The COVID-19 pandemic is a world-historic disaster. The emergence of a novel strain of coronavirus — that spreads easily in the asymptomatic and kills the infected at ten times the rate of seasonal flu — is a catastrophe for humanity. Although the ailment’s official death toll remains under 10,000, the virus still threatens to kill millions before a vaccine is ready for mass dispersal. In much of the northern hemisphere, preventing such mass death requires social distancing measures so extreme, their lengthy maintenance guarantees a global economic crisis. Shutting down bars, restaurants, conferences, and tourism for weeks would be sufficient to sink the United States into a deep recession; as of this writing, it appears that extreme social distancing could be in place for months. In fact, some experts argue that we may need to maintain such conditions for the bulk of the next year and a half, as suspending such measures once the case count declines will ensure the virus’s revival. In Asian nations that had begun to suspend stringent social distancing policies, a second wave of coronavirus cases is now emerging.
Oh — and the man who happens to be at the helm of the world’s most powerful government during this extraordinary crisis is a pathologically narcissistic reality star who chose to treat the burgeoning pandemic as a PR problem, and thus declined to ramp up America’s testing capacity or reserves of emergency medical equipment in the weeks between COVID-19’s discovery and its arrival on our shores.
It is difficult to discern any silver lining in these steadily darkening storm clouds. At first brush, we appear to be the helpless victims of a wildly improbable and unlucky fate. But the truth is that the present crisis is rooted less in misfortune than in misrule.
In reality, we are profoundly lucky that this pandemic isn’t worse than it is. A viral outbreak of this scale has long been inevitable. For decades now, public-health experts and advocates have been warning of scenarios nearly identical to that which has played out with COVID-19. An episode of Vox’s Netflix show Explained from last fall described how a Chinese wet market — where humans and a wide variety of livestock are packed into close proximity — could facilitate the spread of a novel influenza virus from animals to humans, and thus trigger a global pandemic. In September 2019, a report commissioned by the World Bank and World Health Organization began with the warning, “There is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people.” Similar reports, op-eds, and journal articles have been published on a routine basis for years and years. These warnings are less spookily prescient than they may appear. After all, with SARS and MERS, the world received two previews of how a deadly new coronavirus might threaten global public health in just the past two decades.
Both those outbreaks proved too limited and short-lived to capsize the global economy. And so, our government (among many others) carried on underinvesting in pandemic prevention and preparedness in their wake.
The United States is the wealthiest nation in human history. And yet, our Centers for Disease Control and Prevention was spending only $500 million on programs aimed at tackling emerging diseases before this crisis hit. The National Institutes of Health’s total budget for its program on infectious diseases was roughly $5.5 billion last year, only a small fraction of which goes to pandemic prevention. Meanwhile, little to nothing was done to ensure that U.S. hospitals could rapidly scale up surge capacity in the event of a pandemic (even after COVID-19’s potential to go global became clear). To put all these figures in perspective, consider two statistics: (1) Since Donald Trump took office, the Pentagon’s annual budget has grown by $130 billion, and (2) the COVID-19 pandemic’s impact on U.S. equities has already wiped out trillions of dollars in wealth.
By all appearances, voters and policymakers were never going to recognize that increasing spending on pandemic prevention and preparation by an order of magnitude was a money- (and life-) saving proposition until we learned the hard way. Which is to say, the first “once-in-century” pandemic was always likely to catch us underprepared (albeit, not necessarily as underprepared as the Trump administration left us).
Given that reality, we are fortunate that the pandemic we got is both a less prolific killer of the young — and less lethal overall — than many of its predecessors (or potential successors).
The young are by no means immune to COVID-19. The studies we have suggest that children may have comparable rates of infection to adults, and that a small but not insignificant minority of those under 18 can develop a life-threatening illness. Meanwhile, young adults are at a higher risk that many appreciate: 38 percent of the first 508 Americans known to have been hospitalized for Covid-19 were between the ages of 20 and 54, according to a new CDC report. All this said, unlike with seasonal flu, fatality rates among very young who contract the novel coronavirus are markedly lower than among older individuals. And the same was broadly true of the closely related 2003 SARS virus.
There is a coherent theoretical basis for why young coronavirus patients have such low fatality rates. As Anthony King of The Scientist reports:
One explanation for the correlation between age and disease severity is that as humans’ immune systems age, more cells become inactive. “As you age, your immune system undergoes senescence and loses its capacity to respond as effectively or be regulated as effectively,” says [UNC coronavirus researcher Ralph] Baric.
Another explanation, which [University of Iowa immunologist Stanley] Perlman favors, is tied to the aging lung environment. In order for individuals not to easily develop asthma or overreact to environmental irritants such as pollen or pollution, aged lungs counter the usual immune reaction with some tamping down of inflammation. As a result, says Perlman, the lungs do not respond quickly enough to a viral infection. For instance, when his group makes the lungs of older mice more like those of young mice by altering prostaglandins, compounds that respond to tissue injury, “then the mice do well and they can clear the [SARS] infection and don’t get sick,” says Perlman.
Regardless, there is little question that COVID-19 poses a far lesser threat to young people than the initial H1N1 influenza (a.k.a Spanish flu) that terrorized the globe one century ago. That virus not only killed a higher rate of all those infected than the novel coronavirus, but was most dangerous to individuals in the prime of their lives. The smallpox virus, meanwhile, had a fatality rate of 30 percent among all its victims, and an even higher death rate among small children.
COVID-19 is a horrendous illness that has already exacted an immense human and economic toll. But it is nevertheless true that we could be paying a much higher price for our collective refusal to heed public-health experts’ warnings about the necessity of ramping up pandemic preparation and prevention. Given our policy framework, a novel virus was bound to catch us needlessly vulnerable. There is no reason why that bug couldn’t have been as prolific a killer of young, healthy adults as the Spanish flu; or as merciless a slayer of infants as smallpox; or as deadly as the initial SARS virus. We just got lucky.
What we’re living through right now is a nightmare. But it is not remotely a worst-case scenario. Millions are at risk of death as a consequence of our collective failures of preparation and coordination. But if we can maintain social distancing measures until a treatment or vaccine becomes available, the nature of the virus we’re battling gives us a solid chance of rendering the present pandemic less lethal than its historical analogues.
And once we’re on the other side of this, we will have the opportunity to internalize the hard lessons that we’ve learned — and invest massively in a universal influenza vaccine, hospital surge capacity, and global pandemic prevention. In other words, we will have the opportunity to be ready for the worse things to come.
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