by Sanjay Gupta
According to Christakis, gaining perspective can be more easily achieved by thinking about the impact of COVID as three distinct phases: the immediate period, the intermediate period, and the postpandemic period that he believes will realistically begin in 2024. We were still in the immediate period when we spoke, with constant mask wearing, physical distancing, and periodic business and school closures to slow the spread of the virus. Vaccines had begun to roll out, but community immunity was not expected to be reached until likely the end of 2021 or the beginning of 2022. Some of that community immunity, which marks the intermediate period of the pandemic, would also come from natural infection.
It is during the intermediate period, he told me, that we must recover not just from the biological or epidemiological impact of the virus but also from the psychological, social, and economic impact of the virus. If you look at the history of serious epidemics going back thousands of years, it takes a couple of years for a population to recover from the immediate shock of it. Millions of businesses have closed permanently. Millions of schoolchildren have missed school. Millions of people lost loved ones and were grieving. Christakis estimates that for every person who dies of the pandemic, perhaps five more who survive the infection will be seriously disabled and suffer long-term health risks, so we also need to recover from the clinical shock of the disease. Millions of people will need ongoing medical care even when the immediate mortality impact of the pandemic is behind us. So if you put all of this together, we get to the end of 2023 and the beginning of 2024 before we finally put the clinical, psychological, social, and economic impact of the virus behind us.
And then we will enter the postpandemic period. Christakis thinks that period might be similar to the roaring twenties of the twentieth century, after the 1918 influenza pandemic. Christakis tells me:
During times of plague for thousands of years, it’s very typical that people become more religious when they’re afraid and when there is a serious threat afoot. People also tend to avoid social contact. People stay at home. Social interaction ceases when there’s a deadly germ afoot. People become more abstemious—more risk averse. They stop spending their money. All of these changes are very typical changes that are forced upon us by the spread of a deadly pathogen. But when the epidemic is finally over, all of those changes reverse. People are no longer as religious. People relentlessly seek out social opportunities in nightclubs and bars and restaurants and sporting events and political rallies and musical performances and so on.… People have been cooped up for a long time. People start spending their money. They become more risk tolerant. They engage in entrepreneurial activities. They’ve escaped death. And so they see a bigger role [for] meaning in their lives.
That’s some of the good news about postpandemic life. The other good news is that Christakis doesn’t think there’s going to be a fundamental long-term change in the nature of human interaction. For thousands of years, people have fled cities for rural areas during times of plague. In 2020, as the pandemic began to spread around the world, we saw this ancient pattern repeat itself. People fled cities for suburban and rural areas; some chose entirely different states. But Christakis thinks the appeal of cities, with their job opportunities, access to activities, and diversity, remains so powerful that when the plague is finally behind us in a couple of years, people will return.
Some things, however, may never fully revert, like handshaking, superfluous business travel, and going to work or school with a bad cold or flu. I will probably always have a mask handy whenever I go into a crowded situation during flu season; it’s amazing to me how often we’ve been surrounded by people in the past who are obviously ill—sneezing, coughing—and we have just accepted it. Given the concerns about asymptomatic spread, I will be more mindful of crowd density overall. And I will opt for touchless systems and technology when interacting with communal surfaces, as well as work from home more often.
“The bleeding stops eventually” is a common phrase doctors use and one that Christakis found fitting for viewing the pandemic. COVID may have felt persistent and stubborn beyond measure, but plagues always end. I’m optimistic too that we’ll see a wellspring of support for science and medicine given the impact that vaccines have made so far and the way they will continue to revolutionize our world and its overall health. I think it’s possible that having seen the importance of science in confronting this worldwide threat, we may see the importance of science in other areas, such as in confronting climate change and environmental conservation. Pandemics present problems, but they can also give birth to new mind-sets and new solutions.
Full perspective during this pandemic also means fully understanding the codependency between public and economic health. The countries that had the least disruption to their economies were the ones that were able to bend the curve the quickest, even if they took more stringent measures. That has been the case in parts of Europe and Asia. I think of the body as a metaphor for the country. In the early stages of a disease (an infection in the country), the treatment may be less aggressive and of shorter duration compared to treatment at a later stage, but it has to be thorough and consistent. You probably know not to stop antibiotics or chemotherapy early because the disease won’t be fully treated and the resistant cells will be left behind to repopulate. That makes it harder to treat the next time. That is what happened in the United States; we used a half measure and were surprised when the disease roared back for several more waves. We need to remember that recovery doesn’t happen with a single stroke, especially in a country as diverse and heterogeneous as ours.
Although we’ve learned how to slow the spread through basic public health actions like mask wearing and social distancing, we have to prepare for and accept the fact that there is no switch to turn off the contagion’s spread. Perspective means learning to act in the face of uncertainty, even if the threat seems far away. The key will be staying abreast of news, digesting data correctly, and making good decisions for the health and safety of our families. And all of that is dependent on how you acquire new knowledge on which to base your important decisions.
Seek Sound Science and Advice
Peter Hotez, a vaccinologist and dean of the National School of Tropical Medicine at Baylor in Houston, Texas, has spent his career trying to end disease and poor health throughout the world, often training his efforts on poverty-related neglected diseases we don’t think about in America such as leishmaniasis, Chagas, and schistosomiasis—illnesses endemic to other parts of the world. He is one of the most accomplished academicians in infectious diseases and tropical medicine of our generation. And in many ways, he’s been preparing for this pandemic for four decades. His background includes a BA from Yale, PhD from Rockefeller University, and MD from Cornell. He’s fondly been called the “pan man” throughout the pandemic for his panoramic view of not only the biology and science of it all but also the political framework in which we’ve experienced this event. His team started studying coronaviruses a decade ago when most people hadn’t even heard of them. He manufactured a SARS-1 vaccine and came close to a MERS vaccine, two feats that gave him a head start for developing a vaccine for COVID when its sequence came along.
Like me, he has witnessed firsthand the devastating effects that certain diseases can have on peoples and nations. There is no question that pandemic-level ailments are “the most destabilizing force” on the planet, he says. He urges us to stop thinking of disease, COVID included, as only a health issue. For him, it’s also a root cause of global poverty and insecurities of all other kinds—from food to financial—that ultimately affect individuals no matter where they live. From his perspective, what caused the failures in America’s COVID response were things that scientists aren’t typically taught to think about during our training: war, political collapse, urbanization, climate change, and, of course, an aggressive antiscience movement. “It’s a wake-up call about how we need to re-envision medical education to train physicians to think more broadly than we
do now,” Hotez told me.
Medical education has to include education about how people will react and behave when under siege from a disease because that is ultimately a big part of ending it. And, as it turns out, that behavior is fairly predictable. A skim of Nobel Prize–winning author Albert Camus’s existential classic The Plague from 1947 tells of a fictional outbreak of bubonic plague in the French Algerian city of Oran shortly after World War II.5 It tells the story of a pestilence in a more modern setting with postwar technologies like telephones and cars, and its details are stunningly prescient: contagion, denialism, quarantine, untreatable illness, more denialism, a cratering economy, citizens cowering in their homes, and “frontline workers” willing to sacrifice themselves for their neighbors. “Mothers and children, wives, husbands and lovers, who had imagined a few days earlier that they were embarking on a temporary separation… found themselves abruptly and irremediably divided,” he writes. He also states what we’ve all come to learn: “Everybody knows that pestilences have a way of recurring in the world, yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise.” Nostalgia becomes a dominant emotion. We long for living in any time but the present: “The feeling of exile—that sensation of a void within which never left us, that irrational longing to hark back to the past or else to speed up the march of time… those keen shafts of memory that stung like fire.”
Dr. Hotez took a beating at the height of the pandemic for speaking candidly about the unfolding crisis while promoting public health measures and defending vaccines. He has been an enemy of the anti-vaccine lobby ever since he wrote a book a few years ago about his daughter with autism titled, pointedly, Vaccines Did Not Cause Rachel’s Autism. At one point during 2020, a legislator in the Texan government called his scientific work in developing vaccines a self-serving “sorcery,” accusing him of being in the drug industry’s pocket. That did not deter him from making many public appearances in all forms of media to push back against the misinformation campaigns about the power and safety of vaccines and to promote data-driven science because he knew what was at stake. “The vaccine ecosystem is very fragile,” Hotez says. “It doesn’t take much for even a good vaccine to be voted off the island if the public perception is against it.” Hotez believes that antiscience is one of the biggest threats to humanity, on par with a nuclear weapon: “Antiscience is right up there with things that we build a lot of infrastructure to wall off, like nuclear proliferation, global terrorism, and cyberattacks. We need to do the same with antiscience. We have to treat it just as seriously, and do something about the anti-vaccine groups beyond just amplifying the (science-based) message.”
For a long time, Hotez and others believed that responding to the anti-vaccine movement would only fuel it. Over the past decade, his attitude has changed. Anti-vaccine rhetoric is a threat to public health that demands very focused attention and an aggressive response, he told me. This entails robust pro-vaccine education in schools, through mass media, and public service campaigns. As things stand, pro-vaccine knowledge is often buried on government websites. Hotez argues there should be increased funding for health departments to combat rampant misinformation and legislation to make it harder for people to skip crucial shots and harder still for social media platforms to promote anti-vaxx messaging.
Over the past decade, we have learned that the best weapon against vaccine hesitancy is not advertising from politicians, celebrities, public health doctors, our favorite news media outlets, or even athletes. The most powerful couriers to promote vaccines are the very people in our own social circles who get vaccinated and share their positive experience. If that sounds familiar, it’s because it reflects a common mantra: share; don’t shame. The more people we have vaccinated, the more normal vaccination becomes. A virtuous circle of confidence develops as anti-vaxx stances are denormalized. Here is another way to look at it: Much in the way we normalized taking our shoes off at airports before getting on a plane in the wake of the 9/11 attacks, we need to normalize vaccination now because we cannot afford to have little outbreaks in our community that threaten lives. Think of it as creating cognitive antibodies to beat back against the disinformation.
Even if the virus continuously surprises us, human behavior can be disturbingly predictable. In 2018, Dr. Hotez and his colleagues correctly predicted seven locations across the country where measles was most likely to emerge. A year later, there were small outbreaks in those areas, culminating in a larger outbreak when ultimately more than a thousand individual cases of measles were confirmed in thirty-one states. Measles is one of the most contagious germs ever to roam the planet, but it also has an easy and effective antidote through a vaccine. If I had to guess where hot spots for COVID will emerge in the future, I’d say the same places where Hotez predicted measles outbreaks: places where vaccine hesitancy runs high.
Hotez and I agree that how we promote and market science—from vaccines to lifestyle medicine—will become key to inoculating ourselves against future pandemics. The private sector has leveraged the power of target marketing for decades. It’s time we carry that marketing genius over to the public health sector. It is a worthy challenge to make high-quality public health and medical knowledge as engaging and available as sports or fashion.
We live in an information-saturated world that offers special powers and perils. As much as the media can inform and educate, it can equally disinform and mislead, especially in a digital age. To be sure, misinformation refers to information that is false or out of context, whereas disinformation is a subset of misinformation that is deliberately created or spread with the intent to mislead or deceive people. And there’s been plenty of both to go around throughout the pandemic. It’s relatively easy to spot bad information when it comes from dubious sources, but when you hear people in your own circle of friends and colleagues make questionable or even outrageous and dangerous claims, it’s harder to fight back. What do you say? How do you respond to challenge their thinking while preserving the relationship?
When I encounter someone with an absurd claim, I first ask where the person got that information. Nine times out of ten, the invariable answer is, “I heard it from so-and-so,” or “I read that somewhere online,” but more often than not, the person usually cannot recall exactly where the information came from. When we encounter questionable or outright false information, we must challenge it respectfully with evidence-based explanations and sources, couching our language in compassion and empathy. It means we must do our own homework and not fall into the trap of propagating falsehoods.
Here are some ways to check for false information and promote digital literacy, courtesy of Tara Kirk Sell, PhD, a senior scholar at the Johns Hopkins Center for Health Security who works on pandemic preparedness and response:
Use Internet-based tools and services that can provide an unbiased assessment of source credibility.
Verify the information with other news sources or trusted people in your network, or cross-reference any factual statements or recommendations with the best information available.
Scrutinize the social media account, URL, or layout that might suggest lack of editorial oversight.
Watch out for messages that are designed to appeal to emotions.
Become more aware of how disinformation campaigns work.
Think twice about the personal biases that may lead you to bad information.
A few taps of the keyboard can send you to reliable sources or down the rabbit hole toward unreliable ones. The goal is to visit reputable sites that post fact-checked, credible information vetted by experts. This is especially important when it comes to matters of health and medicine.
The best medical journal search engines that do not require a subscription are pubmed.gov (an online archive of medical journal articles maintained by the US National Institutes of Health’s National Library of Medici
ne); sciencedirect.com and its sibling, springerlink; the Cochrane Library at cochranelibrary.com; and Google Scholar at scholar.google.com, a great secondary search engine to use after your initial search. The databases accessed by these search engines include Embase (owned by Elsevier), MedLine, and MedLinePlus and cover millions of peer-reviewed studies from around the world. I often tell people to put the same degree of rigor into researching these topics as you would for a new school you are considering for your child. Do your homework, and take the extra beat to verify what you are learning. In chapter 8, I’ll give you some tips on how to have conversations with people who don’t take the COVID threat seriously or who don’t want to follow public health measures and recommendations.
At a Moment’s Notice
Indiana Jones–like virus hunter and epidemiologist Nathan Wolfe, whom I introduced in part 1, says that while we’ll continue to face threats of pandemics after COVID, our perception has forever changed. That shift in perspective is a good one. “We live in a world with such scientific capacity but flawed human psychology,” he reminds me. And the flawed human psychology that interrupted our response is, thankfully, getting retrained with this new, forced perspective. This shift will allow us to respond more swiftly, especially in the early days of the next pandemic when prompt action can have greater impact.
Wolfe believes that change in perspective coupled with the fact that COVID has rallied the private sector will better position our response next time. It’s a big change compared to ten years ago, when Wolfe appeared on the world’s stages alongside business leaders, trying to convince them that the commercial sector had seriously underestimated the risk of epidemics. On a Prepare for a Pandemic panel in 2010 at the World Economic Forum in Davos, Switzerland, which attracts the world’s leaders in business, academic, and political arenas, Wolfe faced an audience where 60 percent of CEOs believed the threat of a global outbreak was real but only 20 percent had an emergency plan in place. That same year, he’d been invited to a cruise industry conference but could not convince executives that his disease surveillance company, Metabiota, could help them avoid the pandemonium of an epidemic. Nobody was paying attention.6