Pandemic: not the game

If you had told me a year ago that March 2020 would see much of Asia, Europe, and the Americas on lock-down, schools closed, fines for leaving your house without the appropriate forms, shuttered restaurants, closed borders, a ban on international travel, bankrupt airlines, an impending internet collapse, manufacturers switching to emergency medical equipment production, millions of jobs lost, and thousands dying daily due to one virus, I would have told you to lay off the YA novels. But here we are. March 2020: the month Covid-19 became a pandemic.

A couple years ago, we ran a simulation exercise looking at how prepared we are for a pandemic. The result? We are not. Countries ran out of hospital beds, health workers were ill-equipped, at-risk, and in short supply, and containment was stifled by weak and disconnected health systems failing to communicate infection rates in a timely manner. We wrote about how important it is to invest in strengthening public health systems and building resilience to absorb shocks such as outbreaks, climate change-driven disaster, and/or conflict. The report was sent off somewhere (probably the highly-populated land of reports no one reads).

To see the real thing unfold has been a bewildering experience. As someone who doesn’t work on the front lines of health systems, I can’t help but feel useless. The kind of public health work I’m supposed to do comes into play before any of this happens. If we’re doing our jobs right, the average person shouldn’t be thinking about healthcare, let alone fearing for their lives. The feeling of uselessness gets even stronger as the pandemic cripples other public health measures, such as access to safe housing and food.

As Covid-19 rages on, it’s unraveling not just health systems, but also chunks of the social and economic infrastructure we’ve laid out. The gross underbelly is being shoved in our faces and suddenly we’re all surprise-pikachu-faced. As billions of dollars disappear from markets and businesses shut down, those at the bottom of the food chain are faced with impossible rent payments and children they struggle to feed. Trickle down economics works in reverse when it comes to loss. Millionaires sing “imagine no possessions” while the homeless and the paycheck-to-paycheck don’t need the imagination. I shudder to think of what may happen if (likely when) Covid-19 hits refugee camps and homeless populations. We are still in the somewhat early stages of this pandemic’s true impact and we’ve underestimated it for so long that I’m not sure there’s much wiggle-room for mitigation.

There have been several models floating around on what the pandemic could look like and how containment and suppression would work. The “flattening curve” has been ubiquitous (and I say this with the knowledge that cat memes have been created around it, which, let’s be honest, is the definition of ubiquitous). What the flattened curve doesn’t explicitly mention is the potential for several peak infection waves. It seems to suggest that we can all hole up in our houses for a few weeks, boring the virus into submission until it decides to pack up and find a different planet. In reality, without a vaccine (which will likely come in a little over a year), as soon as we loosen the quarantine and social isolation measures, infection rates will rise again and we’ll need another period of quarantine and social isolation. And so on and so forth until there is sufficient population-level immunity. The Imperial College model has also been a particularly intriguing/ terrifying one due to its grim predictions. Basically, millions will die if we do nothing or very little. If we do everything, we can lower that number, but drag out the pandemic and disrupt livelihoods further (which has other long-term health and social consequences). That said, the virus itself, as terrible as it is, could have been a lot worse. For example, it could have been Ebola (though Ebola is kind enough to be less transmissible partly because it knocks people off their feet before they can transmit further whereas people carrying Covid-19 can fly about as they please, spreading the love before they ever feel truly ill).

The moniker Covid-19 comes from it being the “Novel Coronavirus Disease of 2019.” Coronavirus refers to a family of viruses including SARS, MERS (which in retrospect now seem like the nicer siblings), the common cold, pneumonia, etc. Fun fact – the name comes from the crown (corona)- like spike proteins around the virus that bind to the host cell. The origin is often attributed to bats via an intermediary species, potentially pangolins (scaly anteater whose scales are sold as a cure-all) sold in “wet markets.” The virus attacks the respiratory system via the lining of the respiratory tree, namely type 2 pneumocytes in the alveoli. Basically, it triggers an immune response that can eventually lead to alveolar collapse and hypoxemia (hence the difficulty breathing), alveolar consolidation (hence the cough), raised body temp (fever), and so on (I’m not a doctor and I took pathophysiology 10 years ago, but this guy’s great). Imagine all this without the appropriate equipment. Hospitals are already running out of ventilators and in some communities, they never existed in the first place.

The early days of the pandemic were riddled with false reports and denial across the world. China persecuted Dr. Li Wenliang who first sounded the alarm of an outbreak despite efforts to keep it quiet. He eventually died of the disease himself and was celebrated as a martyr. Tragic. Iran then kept things quiet as the virus made its way through Qom, a pilgrimage city, using the holy sites as a hotbed of hosts. The reticence is attributable to the desire of the Grand Ayotollahs to assert their power through the annual celebration of 22 Bahman (Feb 11th). The 22 Bahman demonstrations commemorate the Islamic Revolution’s “victory” in 1979 and mass participation is seen as crucial in affirming the continued will of the people to support the Islamic regime. Not only did they not cancel demonstration in light of the Covid-19 threat, but they encouraged people to show up in masses. Later as the situation disintegrated further, officials hemmed and hawed over closing shrines until eventually announcing their closure in March (I won’t get into the hardliners that then stormed the closed shrines…). Like everywhere else, the outbreak in Iran unveiled underlying social tensions, further highlighting the 40-year battle between religion and secularism.

Four months after the discovery of Covid-19, China’s achieved a success story by quickly applying strong measures to contain spread. They’ve gone so far as sending their response team to help in Italy, where the outbreak is devastating the population. Iran’s had a harder time of it while being further crippled by additional US sanctions. The US had a rough start as well with a testing kerfuffle early-on and a reluctance to believe experts’ warnings. Experts are also scrambling to develop expertise. Nearly everything feels unprecedented. We don’t really know the virus itself. New research is being pumped out at impressive rates highlighting things like the virus’ ability to stay on surfaces for 2-3 days, the potential for re-infection, the effect of ibuprofen, etc. Economic and political impact estimates are being released daily, but they’re rendered obsolete just as quickly as they’re produced. Everything feels as though it’s up in the air.

What happens when technology becomes an even bigger “savior”? Is this the catalyst for a remote working revolution? Will educators shift their focus? What will international travel look like? Should I have bought stock in a telemedicine app?

How long will unemployment last? Will people get their retirement savings back in time? What will happen to supply chains? Who are the winners, beside Amazon, Zoom, and Peloton bikes? Who are the losers, beside the hospitalized and the unemployed? Is the mom-and-pop-shop a relic? Will city design shift back towards sprawl rather than density?

Will we be able to use the crisis to fix the broken underbelly of our public systems? Will the right to health be more respected? Will we see more support for climate adaptive investments? Will people make decisions out of individual fear of future pandemics or out of hope for collective resilience?

Or will nothing happen? Will we emerge from our homes with a few extra kilograms only to slip right back into business as usual? Will we forget that air quality improved dramatically as we slowed down? Will the vulnerability and situational anxiety fail to inspire empathy?

For now, those of us who are lucky enough not to be very sick, to have safe homes, to have protective nationalities, and frankly, to have an internet connection, are coming to terms with “limitations” to which we’re unaccustomed. Governments and the WHO are having so much trouble getting people to stay at home and respect social distancing (sorry, “spatial distancing”) and isolation rules, that the term Covidiot has popped up.

The definition of the word ‘Covidiot’ is when a stupid person who stubbornly ignores ‘social distancing’ protocol, thus helping to further spread COVID-19.

The word Covidiot also describes a stupid person who hoards groceries needlessly spreading COVID-19 fears and depriving others of vital supplies.

The great toilet paper shortage of 2020 will go down in history as a shitty situation nested within a crappier one.

I’ve found myself glued to Twitter, cycling between horrifying predictions, pleas from the front lines, politicians’ speeches reminiscent of war-time pronouncements, and of course, top-notch memes. The internet’s been a much more interesting place over the last few weeks, but honestly, I’d rather be bored.