Greetings from Europe – where the viruses come from! I went to sleep at home in France thinking that the coronavirus was a global public health problem we all needed to attack together. I woke up to discover that it was a problem caused by those damn Europeans – people like me – and it was time to turn on each other. (Build that virus wall! France will pay for it.)
I find myself at midday, the day after the extraordinary speech by America’s others-hating president, wondering what has happened to the country of my birth. My inbox and Facebook page are filled with friends outraged at the personal and in some cases economic inconvenience that is being caused by this pesky virus. St. Patrick’s Day parade canceled? Fools! What about our constitutional right to get drunk on green beer and catch cabbage?
It is unfashionable these days in America to talk about the common good. But for nostalgia’s sake, let’s think back to a time in the not-too-distant past when that wasn’t so hard, and drum up the global compassion for which America was once so famous.
Here’s what we know for certain:
There is a never-before-seen virus rampaging around the globe, for which there is no treatment, and no vaccine.
The virus spreads easily – based on current research, more than twice as easily as common influenza. (R naught = 2.2 for Corona vs. around 1 for the flu)
The virus is highly contagious even when the person who has it has minor or no symptoms at all.
The virus kills efficiently at a rate currently believed to be at least 10 TIMES higher than the flu, perhaps as much as 20 times higher (1-2% mortality rate vs. 0.1 for the flu).
About 15% of those who get the virus get sick enough to need hospitalization.
The virus preys mostly on the weakest among us, killing mainly our moms and dads, grandmas and grandads, and people who have compromised immune systems.
No free democratic country has succeeded in keeping the virus from rapidly (weeks, not months) growing from 1 confirmed case to epidemic proportions.
The most success in stopping the virus has occurred in places (Hong Kong, Singapore, Taiwan) which have been very aggressive, testing by the tens of thousands, closing schools, and banning all public gatherings of any kind the instant the virus was confirmed in their countries. The US is not one of those places.
Close human contact rapidly increases the rate of spread of the virus.
Unchecked, the virus will eventually overwhelm even the most efficient health care systems in the world, and more people will die than is necessary, simply because care they would normally receive isn’t available.
Right now in northern Italy, which has a modern medical system with more beds per capita than the US, that’s what’s happening. People are being rolled out into the hallways to die because they are over 60, and somebody younger and stronger needs the ventilator that would otherwise have saved that person’s life. There’s no other choice.
So here’s the simple epidemiological math that follows from this set of facts: the more public gatherings we have, the more people will die. Not just a few people more. Hundreds or thousands more, multiplied by 50 states.
So when you think about a parade, or a music festival, or a basketball game, or a conference, you can think about it in one of two ways:
1. I’m young, I’m healthy, and even if I get the virus it won’t have any effect on me. So I’m not worried.
Or 2. Although it is an abstract concept, science tells me with a high degree of certainty that this large gathering of people is likely to result in the deaths of several people who otherwise would have lived. And the more people who gather, the more people are going to die. And until we find a vaccine, this gathering isn’t worth that cost.
If you are a No. 1 person, nothing I say is going to change your mind about overreaction or hysteria or whatever word you’re using to denigrate these decisions while the public health officials, doctors and nurses work 18 hours a day try to save as many lives as possible.
But if you actually believe in science, and you’re willing to consider No. 2 seriously, I think you’ll come to the conclusion that most things really aren’t worth it right now.
To be sure, closings and cancellations cause hardship. And we should as a society figure out ways to lessen those hardships. We need to feed the kids whose only square meals are served at school. And we need to make paid sick leave mandatory, which would not only be compassionate, but also would bring the United States in line with nearly every other advanced democracy on earth.
Paula and I are disappointed that an extensive trip we had planned is likely not to occur. We’re disappointed that Jazz Fest, which I haven’t missed since I was 18 years old, is probably going to get canceled or postponed this year. We’re disappointed that our travel insurance policy isn’t going to cover thousands of dollars in losses that we’ll incur, because a pandemic is an “Act of God.”
But we’re not angry. And we’re not outraged. We know these steps will save lives, and an incalculable amount of human pain and suffering. And even though we don’t know who or how many will be saved, it doesn’t change the science.
Make no mistake: the virus is just beginning in the US, and American Exceptionalism isn’t going to stop it.
Italy’s experience is instructive. In late January, three people in Rome were discovered to have the virus. Immediately, they were placed in a hospital in isolation. The people they had contact with were tracked down and quarantined. And Italy became one of the first countries in the world to limit travel from China.
The government was feeling pretty good. Meanwhile, the virus had arrived undetected in the north weeks earlier, and was making its way rapidly through the population. By the time Italy figured it out, it was too late. Thousands were fated to die.
One of the most studied global pandemics is the Spanish Flu in 1918, which killed an estimated 50 million people, including 675,000 Americans. (The pandemic was actually first detected and may have originated in the United States, although no travel bans were ever enforced against Americans.)
A textbook study from 1918 compared the experiences of Philadelphia and St. Louis, and still forms the basis of public health strategy today.
In Philadelphia, the mayor was of the mind that people were being hysterical and overreacting. He insisted that a big parade that was scheduled amidst the outbreak proceed as planned. Days later, every hospital bed in the city was full of dying patients, and many other critically ill citizens were turned away. Nearly 5,000 Philadelphians died.
In St. Louis, meanwhile, the mayor took several aggressive and extremely unpopular steps that today we would call “social distancing.” He closed playgrounds, schools, libraries, courts, and churches. He staggered work shifts. He limited public transit. And he banned gatherings of more than 20 people. The business community was outraged.
But the death rate in St. Louis was less than half of that in Philadelphia. Thousands of lives were saved.
In Italy, one public official adhering to the Philadelphia Method recently criticized the government’s draconian responses. To prove that all was well, Nicola Zingaretti traveled to Milan, the heart of the outbreak, to shake hands with a group of young people and publicize his “all is well” pitch.
Last weekend, Zingaretti got sick. The diagnosis: coronavirus.
In this fight, we must all stand together. Or we will surely fall apart.