“It’s remarkable that bad things don’t happen more often. According to one estimate reported by Ed Yong in the Atlantic, the number of viruses in birds and mammals that have the potential to leap the species barrier and infect us may be as high as 800,000. That is a lot of potential danger.”
—Bill Bryson
This past Christmas, my mother gave me Bill Bryson’s new book on the human body as a present. It was an excellent gift: I spent half my Christmas break totally absorbed in it. The book is fascinating for several reasons. For one, there is an awful lot that most of us do not know about our own bodies—which itself is funny to think about. But perhaps we are better off not knowing, since the book also highlights how many things could potentially go wrong in the intricate functioning of our mortal frames. The existence of life is a miracle in its own right; and the existence of highly complex life—such as us (or so we like to flatter ourselves)—is a miracle of exponential proportions. So many things have to go right in order for you and me to be here.
That means it is easy for things to go wrong. And a viral infection—when malicious genetic code hijacks our cells—is one way that this marvelous process can get disrupted. One of the best chapters in Bryson’s book is on diseases. When I read the chapter, not too long ago, it seemed to be mainly about things from the distant past that used to menace our species. Bryson discusses typhoid and typhus, smallpox and ebola, and of course the Spanish flu of 1918. Most of these illnesses strike us nowadays as historical curiosities, rendered obsolete by the invention of vaccines and effective antibiotics. But Bryson sounds a note of warning in the chapter that now seems quite prescient. He quotes Michael Kinch, a specialist on drug discovery of Washington University, as saying:
The fact is, we are really no better prepared for a bad outbreak than we were when Spanish flu killed tens of millions of people a hundred years ago. The reason we haven’t had another experience like that isn’t because we have been especially vigilant. It’s because we have been lucky.
I vividly remember reading that passage, and scoffing. Surely, I thought, we must be far better prepared than they were back in 1918, when medicine and technology were so comparatively primitive. I was wrong. Bryson deserves kudos for his writing, as this current crisis has completely borne out his warnings. We are in far more danger than we like to think, and we are basically not prepared for it.
One rather stunning fact—stunning because we so rarely think of it—is how many people normally die from the seasonal flu. In the United States alone, it is between 30-40,000 per year, and that number gets much bigger during particularly bad years. According to Bryson’s book, in the 2017-18 flu season, upwards of 80,000 people died of the flu. These numbers are stunning, especially considering the massive international response that is already underway to slow the spread of this new coronavirus, which has so far taken far fewer lives. Perhaps we should always be practising social distancing…
The primary issue, at the moment, is essentially this: our society was not built to handle large-scale infectious diseases with fatality rates significantly higher than the seasonal flu. We do not have enough hospital beds, nurses, doctors, respirators, masks, or anything else. Our entire way of life—hanging out in bars, going to concerts, flying from country to country—is premised on being largely free from dangerous infectious diseases. We really did not know how lucky we were. Our situation was highly anomalous in human history, and it will take months before we can return to it.
What is most frustrating, for me, is the degree to which the situation is out of my hands. Everyone craves a sense of control. In a crisis, we want to know what we can do to protect ourselves, or to contribute to a common cause. Right now, these actions are rather humble: wash your hands, stay at home as much as possible, self-isolate if you show symptoms. This is all well and good; but we naturally want to know what is the scale of the danger and how long this immense disruption will last.
At this point, the information available is far from clear. The more articles I read, the more contradictory the information seems. Some are predicting infection rates of up to 80% of the population, while others predict 20%. Some predict that the disease will turn out to be less deadly than it seems, while others are predicting a complete global disruption lasting for months. It also seems unclear (to me, at least) whether children are effective vectors of the virus. Judging from the school closures, many believe yes; but I also have read that there is little available evidence.
Our best tool in fighting pandemics are vaccines. But unfortunately vaccines can take quite a long time to develop. It is not as easy as I (naively) thought. Many trials must be performed to ensure that the vaccine is effective and safe for the general population, and this takes time: months and months. If we cannot immunize ourselves artificially, then, the only possibility is to develop a herd-immunity the hard way: by getting the disease itself. This is a frightening prospect. That route would entail a great deal of suffering and death. But how long can we wait in our homes? In short, I am unclear how we are going to get out of this mess.
Meanwhile, I am fairly stuck in my little apartment in Madrid, one of the new epicenters of the virus. We have only had three days of isolation, and it is not so bad thus far. I began an exercise routine that I can do in my room, and my brother and I have been cooking a lot of hearty meals. But I really cannot see how everyone will be able to keep this up for the long-term, either economically or psychologically. Without extraordinary government measures, I do not think that people could stay in their homes much longer than one month without a great many people facing serious financial strain. Even in the best case scenario, the consequences for the economy seem quite grave. And this is putting aside the social pressure to resume normal life, which will increase from day to day.
At present, I swerve wildly from optimism to pessimism. What I want most of all is a return to normalcy. Never has my old life seemed so desirable! The strangest thing about this crisis is that it went from trivial to serious so quickly. Everyone seems to have been caught unawares. But even Bill Bryson—a popular writer with no specialized training—was able to see potential danger once he looked into the research. If only our experts had been as intelligent and as anxious as he.
Lotz in Translation 
Pandemics are indeed scary. Perhaps the scariest thing about covid is just how bad it isn’t – how much worse, that is, it could be. If this is what happens when we have a pandemic with a mortality rate somewhere between 0.8 and 8%, just image what life would be like with a really serious disease. It helps us understand, perhaps, what life was like in the era of cholera, of smallpox, of the plague.
On the other hand, Bryson is very much overstating his case: we are far better prepared now than we were in 1918. For one thing, the spanish flu didn’t start in 1918, it started at least in 1917, and perhaps as early as 1914 or 1915 – it took yeas for people to notice it, by which time it was too late. In our case, we’ve known about the virus almost since it made the jump, and our decision to accept mass casualties is largely a political choice, rather than something forced on us (China appears to have limited infection to less than 0.1% of its population; South Korea has now likewise crossed the peak, with more recoveries than new infections. The US and UK have preferred to allow virtually the whole population to become infected (and at least tens, probably hundreds of thousands of people to die) because it’s cheaper and more ideologically palatable; the EU is somewhere between these two extremes). Aside from improvements in monitoring, this has also been made possible in Asian countries by greatly more capable state structures than existed a century ago.
Likewise, we have the prospect of a vaccine in, probably, less than two years (I wouldn’t be surprised if it was further shortcutted ahead of the usual timeline – if the tests seem positive, will we really wait to make sure we’re 100% scientifically sure it works before we start vaccinating?). In 1918, a flu vaccine was still almost three decades into the future (we never defeated the spanish flu – it evolved itself out of its pandemic status, opting to spread more widely but with fewer deaths). And similarly, we’re working on multiple different medications to cure the infected – treatments that might take a while to get working, but that didn’t exist at all a century ago.
And the ventillators that we don’t have enough of? They didn’t exist back then, not at least in the same sense. They did have some forms of support for people with pneumonia, but nowhere near the treatment we can provide now. For a start, we can now treat secondary bacterial pneumonia with antibiotics. In 1918, almost everybody who died of “the flu” actually died of a bacterial infection – penicillin wouldn’t be discovered for another decade.
And this is probably reflected in the death rates. Covid today probably kills under 1% of those infected (the much higher figures in Italy, of over 7%, are probably because there have been vast numbers of infected-but-untested cases who may not even have felt ill; South Korea, where the testing is most extensive, has a CFR an order of magnitude lower). Spanish flu killed conservatively 6-8% on average, and possibly up to 20%, of those infected. This difference is probably less a reflection of fundamental differences in the dangerousness of the disease, but rather of our greater preparedness today.
At least, we’d better hope we’re better prepared today. The spanish flu killed around 3% of the entire global population, which today would work out to around 250 million people…
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Hello Wastrel! Nice to hear from you!
Your post is fairly reassuring, and of course you’re right that we are better prepared than they were in 2018. The above quote is surely an overstatement. But I did hope that we were more prepared than we apparently are.
As I’m cooped up here in Madrid things still look quite gloomy. The virus is bad enough, but the economic and political fallout I fear will be horrid. It’s hard for me to see the long-term plausibility of either the US/UK approach or the EU approach. On the one hand, when many thousands of people begin to die, and the hospitals and morgues are overwhelmed, the citizens will demand action. On the other, there’s a limit to the amount of time the government can keep people locked down. My main hope is that the virus is not quite as virulent as many think now. If that’s not the case, then governments will have to weigh suffering serious casualties vs suffering a recession (or a both), and either way I fear the political repercussions. The shockwaves from the 2008 crisis have been bad enough. But maybe the isolation is making me a bit pessimistic.
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The thing about this is that nobody knows what will happen. In some ways, that’s promising.
Total disaster is possible. Not just in that it might kill millions, if not tens of millions of people (I hope it won’t kill hundreds of millions, in the short term), but also that it might well trigger a depression – particularly given that the financial system is probably critically unstable and unsustainable in the best of times (people were worried about a new financial crises even before this started), and given the geopolitical problems (unrelated oil production and Trump-tariff issues have provided a lot of the scale of the recent series of crashes). And this virus situation might well be permanent – there is no vaccine for any other coronavirus disease (MERS, SARS, and several forms of the common cold) despite years of research, and of course (virologically unrelated, but a sobering demonstration of what can happen) there’s still no sure vaccine for HIV. We may simply have to accept that everyone over 65, and everyone with a health condition, is going to die – or else pen them into isolation cells permanently. And if the virus can’t be defeated, it could have – even once the worst is out of the way – a generation-long impact on people’s willingness to go to restaurants, theatres, public transport and so on, which would have a big long term economic effect.
The worst case scenario is really, really bad.
HOWEVER!
It might not be that bad. We might develop a vaccine – with enough funding, we can develop vaccines to almost any viral disease (although some, like the flu, aren’t perfect and constantly need to be updated to match new mutations). There are also several drug trials now that seem to show really promising results (and few side effects). It could well be that in a couple of months, the dangers of the disease will be much less, and patients will recover faster putting less stress on the healthcare system.
Economically, the short term pain to small businesses and workers who can’t work from home (retail, construction, etc) could be huge, but is also something that governments can deal with. The limits on rich governments are largely ideological, not economic. During WWII, the UK and US ran stimulus deficits of up to 20% of GDP every year (compared to current deficits of 1 or 2%) for about 5 years; it had no major consequences other than causing a post-war economic boom. If we can agree to hang together, and effectively treat this period as a holiday from normal economic rules – mortgage and tax holidays, something like basic income, etc, and encouraging employers to move workers to a ‘dormant’ status rather than sacking them immediately – then the economic consequences needn’t be huge, and could even spur a boom when the crisis passes. Particularly because the crisis is forcing governments to reconsider things they should have been doing already (like making sick pay better and easier to get). [the crisis shouldn’t really damage the fundamentals of the economy, provided we can provide sufficient short-term support to prevent bankcruptcies, redundancies, etc – keeping factories and restaurants empty and unstaffed, rather than having them close, and so on]
So although there’s no short-term upside (other than environmental!), the best case scenario long term is actually really bright.
So which will happen? No way to know. My instinct is that if we can deal with the virus medically – an effective if not foolproof treatment drug by autumn, a working vaccine sometime next year – then the economy will have a disastrous year but will actually bounce back really strongly. Otherwise, we could be in trouble.
[the other unknown: the financial sector. Current declines are probably rational given the short-term crisis and long-term uncertainty, and will reverse once things improve. But if these declines trigger a systemic credit crisis like in 2008 or 1929, that’s when we’ll seriously be fucked. Economically speaking, exogenous shocks like war, plague and famine look scary, but the real killer is endogenous structural weakness…]
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