Issue 59: Stopping the Next Pandemic
6.27.21 | The best time to start is before this one ends
Hello,
We tend to prefer neat beginnings and endings, even though in real life the boundaries of stories are usually unstable. Some more distant precursor emerges; a new turn of events reactivates an old story. Events are restless, and the meaning we make from them evolves with the slow revelation of new information about the past and the relentless layering of new events on top of the old as we move into the future.
The boundaries in time of this pandemic are especially volatile. New evidence strongly suggests that the SARS-CoV-2 virus arrived in the United States far earlier than we knew, as early as mid-December 2019. That’s a month before Wuhan began its lockdown; a little more than a month before the first case in the U.S. was clinically confirmed, and two full months before the CDC, on February 26, 2020, confirmed the first case of community transmission here. The natural history of the virus before it spread explosively in Wuhan is murky and convoluted. It may have had several false starts, spreading slowly and hesitatingly until it either stumbled into the right mutation or found a critical mass of potential human hosts or both. There’s a certain comfort in believing the virus emerged fully formed from a lab — that you could trace it all back to one errant needle-prick or one sneeze — but, as this excellent piece by Justin Ling shows, the lab leak story just doesn’t match with the available evidence.
If the pandemic’s beginnings are elusive, closure just as readily escapes our grasp. Vaccination has effectively ended the pandemic for most people who’ve received their shots. By now, in the U.S., more than 99 percent of all Covid deaths are among people who have not been vaccinated. But the pace of vaccination has slowed enough to allow the virus to rebound in some places. Hospitalizations are on the rise again in Arkansas, Missouri, Oklahoma, Nevada and Utah, all states with significantly below-average rates of vaccination. More locally, in some counties even within states with high overall uptake there are pockets in which fewer than 1 in 4 people are fully vaccinated. These pockets tend to be in communities that already have characteristics that make them vulnerable to Covid — a high share of multigenerational or multifamily households, fewer people who work from home, higher rates of underlying health conditions and less access to healthcare. The more contagious delta variant, meanwhile, is spreading rapidly, making up an exponentially growing share of all Covid cases nationwide, and will be the dominant strain here within a few weeks. In these pockets the pandemic isn’t over at all, but is intensifying thanks to some combination of inaction, neglect, and structural disadvantage. The resurgence threatens even people who’ve been fully vaccinated — in a recent outbreak in Israel, fully half of the people infected had been fully vaccinated, though they did not suffer severe illness, which led the government to reimpose an indoor mask mandate.
Still, now in this period of not-quite-endings is the best time to start looking ahead to the next pandemic, and how to face it. Crises tend to have a short shelf life — people want to assume they’ve learned everything there is to know and put the trouble behind them. As people get comfortable again, political urgency to make necessary reforms fades quickly.
It’s helpful to think about preparedness at three scales: the institutional, the community, and the individual. More and more, the catastrophes we face (pandemics, climate change, infrastructure collapse, industrial accidents, cyber attacks, terrorism) are consequences of forces at the institutional level, and are most effectively dealt with from there.
/ Institutional reform
There’s a reliable pattern in human history since the industrial revolution, in which technological innovations fundamentally change the environment in which we live, creating space for horrible new types of accidents and disasters, which at first are seen as isolated misfortunes of unlucky individuals or “perfect storm” once-in-a-lifetime failures that overcome a community or country. Gradually, as these technologically-driven crises become more frequent, they’re understood as systematic problems that require institutional solutions: laws and regulations, standards, new national and international organizations.
The problem of emerging infectious disease, it seems, has passed that threshold. In the years leading up to the Covid pandemic troubling outbreaks of novel diseases had already become a regular occurrence, driven by the intensified commercial exploitation of former wilderness areas, industrial agriculture practices, and the rapid global circulation of people and goods. The World Health Organization, monitoring outbreaks around the globe through a patchwork of disease surveillance programs, was regularly in the business of announcing global public health emergencies, though the practice wasn’t particularly well-calibrated: WHO was roundly criticized for dragging its feet on designating the 2013 Ebola outbreak in West Africa a Public Health Emergency of International Concern. In 2016, it was seen as having jumped the gun on declaring Zika a global public health emergency. Of course, the agency has come under fire for its handling of the early stages of the Covid pandemic, though even when it did declare a global public health emergency over the new virus, its advice went largely unheeded.
Experts have responded by calling for a dramatic strengthening of global public health infrastructure. World leaders have called for a global public health treaty to create a standard organizational and legal framework for fighting emerging disease pandemics. An independent panel commissioned by the WHO recommended the establishment of a high-level Global Health Threats Council at the United Nations, a framework for sharing disease surveillance data, as well as drugs and vaccines equitably around the globe, and enforceable benchmarks for countries to hit on their own domestic pandemic preparedness measures.
At the national level, in the U.S., the Biden administration’s American Rescue Plan directed $7 billion towards rebuilding the country’s public health infrastructure, providing funding to reverse a steady erosion of public health budgets at the state and local level that followed the 2008 recession, and expanding the CDC’s epidemic intelligence unit, among other things. The administration also ordered the creation of a national National Center for Epidemic Forecasting and Outbreak Analytics, a National Weather Service, but for disease outbreaks.
Building a permanent and robust organizational infrastructure for detecting disease outbreaks, responding early, and communicating with the public will help stave off or minimize the impact of future pandemics. The recent history of hurricane forecasting is a good analog for the benefits and limits of this approach — in spite of hurricanes increasing in intensity and increasing population density in areas where these storms are likely to make landfall, we’ve gotten so skilled at predicting where hurricanes will hit, and getting warnings out to people and organizations, that direct deaths from hurricanes have steadily fallen, to the point that they’re less common than indirect deaths from storm-related infrastructure failures like power outages and traffic accidents.
This also points to the limits of the forecasting and public health infrastructure approach: all the epidemic surveillance and coordinated pandemic response in the world won’t do much to change the persistent underlying conditions of inequality and disadvantage that made Covid such an unequal killer. Communities that are pushed or held into risky positions by racial discrimination or concentrated economic disadvantage suffer worse health outcomes even under “normal” conditions, and experience deeper and prolonged harms from pandemics — as demonstrated by the persistent obstacles to vaccination against Covid in communities of color even now.
Finally, and relatedly, it’s important to ensure that even non-public-health-related institutions take seriously their role in pandemic preparedness and response. The unmitigated failure of primary education and childcare outside of the wealthier precincts of the country during the pandemic, and the haphazardly improvised response among institutions of higher education, will have negative repercussions for years to come. Planning and building response capacity now for future pandemics will blunt those harms when the next crisis arrives.
/ Community resilience
Communities with strong social bonds and healthy trust in one another and in civic institutions fare better in crises, that much is clear from years of academic research into disaster. Neighbors who check in on each other, who share supplies and information, who lend assistance and emotional support, keep damages and deaths down, lift morale and speed recovery. People who feel like they’ve played a part in saving their community, even if it’s just a small part, feel more empowered and are less likely to have lingering psychological trauma in the aftermath.
This excellent profile on community resilience hubs — local non-governmental organizations like churches or community centers that build social ties and response capacity — shows what this can look like in practice. With support but not necessarily direction from the government, resilience hubs help build trust and relationships in neighborhoods, and can be stockpiles of critical supplies. For example, as Carey Biron reports for the Thomson Reuters Foundation:
The Boyle Heights Arts Conservatory has operated in one of Los Angeles’ oldest neighborhoods for decades, running activities such as teaching youths radio broadcasting and helping with translation for the local Latino population. …
Not only a long-time community focal point, the conservatory houses some potentially important emergency infrastructure: radio broadcasting equipment, a large theater space, and even a commercial kitchen in a ground-floor pizzeria. … The city and partners are now helping bolster the conservatory so it has a power backup, emergency planning classes, cooling, and more, and can function as a formal resilience hub.
Whether formal or not, these hubs act as a social infrastructure that makes communities more resilient against crises of all kinds, whether it’s a wildfire or storm, heat wave, civil unrest, earthquake, mass shooting, or a disease pandemic. The point is to reinforce community settings that let people get together without being oriented around buying and selling — spaces that encourage interaction rather than individual consumption.
It’s possible that, as the pandemic recedes, people will choose on their own to reinforce community hubs, to turn to deepening their relationships with neighbors after a year and a half of enforced isolation. But encouraging community-based resilience is already becoming a best practice among resilience and disaster management professionals, so there’s a framework for support if the demand exists.
/ Individual habits
At some point this fall or winter, you’ll probably put on your coat for the first time of the season and find an old mask crumpled up in the pocket. By then, epidemiologists expect we’ll be in the middle of a mild Covid resurgence, as SARS-CoV-2 settles in to the seasonal rhythm most other regularly circulating respiratory viruses follow. The question is what you’ll do when you feel that mask in your pocket.
Regardless of whether or not Covid returns, most of us have become habituated to mask-wearing in some situations, a practice that helps cut down transmission of all sorts of respiratory diseases. With some luck, people will pick up occasional mask-wearing during cold-and-flu-and-Covid season as part of their general hygiene, like covering your mouth when you sneeze, or washing your hands.
Beyond this, there are all the broader habits people picked up in the pandemic: maybe you’re walking more than you used to, or moving to a healthier work-life balance, making more time to be regularly in touch with friends and family, cooking at home more. Maybe you’re more interested in volunteering in your community, or got involved in local politics. Maybe you’ve gotten in the habit of maintaining a few days’ extra supplies in the house, just in case. At minimum — a given, since you’re reading this newsletter — you’ve habituated yourself to thinking about the possibility of disease pandemics, and developed some media literacy for sussing out reliable information about how to get some sense of when danger is coming, and how to minimize your risk.
// Link Roundup
It was more widespread than we knew: In the first six months of the pandemic in the U.S., nearly 5 out of every 6 Covid infections went undiagnosed, according to a new study by the National Institutes of Health, meaning nearly 17 million cases went undetected in the first few months of the pandemic.
— “Nearly 5 Out of 6 Coronavirus Cases Were Undetected in Pandemic’s Early Months.” Amina Khan, Los Angeles Times.
— “Undiagnosed SARS-CoV-2 Seropositivity During the First Six Months of the COVID-19 Pandemic in the United States.” Heather Kalish et al, Science Translational Medicine.Domestic violence under the lockdown: The number of domestic shooting deaths in the U.S. was 4 percent higher in 2020 than the year prior, and the increase was driven by huge upswings in just a few states — domestic-violence-related shooting deaths were up 67 percent in Missouri, 69 percent in Texas, 93 percent in Maryland, and an astonishing 160 percent in Utah.
— “A Handful of States Fueled a National Increase in Domestic Violence Shooting Deaths as COVID-19 Spread.” Dan Glaun, Frontline.The misanthropes of Nextdoor: A social network tied to people’s real-world neighborhood is the next front in the fight against toxic disinformation. Jane Elizabeth reports on her experience fighting anti-vaccine trolls on the platform, where her “efforts to help people navigate the Covid vaccination process brought out the conspiracy believers, one by one, until the dialogue exploded into accusations of everything from child abuse to Satanism.”
— “The Covid Vaccine and the People of Nextdoor.” Jane Elizabeth, NiemanLab.Birthdays as spreading events: An analysis of insurance data on 2.9 million U.S. households suggests that, in counties with already high levels of Covid infections, birthday parties, especially for children’s birthdays and milestone birthdays for adults, were significant drivers of Covid spread. In high-Covid counties, households were 31 percent more likely to receive a positive Covid diagnosis in the two weeks following one of their members’ birthdays than households where no one had a birthday. The effect was stronger in households where the birthday was for a child, or when one household member reached a milestone (say, turning 40). The analysis observes only people’s birth dates, and can only infer that birthday parties are the cause of the increased risk of Covid diagnosis in the two weeks following.
— “Assessing the Association Between Social Gatherings and COVID-19 Risk Using Birthdays.” Christopher M. Whaley et al, JAMA Internal Medicine.It’s not what you drink, it’s who you drink with: During the pandemic 1 in 4 Americans reported drinking more, but the upward trend in alcohol consumption in this country has been under way since the turn of the millennium, with increases in wine and liquor consumption coming every year. That’s come with large increases in alcohol-related illness and death. The problem isn’t necessarily alcohol consumption itself, it’s the fact that, increasingly, Americans drink alone.
— “America Has a Drinking Problem.” Kate Julian, The Atlantic.Virtual Sol LeWitt: One of my favorite summer traditions is going up to MASS MoCA to visit their massive installation of Sol LeWitt wall drawings. The pandemic closed the museum last summer of course, but it’s back now, and they’ve made a virtual 3D tour of the installation you can see right through your browser by clicking here.
— “Sol LeWitt: A Drawing Retrospective.” MASS MoCA.
That’s it for this week. The final regularly scheduled issue of The CovOdyssey will hit your inbox July 10th. If you’re just coming across the newsletter for the first time, make sure to subscribe in the box below so you don’t miss it.