This was a crazy week in the U.S. as Americans started to panic over many of the concerns other countries started having a few weeks earlier. The stock market tumbled some more, people hoarded essentials from grocery stores, companies issued broad work from home policies, and massive events such as the NBA season, March Madness, SXSW have either been canceled or postponed. I have been freaking out along with everyone else, but I have also been reflecting on pandemics and existential risk, and two main thoughts remain on my mind:
- We should have been better prepared for a coronavirus-level event as scientists, Bill Gates, mass media, and others have been warning about this for over a decade.
- We should properly calibrate how we think about the main existential risks to humanity and how resources are allocated to those risks (climate change, nuclear war, biological war, AI).
The coronavirus should not have been a surprise to the world. At least since the breakout of SARS, Ebola, and other recent epidemics, epidemiologists have been warning of the possibility of a spillover (a disease traveling from one species to another) causing a major pandemic. It was always one of the existential risks that Bill Gates and others have listed over the years. Contagion, a movie that depicts the effects of a far deadlier pandemic, was released in 2011 by a well-known director and had moderate box office success. As a country, America has not put enough resources into pandemic prevention in the short-, medium-, and long-term. The short- and medium-term failures can be attributed mostly to the Trump presidency, but we, the inhabitants of the U.S., have also failed to raise enough alarm about it.
The short-term failures of the government are all related to inadequate preparation for the coronavirus domestically, even once knowledge of the coronavirus surfaced. As soon as large numbers of cases were being reported in China, officials should have started turning the governmental gears to prepare. Once it started spreading to other countries, the presidency and Congress definitely should have acted to ensure that if it spread to the U.S., there would be a plan to contain the disease. Our testing is still far behind other comparable countries and earlier this week, we had tested even fewer people than Vietnam. The CDC and FDA, in a misguided attempt to centralize control of the response, prevented private labs from offering their own tests for too long. The government has also failed to give citizens the support to isolate themselves. Those of us in office jobs can just work from home with minimal disruption, but many workers have little or no sick leave, are in jobs that require their physical presence, or both. Many of those workers are likely to be out and about as most of them live paycheck to paycheck and cannot afford to do otherwise. Then, there are the uninsured people who cannot afford to get tested. There is probably overlap between those two groups so what ends up happening is that the poorest people cannot get tested and are more likely to both catch and spread the disease as they are forced to be out in public. The House finally just approved an aid package, but it is still waiting for Senate approval. This should have all be in the works weeks ago when we knew that coronavirus was spreading rapidly across other countries.
The medium-term failure of the U.S. government, which tie into the long-term failures, is the de-prioritization of pandemic preparation. The Trump presidency proposed major cuts to the CDC and the NIH in each of the four proposed budgets it submitted, and though Congress ended up appropriating more money to those agencies each year, Trump’s actions clearly signal the priorities in his administration. Which brings us to the long-term failures around pandemic prevention in America: the lack of concern among all citizens around the issue. As I mentioned previously, scientists, well-known public figures, and the mass media have been warning about the existential risk of a pandemic for a long time, but we, the people, have failed to properly heed those warnings. Compare the public attention paid to pandemics versus climate change or even artificial intelligence and we can see just how lacking the attention has been. Many smart, young people dedicate their careers to tackling the other two issues but it seems like far less talent is flowing into pandemic control than should be given the severity of the problem. A recalibration of our various existential risks is in order and coronavirus might be the spur we need. I have no idea what the ideal balance is for the attention we pay to each existential risk and I am definitely not saying that climate change and AI are not important. In fact, though I think we should be paying much more attention to the threat of a pandemic and should devote more resources to combating that threat, I do not want us to over-adjust because of the panic caused by the coronavirus and ignore the other threats. If anything, the risk that we should probably pay more attention to after we get through this is the threat of nuclear war as that seems to be the one that will be ignored by most people.
Still, I hope that coronavirus leads to society paying more serious attention to the risk of pandemics. In some ways we have been quite lucky. Though the coronavirus seems to be more fatal than the seasonal flu, it is not extremely deadly and does not seem to have much effect on children and healthy adults. It has allowed us to see the cracks in our system, specifically the supply chain risks, the inadequacy of our current testing capabilities, and the containment flaws in the U.S. With the American public sufficiently scared, we are now in a better position to contain the next pandemic. The coronavirus could have been so much worse. Imagine a virus that, like the coronavirus, has a long incubation period (or even longer), but is much more contagious and deadly, yet takes a long time to kill so that people have plenty of time to spread the disease. Though the coronavirus is spreading across the globe relatively quickly, it is not as contagious as some of the most contagious diseases out there; measles for example is much more contagious. As a frame of reference, the R0 (the number of people, on average, that each person infects) of coronavirus is estimated to be around 1.5 – 3, whereas the R0 for measles is around 15. Imagine if we had been hit with the worst-case scenario pandemic before the coronavirus. There is already panic among the people as everybody hoards supplies and food, leaving stores bereft of necessities. But at least there isn’t chaos in the streets. People are not looting stores or destroying public property. A sufficiently bad pandemic could lead to all of that. If our hypothetical virus was spreading even more rapidly, causing far more deaths (including child deaths), the panic sowed would be enormous. Now that we are facing coronavirus as a society, we should realize that it is far from the worst-case scenario and will hopefully be better prepared in the future as a result.
So, what should those preparations be? I do not work in epidemiology nor am I even a scientist, so I cannot prescribe specifics, but I do have general suggestions. First and foremost, xenophobia is not the answer. Sure, companies should seek to diversify their supply chains so that they are not so dependent on a country halfway around the world, but the debate about whether to globalize is already long past. Globalization is here to stay and regardless, we need to come together as a planet to deal with the other existential risks we face. Geopolitical isolation is not the answer. Instead, we should be investing more money into pandemic detection and testing capabilities once one is detected. We should definitely not prevent private labs from providing testing especially when governmental tests are inadequate. Our best and brightest should be encouraged to pursue careers in epidemiology. Our government should have policies in place to provide citizens with financial relief whether it be in the form of healthcare support or paid leave support so that the poorest in our country can get tested and isolate themselves. Even though we are still in the early innings of fighting the coronavirus in the U.S., I am optimistic that we will overcome it with relatively minimal damage to our society and that we will be in a better position to deal with an even worse pandemic in the future.
On The Nose 