What a difference a month makes. Just 30 days ago, the Wuhan Coronavirus seemed like a distraction from the seriousness of the Democratic beauty pageant. Partisans sniped about whether COVID-19 represented an existential threat to the species or a hoax to get Trump. The Dow was looking to crest 30,000 points. Life offered predictability.
In fact, just six weeks ago, I remember sitting on the porch of our rented apartment in Bonaire, overlooking the Caribbean Sea, enjoying rum and a cigar and talking to Dave (who frequently travels to China) about whether he had been to a place called Wuhan, because the news stories out of China were looking scary. He told funny stories about his travel adventures in China and India.
Now? No one’s laughing. No one with working synapses thinks it’s a hoax.
Where to begin?
Let’s start with the science.
The novel coronavirus that originated in Wuhan likely originated with a wet market. That’s a market serving slaughtered animals, many of them exotic. The Chinese government made motions to shut them down after the SARS epidemic but let them persist.
Some terms: The virus, called SARS-CoV-2, sometimes leads to a disease called COVID-19. People can be infected by the virus and, because they’re asymptomatic, not actually manifest the disease. The math about the dangers of COVID-19 are based on reported cases of people whose infections have morphed into the disease. However, some unknown proportion of the country has acquired and defeated the virus without developing the disease. Keep that distinction top-of-mind when you think about population-prevalence statistics. A good deal of reporting has mixed, willy-nilly, cases of infection and cases of disease.
It’s difficult to get a good sense on how wide the disease has spread, in part because people with very mild cases are likely under-counted in the denominator and in part because some of the worst outbreaks occur in countries with regimes that shade the truth (China, Iran, possibly Russia and Venezuela). For people with mild-to-moderate infections, the disease symptoms are so similar to influenza that only a specific test yields a concrete diagnosis. In general, though, the danger signs of COVID-19 include dry (often extreme) coughing, shortness of breath, and fever.
The CDC offers an online symptom self-checker that helps put your mind at ease about what your best course of action may be. In general, if you experience trouble breathing, become confused or lethargic, show a bluish tint to your face or lips, or feel persistent pain/pressure in your chest, seek immediate medical attention. Those are signs of hypoxemia—low blood oxygen—and is caused by, among other things, acute respiratory distress syndrome, which is a serious complication from COVID-19. Basically, your lungs fill with fluid, preventing oxygen absorption in your tissues, which is why the number of ventilators is important. (If you’re a worry-wort and you merely think you’re having difficulty breathing and then hyperventilate and then generate the same symptoms of respiratory insufficiency … get yourself a pulse oximeter and learn how to use it.)
When you consider how COVID-19 differs from the cold or the flu, two statistics matter:
- The R0. The R-naught of a pathogen marks its replication multiplier. A pathogen with R0 = 1 generally results in one infected person infecting a single other person, in the long-run average. Diseases with an R0 of less than 1 generally self-contain; not enough people get them to cause a pandemic. Diseases with R0 above 2 spread like wildfire. It’s easy to see why: One person infects two. Those two infect four. Those four infect 8, who infect 16, who infect 32. Imperial College London estimates the R0 of COVID-19 to be 2.4. That’s code for “a lot of people will get exposed to this thing in the normal course of business.”
- The case fatality rate. The case-fatality rate is the proportion of people infected by a pathogen who will die from the pathogen or complications related to it. A study published 24 February in JAMA suggests a case-fatality rate, as represented by official Chinese statistics, of 2.3 percent. That rate, however, is highly dependent on the age and chronic comorbidities of the afflicted. Relatively few young-and-healthy people die of COVID-19, for example, although they can and do. In Italy, the official case-fatality rate is somewhere above 8 percent, but Italy’s population skews older and they’re classifying any cause of death that looks like COVID-19 to be COVID-19, so that number is almost surely overstated. In the United States, it appears to hover around 1.45 percent with statistics current as of 26 March.
People sometimes ask: Is all this drama worth it? After all, more than 80 percent of infected people experience no or very mild symptoms. In fact, absent clinical testing, doctors can’t tell the difference between COVID-19 and the flu. So why worry?
The best way to answer that question is to look at the interplay between the case-fatality rate and R0. The flu’s case-mortality rate is around 0.05 to 0.1 percent with an R0 of 1.3. Compared to the flu, it appears COVID-19 kills 15 to 75 times more people and infects twice as many people. Although it’s true that for a broad swathe of people, COVID-19 infection proves utterly anticlimactic, the public-health concern isn’t with the 80 percent. It’s with the 20 percent who require hospitalization. Of those, 5 percent will die, and a proportion will only survive acute respiratory distress syndrome through the use of a ventilator—and many those extreme survivors will never regain full pulmonary function.
If we leave the disease unmanaged, the prospect that 1 million or more Americans could die from COVID-19 isn’t scaremongering—it’s science. Given that there’s presently no vaccination or treatment, the only tool in our toolkit becomes an artificial reduction in R0 through tactics like enforced social isolation. Because even though the virus might have an average “natural” case-fatality rate of 1 percent in optimal-care settings, if a large chunk of that 20 percent who require hospitalization can’t get a ventilator, the case-fatality rate increases. Sometimes dramatically. In an overstretched healthcare system with inadequate ventilator supplies and fewer healthcare providers (because they, themselves, are sick!), that death rate climbs. And climbs. And climbs.
Are these broad shutdowns scary? Sure. Unprecedented? Yup. Necessary? Absolutely!
In a perfect world, by mid-summer, we’ll all look at these shutdowns and wonder if it was all a let-down. Much ado about nothing. If that’s the case, then congratulations to us all—these measures worked. And if mid-summer comes and the world feels like Thunderdome—well, then, they didn’t. And may God have mercy on our souls.
Shining Points of Light
Resist the urge to see only the bad and the scary, though. Use this moment as a ready-made excuse to connect with old friends (remotely, of course) and to practice random acts of kindness. Stories abound of people doing good things—like people who organized a drive-by celebrating a 7-year-old’s birthday. Or the teenager who delivered dinner and offered an impromptu trumpet performance for an isolated elderly couple. Or the students who use their 3D printer to help create face masks for healthcare workers. You can be the hero of such a story, too.
I’ve been eating my own dog food. The last few days, I’ve been sending occasional text messages and emails to folks I haven’t seen in a while, or who I know might be struggling, or who happen to live in a hot zone like NYC. We each enjoy our web of networks. Now’s as good of a time as any to make sure the strands connecting each node remain active and strong.
Some institutions are doing their best and thereby demonstrating their resilience. My home parish, for example, has followed the orders of the bishop and the governor to suspend public services, but the church stays open for private prayer and individual confession remains available. Plus, the parish has called every registered parishioner to check in, and the pastor has been releasing daily YouTube videos with Lenten reflections on the readings of the day plus a blessing. (And the bishop live-streams Sunday Mass from the Cathedral.)
Arts institutions have offered creative online performances. Even Sir Patrick Stewart has been tweeting a sonnet a day. Because Shakespeare. And corporations are helping, too—Xfinity/Comcast is, for the next few months, waiving all Internet usage caps to accommodate work-from-home activities.
When you’re part of the solution, you’re not part of the problem. You can be a shining point of light. And when enough points of light glow in the darkness, the darkness shall not overcome it.
The Problem of Information
Speaking of darkness, let’s turn to the media.
The most significant gut-churning lesson from the last 90 days isn’t about the virus or the economic aftereffects of it. Rather, for me, the big story has been the utter failure of the press to be serious about, well, anything. Consider:
- Reporters have repeatedly asked President Trump if it’s racist to call the disease the “Chinese Coronavirus” or the “Wuhan Coronavirus” despite that it’s common practice to name new diseases after the location they first appeared. Think about that. You’re a reporter. It’s a pandemic. You have access to the President of the United States. And your primary goal is to try to dunk on him about terminology? Seriously?
- The conservative media went on, and on, and on, about how COVID-19 is just the flu and complaining about it is like impeachment all over again. Then they decided it was serious and Trump’s response has been perfect.
- The progressive media attacked Trump for not locking the country down, days after attacking him for locking down the borders, despite that the president has no authority to lock down parts of the interior—let alone the entire country—except in specific instances of armed insurrection. No matter what Trump does, it’s too little, too late, too corrupt. Even Governor Cuomo has found nice things to say about Washington’s response, for cryin’ out loud.
- The centrist pundits tried to prognosticate their way into relevance, only to be proven wrong (in the aggregate) at every step of the way.
For a long time, China lied about the respiratory illness arising from this virus. Chinese authorities at all levels suppressed information. None of this information is in dispute. As recently as this week, China maintained that a U.S. Army athlete brought the virus to China last November. To mention the duplicity of the Chinese Community Party in allowing the disease to spread isn’t racist. It’s truth.
A Gallup poll taken March 13 to March 22 shows that of nine polled entities, the U.S. news media was the only institution underwater in its approval rates. Overall approval for the media stood at just 44 percent, with 55 percent disapproving. Contrast that to the media’s foil, President Trump, whose approval rate for the coronavirus crisis stands at 60 percent. Even Congress is at 59 percent approval.
For an excellent case study in the utter lack of self-awareness “infecting” the media, consider Damon Linker’s March 27 column in The Week in which he wrote:
Over and over again, those who report on and analyze politics at close range have documented the president’s lies, exposed his schemes to enrich himself, taken note of his errors and their consequences, and highlighted his incompetence and cruelty — and at every step of the way they have assumed this would make a political difference. But it hasn’t.
Maybe it’s time to recognize that it won’t.
Accepting this is hard. Journalists, academics, and intellectuals tend to be idealists. They went into this line of work not because they wanted to be rich but because they wanted to make the world a better place in some way. This doesn’t mean their ideas on improving things would always have positive outcomes if they were enacted, or that their favored policy proposals deserve to take priority in our public life. Not at all. But it does mean they tend to assume that most people will recoil from outright lies, deception, malice, injustice, sleaze, and thuggish imbecility when it is exposed and demonstrated to them.
But maybe that isn’t true.
It’s isn’t true at all, but it’s a perfect encapsulation of the tendency of the modern commentariat to loathe Trump and the Republicans so much that bumper-sticker slogans substitute for truth and moral catastrophizing reins supreme. Nassim Nicholas Taleb defines the Intellectual Yet Idiot as “the inner circle of no-skin-in-the-game policymaking ‘clerks’ and journalists-insiders, that class of paternalistic semi-intellectual experts with some Ivy league, Oxford-Cambridge, or similar label-driven education who are telling the rest of us 1) what to do, 2) what to eat, 3) how to speak, 4) how to think and 5) who to vote for.” Sounds a lot like the press corps, from top to bottom, and their fellow travelers in Twitter’s Blue Check Mark Brigades.
I think there’s a lot of truth to Taleb’s framework. And—forget the coronavirus a moment—the prevalence of the IYI crowd in the media and in the commanding heights of academic administration and cultural institutions hints at the weakness of the elite worldview that’s part of the current repatrimonalization of Western institutions. Individual people cannot make prudent decisions about life-or-death choices, let alone inform their economic and political beliefs, when the primary gatekeeper of information is across-the-board corrupt. How much of the populist resurgence roots in some way to a reaction against IYI narratives?
Yet that’s where we’re at. I’ve dreaded this conclusion for a while now, but the systemic failure of the press seems inescapable.
Preparing for Tomorrow
Pundits churn out prediction stories like the genre’s en fuego. Every single one of these predictions is utter horseshit. No one knows what lies ahead. No one knows how long it’ll take to get Wuhan Coronavirus under control; no one knows the final death toll; no one knows the secondary toll taken from loss of livelihood in the shutdown; no one knows how long the economy will take to return to pre-crisis levels; no one even knows if the economy will ever fully recover given the presently unquantifiable risk of radical social disruption that renders the Washington Consensus moot.
So I’m not going to offer predictions.
Instead, I do two things:
- Hope for the future. Humans tend to rally in the face of adversity. I’m generally bullish on the short-term prospects. I wouldn’t be surprised to see a bit of a renaissance in organized religion and in the strengthening of the “little platoons” in hyperlocal contexts. I believe we’ve got it in us to come out ahead. I remain hopeful that human ingenuity will find a way to defeat this virus and that by mid-summer or autumn, we’ll have something like a solution that allows for a significant degree of a return to normalcy. I’m betting that by Thanksgiving, we’ll be giving thanks for the CoronaCrisis receding in the rear-view mirror.
- Plan for the apocalypse. I also remain aware that things can always get worse. How much worse? No one knows. But just as the best-case scenario isn’t likely to materialize, neither is the worst-case scenario. That said, if you plan for the worst-case scenario, you’re prepared for everything. So I’ve been slowly working on stocking some non-perishable food items and jugs of water. I’ve made sure all my first-aid kits have been re-stocked and that stuff that’s expired got rotated out. I’ve added recurring tasks to my to-do list to swap and recharge the batteries in my radio and flashlights. I’ve re-inventoried my hiking-and-camping gear. I’ve been making checklists in case I need to get out of Grand Rapids in a hurry—Where will I go? What will I bring? How shall I provision for, and transport, the cats? If I’m traveling by car, what else might I toss in my bags if I’m not sure how long, or ever, it might be before I return home?
Think about these things. Being prepared for the worst while hoping for the best means that you’ll take whatever happens in stride.
All that said: Stay safe and healthy.