Field Notes from a Pandemic
Page 13
There is thus no such thing as a crisis of this scale for which we were prepared; a crisis is inherently an event for which we were unprepared. If we had been prepared for the pandemic, if we had done everything right and lost no lives, then it would not have been a pandemic but rather a vaguely worrisome little blip that barely registered in our consciousness. Maybe for decades, that was precisely what happened: all the safeguards were in place, and all this time we’ve been constantly saved without knowing it. Politicians would have looked at that costly health spending and said: “What do we need all this for, when there are no pandemics to deal with?” “Why bother with the recommendations from this silly simulation?” “Why buy ventilators?” And proponents might have argued, “There are no pandemics precisely because it’s been working!” — maybe and probably true, but mostly, if not completely, unprovable. Many experts may have foreseen a looming pandemic, but who could have known it would be this specific bat-borne bane from Wuhan in December 2019? Even they, the people sounding the drums back then, could not have beaten their booms with the same gusto as they did after the fact. When the experts made their case against cutting funding, even they would have understood at least a small part of what the politicians heard — the elephant joke. Maybe the fact that we had been prepared for years is precisely the reason we are unprepared now, a cycle doomed to repeat.
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In the animated television comedy Family Guy, when staring down the barrel of a gun, Mayor Adam West says, “I have a tiny bulletproof shield the exact size of a bullet somewhere on my body.” If West were to be hit in that spot, he says, he would be unharmed: “You’ll be the laughingstock of me.” The physics, of course, doesn’t make sense. The entire point of a Kevlar vest is that it spreads the projectile’s impact over a wide area so it does not penetrate the skin. A shield the size of a bullet simply does not work. But let’s assume it does. The other, more obvious problem still remains: West does not and cannot know where the shooter’s bullet will strike. No matter how hard we try, how masterfully we attempt to plot the path of disaster, predicting for just a single circumstance is impossible. In the Second World War, the British expected a naval assault on Singapore and armed the south with canons pointed to the sea. The Japanese came from the other side, through the Malaysian jungles, on bicycles. If only those big British guns were in the north. In the wake of the North Sea flood of 1953, the Dutch built the mightiest dyke system ever, only for the next destructive, overwhelming tide to come from the inland waterways. If only they had built the dam around the rivers, then all that death and destruction could have been avoided. If only we had just stocked up on the ventilators and test kits the pandemic world so desperately needs, then far fewer people might have died. But it doesn’t work that way.
Experts aside, many critics came to realize the importance of ventilators precisely because so many died. Then they may say we need to make note of what was not done this time and start doing it. But consider what would happen if the next crisis is just slightly different in where it begins or how it afflicts people or spreads. In a way, that is precisely what happened with COVID-19. Everything else aside, one reason U.S. health authorities did not have enough test kits was because they had reportedly been anticipating a different type of pandemic — not coronavirus, but influenza, like the 2009 swine flu, which required completely different test kits. Those were the very experts sounding the drums, and to be fair to them, an influenza pandemic could just as easily have been the case.
It is perhaps impossible to predict the specific pathway of the next big threat — or even to pin down its broad nature, as argued by the former U.S. general Stanley McChrystal in his book on interconnectedness and complexity, Team of Teams. Imagine coloured billiard balls, arranged in a triangle, being struck by the white cue ball. The onward motion of the coloured spheres is based on how they are hit, but they also hit each other and bounce on the edges of the table. Then maybe they bounce against each other again. In that system, any small deviation in any component — the motion of the white ball, the flatness of the table, the smoothness of the felt — ripples massively and unpredictably. The term “butterfly effect” comes from the academic paper, “Does the Flap of a Butterfly’s Wings in Brazil Set Off a Tornado in Texas?” in which a researcher recounts how a rounding error caused a massive divergence of data in his complex weather-forecasting model. Our densely integrated world has become like that weather model — or those tightly packed billiard balls. This is a world in which events that may previously have been isolated now ripple farther and wider — and in ways we do not expect and can hardly foresee.
We cannot be prepared for every eventuality, and it is the ones for which we are unprepared that will devastate. Every property of COVID-19 hits at our raw, exposed nerves. It spreads through the air, and we have a complex web of international travel. It is mild enough to be passed by unsuspecting carriers, and we live in densely packed cities. It causes breathing difficulties, and we lack ventilators. But there was no brilliant mind that tailored this plague just for us. Nature is just a cesspool of disease, constantly flinging a wide assortment of filth. Humanity has been a successful animal and has no doubt fought off countless extinction-level threats, some without us even knowing it, as the lesser viruses that failed to target our weaknesses died in oblivion. We see only the few plagues that snaked past our armour and pierced our softest spot beneath. Thus the path of the pestilence is a bit like how lighting arches across the sky. Even with the massive electrical resistance of the air, the bolt finds a way. And its specific path — narrow, winding, and unpredictable — is paved precisely because of that resistance and not in spite of it.
There is a lesson to be learned from the pandemic, but that lesson is not, as the saying goes, to emulate the generals who are always fighting the last war. The lesson is that the threat we do not see will have the most impact, and that we do not know what we cannot know. In The Black Swan, Nassim Nicholas Taleb writes: “Consider a turkey that is fed every day. Every single feeding will firm up the bird’s belief that it’s the general rule of life to be fed every day by a friendly member of the human race.” Then, just before Thanksgiving, the same hand that feeds the turkey brings a blade to its neck. Nothing a turkey does in its life, nothing it ever learns, and no amount of cunning or diligence on the part of the bird can ever prepare it for its day of slaughter. To be truly ready for the next crisis, we have to accept the humbleness of the human set against the ceaseless cruelty of the cosmos, that there will always be a calamity for which we are ill-prepared.
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A possible ancestor of mine is the Chinese emperor Yu the Great, from the third millennium B.C.E. The keyword, however, is “possible.” My father told me about this potential connection after some Internet research, and years later, he would in fact deny ever saying it at all. I’d always found the link dubious anyway, like how Egyptian Ptolemaic kings claimed descent from gods and legend. The other possibility, my father said in the conversation he does not remember, was that we descended from nameless nomadic Mongols, which is far more believable. Yu, after all, came from an era in Chinese history during which records weren’t well kept, so history is often mixed in myth. But veracity aside, Yu’s story is relevant, emerging out of an era of havoc wreaked on China by great floods, only ended, finally, by Yu himself. For while others had attempted and failed to tame the tides by setting up barriers to block the flow of the water, Yu succeeded by drawing irrigation canals, diverting and splitting the waterways.
Nearly four thousand years later, Dutch engineers would have the same idea. It came to them fresh after terrible floods in the 1990s, when the Meuse, Rhine, and Waal rivers swelled with mountain meltwater and flooded in a way their earlier billion-dollar wall-against-the-sea could never have prevented. So, the Netherlands government tried something new, as Stanley McChrystal notes in Team of Teams. It had to fortify the rivers, and to do so, it started carving
out new waterways. In some places, instead of building higher dykes to guard against rising water, engineers lowered them, so that farmland around could serve as floodplains. The people already living there were relocated. The plan was called “Room for the River.” The Dutch and Yu had accepted a fundamental rethinking in how to tackle the tides: that the reality of floods is inevitable. They did not focus on trying to control the course of the current. They sought instead the ability to deal with it. The essence of this idea is encapsulated in a quote often attributed to Greek mythology, when Atlas, forced by Zeus to hold up the world, pleads not for the erasure of the punishment but for the ability to take on the task: “I do not pray for a lighter load, but for a stronger back.”
There will be another pandemic, a catastrophic natural disaster, a major war, a great recession, a tumultuous upheaval, or an unprecedentedly new crisis that will catch the world off-guard, like the turkey and the blade to its neck. If we cannot prevent the universe from crashing upon us when least expected, bearing down with all the weight of the epochs, and if we cannot predict the specific nature of the threat, then we can hope only for resiliency in the face of that. We, similarly, need to strengthen our backs.
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While nobody was truly ready for the pandemic, some countries acted fast and decisively, and that saved lives, one study showed: At its peak, South Korea had 0.1 deaths per million residents per day, while the figures for Germany and Denmark were about the same at 2.8 deaths. It’s a big range, but despite that, those figures are all considered to be on the low end of the spectrum. Sweden, which believed in a different method and did not enforce lockdowns for its citizens, and Italy, which acted late, had more than 10 deaths per million people per day. Spain had nearly 20 per million. Research suggests that if the United States had locked down just one week earlier, it could have avoided more than 35,000 deaths. If it were two weeks, 50,000 deaths. The top qualities we need in the face of any crisis are nimbleness and resiliency. The greatest failure of many countries against the pandemic wasn’t the failure to predict and prepare, it was the failure to react. Leery of stepping on individual liberties, much of the West had suffered from that. However suddenly the lockdowns came later, they were all too late. The world needs to do better.
Such a conversation, of course, cannot be had without the prime yet complicated example of China, where the virus originated but where the government response was quick and decisive, not to mention effective, at least in the short term. Already known for keeping close tabs on its citizenry, the Chinese government went into hyperdrive during the worst days of the pandemic, tracking mobile phones through ubiquitous apps and compliant telco companies and unprecedentedly locking down entire cities and even regions of the country. The Communist Party’s more than 90 million members became lockdown enforcers. There were stories of violators being tied to poles or otherwise humiliated publicly and coercively quarantined. Two medical facilities, 2,600 beds in total, were built in ten days. Then, as the Western world reeled, Chinese hospitals that were once overwhelmed had unoccupied beds. Drug trials had difficulty enrolling volunteers as new infections dropped. That bliss was disturbed just two months later when a relaxation of lockdown rules brought a new wave of infection, which just goes to show how effective everything had all been. The Chinese authoritarianism at the heart of the response was cited as a shining example of how to handle the outbreak. A Bloomberg headline about the initial draconian lockdown on Hubei read, “China Sacrifices a Province to Save the World from Coronavirus.” China’s “bold approach” was “ambitious, agile, and aggressive,” and it had worked, read a World Health Organization report. That’s one way to look at it, but China being China, things are never one dimensional — its reaction to the virus is hardly one to emulate — quite the opposite given other, darker, aspects of its approach.
The central government certainly reacted quickly to the outbreak, but between the first reported cases and the January 23 lockdown, the virus had stirred in Wuhan for nearly a month. The first reactions of local officials to the virus had been to cover it up. Heads roll easily in China — literally. From Chongqing to Hangzhou and Suzhou, from judicial chiefs to vice mayors, many have faced the death penalty for a plethora of crimes. In the aftermath of crises, such as the SARS epidemic, floods, and earthquakes, local officials are routinely suspended, dismissed, demoted, or blacklisted. Perhaps Western leaders can learn a lesson in accountability from China’s post-crises retributions, although when you’re dealing with a country where rule of law is questionable, where those purged can rarely dream of a fair and open trial, it is not surprising local officials responded to the pandemic by hauling to the interrogation room the whistleblower, Dr. Li Wenliang, who later died of the virus. Local bureaucrats valued their image and their careers more than containment and feared the wrath of their bosses more than the devastation of the plague, and that cost the world dearly.
However much China’s subsequent swift clampdown stunted the spread of the virus, that same effort spent earlier would have had a drastically bigger impact. With one carrier transmitting to several others, infections grow exponentially, meaning the virus spreads more quickly the longer it gets to spread. If it’s not stifled in the seed, it takes vastly more effort to try to contain it later on. According to research from the University of Southampton in the United Kingdom, China could have prevented 95 per cent of infections if it had acted quickly from the first hint of trouble. That delay may have been fuelled by different factors than the slow reactions of Italy, Spain, or the United States, but its impact was the same. Nimbleness, or the lack of it, has less to do with forms of government that it may appear.
Indeed, the countries that have been able to get by, with relatively low infection or death rates, are varied and, in some ways, fundamentally different from each other. There are those like South Korea and Singapore, which did move with more authority than others, with aggressive testing and contact-tracing that invited privacy concerns. Singapore did end up with a second wave of infections from its sometimes-overlooked migrant-worker population, and each successful country has its own faults. But for the most part, they showed a certain level of success, and they all shared something. They were able to move quickly because, on the whole, their people voluntarily accepted the trade-off of certain liberties in exchange for the common good.
A good case study is New Zealand’s response, widely cited by experts as successful, and with a noted absence of criticism from human rights groups. The country restricted travel early, prior even to any known cases, and started widely testing and contact-tracing. Eventually, there was an initial spike of cases in the country, like everywhere, but in the phrasing of the health-policy mantra going around at the time, that curve was quickly flattened. In April of 2020, New Zealand’s cases stabilized in the 1,100-range, with under ten new instances of infection per day. By May, only twenty were dead, and soon after, the authorities there started reporting zero new cases. New Zealand definitely has natural advantages, being a sparsely populated collection of islands with only five million people. But the success of the country’s pandemic response, the reason it had been able to act so quickly, draws from a deeper reserve. Mid-pandemic, a poll showed nearly nine in ten New Zealanders trusted their government to make the right decisions about COVID-19, compared to the average of six in ten in G7 countries. New Zealand’s numbers were not just the result of people’s gravitation toward bigger government amid crisis. The country has always had high levels of public trust, which had been rising over the years. In 2018, when citizens were asked whether they trusted the State to do what is right, 65 per cent said yes, compared with 48 per cent in 2016. So, in 2019, when a mass shooter killed fifty people, Prime Minister Jacinda Ardern was able to announce an assault-rifle ban within a week, which became law within a month. Regardless of whether that ban was warranted, it demonstrated an ability to act quickly and with the backing of public trust. What made Ne
w Zealanders comply with the government’s orders to stay home wasn’t the heavy enforcement of China, but the same belief held by the Germans, the South Koreans, and all the other countries that were able to respond relatively quickly, that the government was doing or, at least, trying to do the right thing. Therein lies the key to nimbleness — a wellspring of public faith, usually built up over years. As obvious as it is when it’s there, it’s glaring when it’s not.
Enter the United States, where confidence in public institutions isn’t even held by its current president, who makes a habit of raging about the supposed entrenched, unelected “Deep State” that is constantly out to get him. In 2019, the U.S. citizenry’s trust in the government was a pitiful 17 per cent, so it wasn’t exactly a surprise that protests broke out against the lockdowns and restrictions. In a country long steeped in its constitution’s protection of individual freedoms, a belief often taken to the extreme, the demonstrations ranged from a few hundred protestors to several thousands and slammed the financial and social impacts of the containment measures, demanding they be reversed. In the state of Michigan, protestors — armed with both guns and the Second Amendment that protected their right to do so — stormed the state legislature building. Lawmakers wore bullet-proof vests. Then they cancelled a scheduled session to avoid armed confrontation. And in the state of New Hampshire, whose motto emphasizes liberty above all, similar protests occurred in front of the legislature, prompting Canada’s the Beaverton humour website to write this headline: “Protestor holding up ‘Live Free or Die’ sign excited to do both.”