World War C

by Sanjay Gupta

  On December 31, 2019, Wolfe’s CEO at his company, Nita Madhav, was at a family wedding in Portland, Oregon, when word of a virus in Wuhan, China, reached her. An epidemiologist by training, Madhav had taken the helm at Metabiota earlier that summer after four years leading the infectious disease data science team and, before that, spending a decade modeling catastrophes. Her goal as CEO, with a team of epidemiologists, data scientists, programmers, actuaries, and social scientists, was to build the most comprehensive pandemic model possible. They started by turning to history and amassing all the data on major disease outbreaks since the 1918 flu among 188 countries and eventually developed what they called the Epidemic Preparedness Index. The model allowed one to create the criteria around a hypothetical virus such as its geographic birthplace, transmissibility, and how easily it could harm or kill people. It then showed various scenarios of how it could spread around the world. These insights can help companies respond, including pharmaceutical companies seeking information for treatment rollouts and manufacturers who need to know how an outbreak would affect their supply chain. Metabiota’s system was elegant and innovative, but its most challenging and elusive factor in the model was calculating people’s fear. The economic consequences of a pandemic were a complicated interplay of both society’s response and the virus’s behavior.

  Thus was born the Sentiment Index, or what one of its designers at the company who’d studied how human beings perceive and respond to risk called “a catalog of dread.”7 The index could churn out a score from 0 to 100 based on how frightening the public would find a given pathogen. Then that number could help determine the possible financial disruptions and losses from an outbreak as businesses closed and major projects were put on hold. Madhav and her team, including Wolfe, also looked at the broader economic consequences of pandemics to figure out which societal interventions equated with what’s called the cost per death prevented. They found that “measures that decreased person-to-person contact, including social distancing, quarantine, and school closures, had the greatest cost per death prevented, most likely because of the amount of economic disruption caused by those measures,” they wrote in a chapter for the World Bank’s 2018 third edition of Disease Control Priorities.8

  A year later, Madhav and her team would find themselves living inside their own model’s projections. On New Year’s Day 2020, Madhav tried to gather data to make predictions on the outbreak, but it was difficult because no one was panicking. There was no response to measure yet. By the third week in January, the tone had radically shifted and everyone scrambled. Ben Oppenheim, head of the product team and a political scientist at Metabiota, said they had done so much to predict every aspect of a pandemic that when it actually happened in 2020, it felt like the team was reliving a well-told story. It was déjà vu.

  According to Wolfe, it comes back to the new perspective the world has gained through this pandemic. The combination of heightened awareness in both the public and private sectors, he says, will be key to our future. It is about harnessing the unforgiving reality the virus has had on our conscience. COVID is persuasive, and its tools include killing people around the world, devastating economies and government budgets, and causing massive unemployment. The key to our survival will be to not forget.

  5 Stockpiling Goods for Your Pandemic Prep Kit

  High-quality masks. Remember the three Fs: fabric, filters, and fit. Some of the most effective masks have two tightly woven layers of outer material with a filter material sandwiched in the middle. You can use surgical mask material or even a piece of a vacuum bag as a filter between two pieces of fabric. According to research done by a group of engineers at Virginia Tech that includes some of the world’s leading aerosol scientists, you don’t necessarily need an N95 medical mask to stay safe from coronavirus, although that is the gold standard.9 A high-quality, properly fitted cloth mask does a good job of filtering viral particles; a well-fitting fabric mask with a third filter layer can stop 74 to 90 percent of risky particles. Remember to have smaller masks on hand for children.

  Soap, cleaning supplies, and hand sanitizer with at least 60 percent alcohol. Note that bleach has a shelf-life of about six months. A virus like COVID is most vulnerable to plain soap and water because it is encased in a fatty lipid layer. Picture a greasy pan: Would you have better luck cleaning that with soap or a bleach wipe? Although the risk of surface transmission of COVID is low, keep indoor surfaces clean because pathogens such as norovirus and the flu spread more easily on surfaces.

  Basic medical supplies like over-the-counter medicines (e.g., Tylenol, Advil, aspirin) and prescription drugs for thirty days. Have an emergency kit that includes a thermometer and pulse oximeter that measures how much oxygen is in your blood. If there is an outbreak in your community, you may not be able to leave the house to visit the pharmacy. Don’t forget to think about medications for pets and other members of your household.

  Personal health and hygiene basics like toothpaste, shampoo, body wash, deodorant, and feminine products. If you have a baby, stock up on diapers and wipes. Aim for an extra month’s supply.

  Shelf-stable and frozen food products. If you have to stay at home and avoid grocery shopping, a supply of nonperishable food will come in handy. Store pasta, canned tuna and salmon, frozen fruits and vegetables, dried beans and lentils, nut butters, soups and broths, and perhaps dessert like dark chocolate.

  Be at the Ready

  On the northeastern coastline of Japan, in a forested hillside below the village of Aneyoshi, sits a stone tablet—an obelisk-like stone carved with a warning: “Remember the calamity of the great tsunamis. Do not build any homes below this point.” It was placed there after a devastating tsunami hit the area in 1933, and its warning saved the tiny village of eleven households nearly eighty years later in 2011 when another tsunami landed whose waves stopped just 300 feet from the stone. Hundreds of these so-called tsunami stones, some more than six centuries old, dot the coast of Japan.

  When the last wave of the coronavirus recedes, what kind of guide stone will exist for future generations? As I previously mentioned, America lacked experience with SARS and MERS to push us to rapidly respond to this pandemic. Unlike our CDC, which initially failed to protect us from threats to our health, safety, and security, the CDCs in South Korea and Taiwan helped those countries act swiftly against COVID. The Taiwan Centers for Disease Control immediately activated the Central Epidemic Command Center and imposed home quarantines, border restrictions, a face mask distribution system, and other preventive measures. The CDCs in Taiwan and South Korea set in motion rigorous detection and contact tracing, communication, and isolation.10 Their coordinated and immediate approach explains their successes. The memory of SARS and MERS still haunted those countries and motivated them to act. Unfortunately, we suffered from a kind of collective myopia that caused us to underestimate risks, insufficiently prepare, and lack adequate protection. Federal funding shortfalls further undermined the CDC’s response. Between 2002 and 2017, the CDC’s core emergency preparedness funding was cut by over 30 percent, or $273 million.11 Insufficient funding has also meant public health labs have been understaffed or shut down, which resulted in painful effects when COVID arrived.

  As the United States reinvests in the CDC to turn systemic fragility into resilience, each of us on an individual basis must do our part to keep ourselves and our families safe. This means not only avoiding the virus but also avoiding the paradox of preparation, which refers to how preventive measures can intuitively seem like a waste of time both before and after the fact. Most of us don’t stop brushing our teeth because the dentist didn’t find any cavities at our last checkup, and we continue to buckle our seat belts when we’re in a moving vehicle even though we may not have experienced an accident recently. But with larger events with impacts more difficult to gauge, as is the case with COVID, spurring people to action can be hard. As a society, we have not been willing to invest in pandemic preparedness the way we do for defense
even though this is also a threat. Remember that, according to Robert Kadlec, who spent decades developing disaster response plans, the cost to prepare for a pandemic would be a few dollars per citizen—about $30, or the cost of a couple movie tickets. We could have vaccine platforms ready to roll, virus hunters like Wolfe in the field, robust surveillance, and a strong public health infrastructure. None of that seemed important until it became the only thing that is important.

  Whether it’s a pandemic or our own personal health, what inspires us to do the things up front so we don’t have to pay more later? What encourages us to eat healthy foods and move more today to avoid heart disease or cancer tomorrow? When I posed that same question to Dr. Kadlec, he looked at me with watery eyes and said, regretfully, “I guess it takes something like this,” referring to the gravity of COVID. “I guess it takes hundreds of thousands of people dying to say, Oh, yeah. Next time we should be better prepared.” His response reminded me of the stories of addiction I have covered in the past. Some addicts have to hit rock bottom to finally emerge from the depths of despair. This is our own story of addiction. Fake it until you make it. I’m going to get lucky. This is a problem that affects other people; it doesn’t affect me. And then, one day it does.

  Years ago, I had a conversation with my wife about getting lightning rods for our house. She thought the guy was charging too much money and it wasn’t clear that we would ever really need them. So if we never needed it, then any money we spent would be too much. I understood that point of view, but two things came to mind. First is the perspective of having insurance. You often have to invest in things to protect yourself against hypotheticals that may never happen. It can be a tough decision, but if you are ever in a situation where you use an item like a lightning rod, that money is the best you’ll ever spend in your life. And there is also something else less perceptible, but no less important: Those lightning rods or other protective devices offer confidence and calm. When there’s a lightning storm, we are much more assured that our house isn’t going to burn down. That sort of anxiety reduction is a difficult thing on which to put a price. The point is that investing in prevention cannot be measured just in terms of whether the disease happened or didn’t happen. It can also be measured in peace of mind, which is priceless.

  For example, few people have trouble appreciating the purpose of public education. It’s a clear and concrete social program designed to improve our lives. Results are measured by test scores, graduation rates, college admission rates, employment status, and so on. Public health accomplishments, however, are not evaluated by tangible metrics. Success is defined by what is prevented rather than what is produced.12 This creates an odd dynamic in our calculating minds. When public health programs work, they work invisibly, and what we cannot see, we take for granted. You can’t really celebrate avoiding a disease you hardly knew existed. That makes it easy for shortsighted individuals, including politicians and leaders, to deny long-term realities. And that is what they typically do.

  There are also ancillary benefits of preparedness other than tools to fight a specific disease. Part of being prepared for a pandemic could mean significant investments in universal vaccines—not just a vaccine for this coronavirus but for any other coronavirus. Not just for one flu virus but for any other flu virus. In fact, scientists are currently studying how we can develop a “pan-vaccine” that will cover all coronaviruses and influenza strains. Kadlec reminded me of the investments we made when we sent a human to the moon. What was a real benefit of that other than the fact that we could say we did it? Well, a lot. Technologies like GPS came out of that, as did intraoperative navigation technology, food safety control methods, and satellite imagery.

  In Greece, the Museum of the City of Volos serves to raise awareness about disasters. Originally built to house general information about the region, including facts about earthquakes and floods from the 1950s, this smart, modern museum has recently aimed its focus on promoting disaster risk awareness. It worked with disaster preparedness experts and civil authorities to identify and reach at-risk groups, develop cultural memory games, and play a more visible role in the life of the city. Now, in the wake of COVID, it acts as a case study in how organizations can help preserve collective memory about risk. We all want future generations to be in the best position to deal with the next inevitable pandemic. And knowing how to evaluate risk constantly is tantamount to that positioning.

  CHAPTER 6 R: Rethink and Rewire Risk in Your Brain

  Evaluate Uncertainty and Deal with Unseen Threats

  From the moment you wake up in the morning, your brain makes an untold number of decisions. Most of them occur subconsciously. In the seconds it takes for you to read this sentence, your brain will have fired off a miraculous number of electrical signals to keep you alive—breathing, moving, feeling, listening, interpreting visual cues, digesting, pumping blood, and thinking. Some of the information zipping through your billions of neurons is traveling faster than the speed of a race car. The human brain is a remarkable organ, an evolutionary marvel. Scientists often describe it as the most complex thing we have ever discovered; one of the discoverers of DNA went so far as to call it “the last and grandest biological frontier.”1 It is arguably the most enigmatic 3.3 pounds of tissue in our universe.

  Every time I operate on the brain, I am in awe at this interwoven bundle of tissue that sculpts who we are and the way we experience the world. Every joy, pain, love, sorrow, worry, and fear we have is somehow embedded in there. It is your brain that allows you to adapt to environments, tell time, figure out space, know up from down, hot from cold, and wet from dry. It is the ultimate record keeper of our story. It even whispers dreams to us when we sleep. It is the commander in chief of all your other organ systems.

  Perhaps most intriguing is the way the brain assesses risk because more than anyone or anything else in your life, your brain wants to keep you safe. Our very highly tuned sensory systems act as perimeter defenses, constantly scanning the environment for threats. And then, through a sophisticated data management system, the brain integrates incoming new information and cross-references it against old memories. It is then that the brain tells the body to act, and fast. Think of this as our gut instinct, relying on images, sounds, even feelings that can be processed swiftly. A baseball whizzing toward your head. Duck. An aggressive animal with sharp teeth. Run. A bitter taste in your food: a possible toxin. Spit.

  But what if a threat is truly invisible, and effortlessly evades our senses? (Fans of The Princess Bride will know the ideal poison is iocane powder: “odorless, tasteless, dissolves instantly in liquid.”) And what if there is no memory of it on which to draw, given we have never encountered such a threat before? Something truly novel. It would be the absolute worst-case test of our ability to assess a risk. It would be like flying blind with no automated guidance system in place. And yet this is what we have asked of our brains since the start of this pandemic. Every time we stepped outside our home, had a casual interaction with a friend, or simply breathed in someone else’s air, our brain tried to assess risk, and failed. COVID-19 is in many ways the perfect unseen enemy.

  Over the past year, just about every call I received, as well as every discussion around our own dinner table, was a version of the same thing: What is the risk of a particular activity? Given that I was reporting on the pandemic, people often turned to me to help fill in the information their own brains could not compute. I usually recommended they err on the side of caution, staying home as much as possible, not visiting older or other vulnerable family members, and generally physically distancing from potential exposures. It was the same philosophy I told my teenage daughter when teaching her to drive. Slow down when driving around a blind corner, because you simply don’t know what lies on the other side. You definitely don’t want to accelerate. Truth is, though, my brain was at the same disadvantage as everyone else’s. And I fully recognized the trade-offs—the significant risks to not engaging with the outsid
e world. Our three daughters, ages fourteen, twelve, and ten at the beginning of the pandemic, had an understandable desire to be with their friends and immersed in a sea of humanity. At that age, social interaction is particularly necessary for their psychological growth. One of the most difficult times for me personally was finding my oldest daughter silently sobbing into her pillow. “I really have no idea,” she responded when I asked what was wrong. Then she suddenly sat up and clung to me for the longest hug we have ever had. She was desperate for physical and emotional touch.

  Yes, they love their parents, but my girls wanted out of the house, and there was a tangible risk to keeping them locked down. I remember staring at my wife across the dinner table on many summer evenings and repeating a version of what my daughter had said to me: “I just don’t know.” For a guy they always counted on to have the best information, the answers didn’t come easily.

  So over the past year, I created my own way of understanding and assessing risk during a pandemic or any similar threat that is both invisible and novel. It is by no means perfect and it must be highly flexible, able to change as the threat evolves. More than anything else, though, it must start with an understanding of the individual who is evaluating the risk. While none of us have a memory of this virus, given that it is novel, we do have a baseline tolerance for risk overall, and that tolerance is perhaps the truest reflection of who we are and what we value.