerful are just consumers here, responders, sometimes influencers, salespeople of a certain frightened view. But the story of COVID-19—a surrealist masterpiece—masked citizens, ubiquitous squeeze bottles of Purell, conspiracy theories, bravado, insouciance, boredom, and anxiety—is taking shape purely out of information.
A little epidemiology to start with. It’s becoming clearer by the day that COVID-19 is a conventional virus. By this I mean that many people who are infected (perhaps most) do not get sick at all or become only mildly ill. Most of those who do get sick are older (children under age 15 are almost never reported among the seriously ill). They may have a concerning but not serious illness, including fever and cough. A few suffer badly. Some must be hospitalized, and a fraction of those who are hospitalized have and will continue to die.
The virus is potentially deadly, in other words. I don’t intend to minimize the danger (and allow me to note that as an older man with an underlying respiratory problem, I’m more at risk than most of you, dear readers; I’m not dismissing this as somebody else’s problem). But a sense of proportion is useful. Yes, two or three percent of those who are reported to be ill with COVID-19 have died from it. However, the mortality among all of those who are infected—a much bigger number—is almost certainly less than one percent.
“Resist the impulse to make more of the COVID-19 event than it is, i.e., a garden-variety outbreak of a potentially, but rarely, serious infection.”
Transmission within households shows that the virus is easily and rapidly spread through close-order contact, but that many contacts of sick COVID-19-infected people are not themselves sick, or not sick enough to hospitalize. This finding suggests that the number of infections must be five- to 10-fold higher than the number of reported cases. As of this writing [March 10, 2020], the 4,088 deaths known to the World Health Organization (WHO) therefore occurred among at least 550,000 infections—a mortality rate of 0.74 percent as an upper estimate. Possibly much lower. That makes COVID-19 more virulent than the coronaviruses that cause common colds each winter, but no more virulent than influenza, and compared to smallpox or Ebola, this virus is a sissy.
The virus is transmitted easily, but only through very close contact or, perhaps, by touching surfaces on which a virus carrier has coughed or sneezed. Think of seasonal flu, in other words.
Why is information driving the drama?
First, information travels much faster than thought today. In an influential monograph published nearly 75 years ago, Jeremy Morris noted that one of The Uses of Epidemiology (the book’s title) is to “complete the clinical picture.” Systematic study would reveal that not all instances of an infection result in serious-enough illness to merit a visit to the doctor, for instance—whereas the physician, seeing only the cases that come into the clinic, wouldn’t know this. But that was 1957. In late 2019, the information reported from Wuhan, China, that a new virus had appeared and some people who acquired it had died, spread widely, long before anyone could assess the situation. No time for Morris’s sort of reasoned study. No time for thinking, deliberating, assessing. No time for making sense. The story began not with the outbreak; the story began with the story.
Second, disease outbreaks have a different resonance in today’s world. By “today’s world” I don’t mean the age of global trade and jet travel. I mean the world of statecraft that often takes the form of paranoia, of cruelty in the name of xenophobia, of public celebrations of victimhood. A virus that sometimes kills people and originated far away has a new valence in a world in which threats are, perversely, prized because they can be used to prove that your enemies are rampant. President Trump has already stated that the COVID-19 outbreak was overstated by the Democrats for political reasons. And every potential harm that can be imputed to immigrants, however implausibly, serves the nationalist parties that are already in power or seeking it in many countries.
Third, China. When SARS appeared in 2003, it was our Western attachment to the belief that China is inscrutable that made the outbreak noteworthy. Seventeen years later, we may well be no less ignorant of life in China, but we are certainly more aware of China as a political force. News of the coronavirus epidemic was infused with geopolitical concerns from the get-go.
Figure 1. St. Louis Red Cross Motor Corps on duty, Oct. 1918, during the influenza epidemic. Courtesy Library of Congress Prints and Photographs Division.
Fourth, the Return-of-the-Spanish-Flu industry. For 40 years, many public health professionals and a number of journalists and writers have made their careers by predicting that there will one day be a reprise of the deadly flu pandemic of 1918-19. That outbreak involved an unusual strain of influenza and a world exhausted by war. It led to 50 or 100 million deaths worldwide. There is no reason to believe that the set of circumstances that allowed that event to be so deadly will recur. But you will hear and read, asserted as fact, that it will. Federal health officials say it whenever the subject of flu vaccine comes up. Predicting the return of the 1918 flu is a profitable business that seems never to wear out. People must be forgiven for thinking, constantly, that some new pandemic is going to wreak havoc in the old way.
The most curious aspect of the COVID-19 drama is its transformation of authoritarian, or wannabe-authoritarian, regimes into fickle blitherers. In the past, the Trump administration in the US, Putin in Russia, the Xi administration in China, and their many imitators had been decisive and ruthless in locking up their undesirables and in delivering policies that appeal to hypernationalist rhetoric. But none of them has been able to institute a sensible policy on coronavirus—a policy with clearly articulated aims, with criteria for the determination of when the policy can end. Plus, the policies change every day. There will be testing, there will be enforced quarantines, there will be suggested self-quarantine, there won’t be testing because the test kits aren’t ready, there should be a vaccine soon, there won’t be a vaccine soon, stock up on a month’s supply of food and medicine (do that many people live in apartments big enough to accommodate a month’s supply of food?). Chinese officials are building blue walls within cities. Trump, the wall man, says his wall will stop the virus until it’s pointed out that there isn’t a wall, and then he blames Obama. The U.S. Centers for Disease Control and Prevention recommends more testing but rejects an effective test for the virus adopted by WHO, then announces it will take more time for a U.S. test to be ready. People must be forgiven for not trusting governments to protect them.
What should governments be doing?
Stop issuing warnings, start protecting people who are older and have health conditions. Closing schools is rarely the right thing to do: children are not susceptible to serious illness from this virus. The more that COVID-19 spreads among those who don’t get sick from it, i.e., children, the faster it will evolve into a less pathogenic form. But adults who stand to get seriously ill if infected by schoolchildren must be well protected—through surveillance and medical support. The risks of keeping schools open are outweighed, in that case, by the potential benefit in hastening an end to the danger.
“The more that COVID-19 spreads among those who don’t get sick from it, i.e., children, the faster it will evolve into a less pathogenic form.”
But, and it’s a fundamentally important but, in the United States, this plan demands a wholesale shoring-up of our medical-care system. It cannot be the case that the poor, the undocumented, or the otherwise uninsured are unable to get testing, treatment, and care if they are sick with COVID-19. It cannot be the case that that affording care to the ill becomes grounds for their apprehension by ICE. And not only on humanitarian grounds (although those should be sufficient), also because if the medical system can’t take care of everybody, it will allow the outbreak to progress. That’s the thing with contagion: unless you protect everybody, you’ve protected nobody.
Protecting medical workers from infection by the sick is crucial. Keeping schools open to promote transmission of low-pathogenicity strains will hasten the evolution of the COVID-19–human relationship in one way; preventing transmission of highly pathogenic strains is another.
What should individuals do?
Stop worrying. Keep away from people who are coughing or sneezing. Wash your hands often, more often than you think. Try not to touch your face. Stay home if you’re sick. If you have a cough and fever, see if you can get tested. If you have COVID-19, isolate yourself. In other words, do what mindful people do during flu season.
But equally important: resist. Resist the impulse to make more of the COVID-19 event than it is, i.e., a garden-variety outbreak of a potentially, but rarely, serious infection. Resist the inducements to pass along errant information. Resist social media surges. Resist governments that are using the outbreak as an excuse to ramp up xenophobia, interdict migration, restrict travel, or promote suspicion.
The new virus, in its own time, will become less virulent. Sooner or later it will disappear from the news. Whether it will have moved people to retreat into even more craven angst about the wide world’s dangers, whether we will cede even more control to the powerful, or whether we will collectively move away from fears that make us subservient and move, or inch, toward a more interconnectedly humane world—this, as far as I can tell, remains up to us.
