I generally try to stay away from anything political in this blog, particularly if it involves partisan politics. I am a definite non-subscriber to the notion that everything is political. I don’t pretend that I don’t have a worldview or even that I don’t have some strong political policy preferences, and those no doubt come through now and then. It would be unnatural for them not to. But you are not going to get any party or candidate endorsements on this blog, nor any posts specifically about political policy preferences, unless they are very narrowly relevant to science. (And probably not even then.)
If it helps any, I am currently registered as an independent voter in the state of New Mexico, meaning that I am not affiliated with any political party but still conscientiously vote in general elections. Sometimes this means turning in a ballot with some choices left blank, because I don’t believe in voting for the lesser evil. It’s still voting for evil.
However, it’s impossible to say anything meaningful about the coronavirus pandemic and our societal response to it that does not have political overtones. This is not because public health is inherently political; it is because so many folks have insisted on politicizing it. I am going to be scrupulously nonpartisan in what I say here, but if you are the kind of person who stops reading an author or listening to a singer or watching an actor because you discover they have political views, and those views are different from your own, I urge you to skip this post. I like having readers and I don’t aim to drive them away.
Along with my writings on geology and other topics redolent of geeky goodness, I occasionally say a little about myself. This is in part because my readers include friends and family who naturally have an interest in how I am doing. I got a little more personal back when I broke my ankle looking for orbicular granite. I’ve gotten a bit more personal recently because I apparently tore a meninge that needs repairing to keep my cerebrospinal fluid pressure up.
My condition is, thankfully, not immediately life-threatening nor presently very disabling. The chief symptoms are headaches, which remain quite mild if I am careful to drink lots of fluids; a very slight tendency to lightheadedness; and some slight vision difficulties. I can live with these indefinitely if necessary.
Which is presently necessary. All nonessential surgery is on hold in New Mexico for the next three months. All healthcare that is not directly relevant to coronavirus is curtailed. When I saw the neurosurgeon a week ago, he gave me an order for further imaging and told me to come back in late April for a consultation to plan from there. Most likely I need to be hospitalized for a final round of imaging to pinpoint the leak, which will then be repaired, hopefully by a not very invasive form of surgery with a high success record. But when I called to schedule the preliminary imaging, which does not require hospitalization, I was bluntly told that the order had been put on “health review.” My translation: I won’t get it until after the pandemic is controlled, because all health services are now on emergency standby for a possible flood of deathly ill coronavirus patients. I expect to have to call and reschedule the consult indefinitely. I’m actually okay with that; more in a moment.
It would be wrong to say that no one saw this coming. The intelligence community has been publicly worried about the possibility of pandemics for years. And, of course, it’s been just over a century from the 1918 Spanish influenza pandemic, which is estimated to have killed somewhere between 17 million and 100 million people worldwide. Public health experts have always assumed that another pandemic is possible. Sure, medicine has improved tremendously in the last century. So have global communications, which help spread viruses faster. Faster communications are a huge blessing to humanity, but one must remember that every silver lining has a dark cloud.
However, individual epidemics do tend to come out of nowhere. They start with one or two cases whose origins can rarely be identified. We have good reason to think this epidemic began with a single case from a wet market in Wuhan, China, in late December, but how it got there remains unclear. In their early stages, epidemics show exponential growth, in which the numbers double every few days. In casual language, this means the numbers skyrocket once the epidemic gets going.
You can’t be in a constant state of high alert for a pandemic. Resources kept on standby in case of emergency are resources not available for current needs, including needs that can extend life expectancy and quality of life. It is well established that poverty kills, and resources left idle are impoverishing.
We often find that our bright ideas were previously already thought up by Nature. Consider the human immune system. We have something on the order of 10 billion B cells in our bodies, each attuned to a different potential antigen — a protein or other large molecule marker that identifies something as foreign to the body. Only a few of those cells are sensitive to any particular antigen. When a B cell detects the antigen it is “keyed” to, it becomes activated, with the help of a T cell, and begins proliferating into a large number of plasma cells. Some of these plasma cells immediately begin producing fairly weak, nonspecific antibodies to produce some immediate resistance to the infection. Others move into a lymph node, and there they undergo somatic hypermutation, in which they experience a kind of rapid selective evolution to become very sharply attuned to the particular antigen they have detected. The resulting plasma cells produce much more specific and effective antibodies in vast quantities, which eradicate the infection. After the infection is eradicated, most of the plasma cells expire. A few become memory B cells, which go quietly back into circulation. Should the same invader come along, these can skip the intermediate steps and go straight to proliferating and cranking out highly specific and effective antibodies, stopping the reinfection in its tracks.
Now consider our societal response to a novel pathogen. We have public health organizations like the CDC and local health officials, who are something like B cells. Just as the human body maintains only a limited number of B cells (10 billion is not that many, out of a human body containing something like 37 trillion cells) because its resources are usually needed elsewhere, our public health organizations are relatively lightly manned between emergencies. The idea is that the standing organizations are supposed to detect a novel pathogen early, giving us enough time to rapidly ramp up our response (analogous to plasma cell proliferation) and tune it to the specifics of the threat (analogous to somatic hypermutation) and, when the pandemic is under control, develop permanent immunity in the uninfected population through vaccination (analogous to memory B cells, which vaccination literally gives us.) Vaccines take a long time to develop, just as it takes time for memory B cells to develop, but they are the long-term protection against a repeat of the pandemic.
When we catch a virus, we experience what is called the prodrome. This is the stage where you start feeling sick but do not yet have very specific symptoms. Eventually you have a high fever, because this hinders the multiplication of many viruses and ramps up your own immune response. Your muscles ache because your immune system is churning out cytokines, signalling molecules that basically put everything on high alert and shut down nonessential functions. In this coronavirus epidemic, we’re taking a huge social and economic hit from quarantine and stay at home orders. These are really painful. I do not think any reasonable person wants these to last longer than necessary, but they are necessary now.
How well has our response gone? Early indications are that it was sluggish and this has hurt us. I see two components so far to this failure.
The first was the mendacity of the Chinese government. Look, there’s no gentler way to put it. The Chinese leaders lied to the world from the start, and they are still lying to us now. The one nation whose leaders have come out of this looking pretty good, South Korea, is a nation that reflexively distrusts the Chinese, had previous experience with the SARS epidemic a while back, and assumed the worst immediately. My own past policy preferences have been towards constructive engagement with the Chinese, mostly in the area of trade, which requires a certain measure of good faith. That failed here.
The second was the very slow start to testing for coronavirus in the United States. A full postmortem on this will be written someday, but the early signs are that this was a consequence of bureaucratic and regulatory inertia. The politicians are not primarily to blame, except in the sense that it was politicians who erected our current federal bureaucratic structure to begin with. It’s not the job of Donald Trump or Nancy Pelosi to make sure test kits work properly, and neither can fairly be blamed for the bureaucracy put in place by their political forebears. That’s a hazard of politics: An incompetent can run for office, manage to be elected, make rotten policy choices, and retire comfortably long before the chickens come home to roost.
Two things make this virus particularly dangerous: It has a high transmissibility, and it has a high mortality rate. Both are hard to precisely quantify, but it is clear that this virus lies somewhere between ordinary seasonal flu and the 1918 Spanish flu. The mortality and transmissibility rates are much higher than seasonal flu. However, coronavirus seems to be significantly less deadly than the Spanish flu. The Spanish flu had high mortality among healthy young adults, and an overall mortality somewhere around 5%, whereas mortality is low for such individuals with coronavirus (though still a frightening 2% overall), as is also true for seasonal flu. Nevertheless, my admittedly non-expert impression is that this is closer to the Spanish flu than an ordinary seasonal flu. For one thing, the folks dying from coronavirus have generally had access to much better medical care than folks in 1918, but have died anyway.
One very depressing thing about this is the amount of stupid the epidemic has brought out.
Politicians gotta grandstand. It doesn’t terribly surprise me how Trump or Pelolsi have behaved, because that’s always how they’ve behaved. Trying to play the god-king who can heal with a touch is repugnant but not unexpected. Trying to sneak your favorite pet provisions into the relief bill, which would never pass in normal times but no one will dare vote against in this emergency, is repugnant but not unexpected.
I’m more disappointed by some of the reactions among the punditry. At one extreme of stupid, there are two political sites I’ve read pretty regularly that I probably won’t be visiting any more, because the discussion has devolved into conspiracy theories that this epidemic is all a hoax or that the government is deliberately overreacting to it to further its power. Look, there’s no question politicians love to use a crisis to increase their power. It doesn’t change the fact that there really is a crisis this time. Particularly galling are snarks about how so-and-so visited a hospital and saw all kinds of empty beds. Well, yeah. I’m one of the patients that should be occupying one of those empty beds about now. But I’m not the kind of boob who takes this personally. Those empty beds are a good thing at the moment.
As I said earlier, pandemics are exponential in their early phases. If your response is adequate, you will have lots of empty beds, until you don’t. If your response is really adequate, it will look a lot like an overreaction. This is going to be a big issue in the postmortem, because of course overreactions are possible. The problem is that a highly successful justified response looks a lot like an overreaction. The scientific postmortem will not be primarily about blame; it will be about how to fine-tune future responses based on what we did not know this time, but learned from this experience. Blame is meaningful only in the context of what we knew at the time, and if there is any blame on this one, based on what we know now, it is in not reacting forcefully enough. But, of course, blame will be the focus of the political postmortem, and I have no confidence whatsoever it will be assigned correctly.
At the other extreme of stupid are politicians who obviously relish exercising emergency power, and their acolytes, who want this kind of thing to become normal. These are folks who want the fever and muscle aches and coughing and puking to go on, because they were so successful in dealing with a dangerous virus that they must be inherently good things. If your politician is talking about how this emergency is a great opportunity to transform our government, then I beg you, in the name of all that is good and holy, to vote for someone else this fall. Or no one at all.
Then there is individual stupidity. I can kind of understand folks panic-buying toilet paper. There really isn’t a shortage, until there is. But it’s a gross overreaction, particularly since one can find alternatives.
My local grocery has also had shortages of cleaning and sanitizing supplies, which is kind of understandable. There’s genuine increase in demand there. But milk? Sugar? Meat? Bread?
The mass purchases of bottled water make no sense to me. Water utilities are about the last thing that will go out of business.
Meanwhile, I am working at home. (No, really; I have some benchmark problems running even as I type here.) Work is hindered by a slow Internet connection that I have to share with four other adults in the household, two of whom are also trying to do their jobs at home. But I realize full well I’m lucky to still be in a job. If you are still able to work, I hope you will consider donating your relief money to your favorite charity.
Thanks for a well-reasoned, thoughtful view on the worst thing that’s ever happened in our lifetimes. 150,000 dead and counting.