Triple Endemic Troubles

On Radical Uncertainty and Silver Linings in a Post-Truth Pandemic

by Steve Heilig

A tiny bacteria or even tinier virus gets into a flea, who jumps onto a rat, who sneaks onto a boat and then off into a new city, and changes the course of human history by spreading an infection that kills almost half of all the people alive. That’s just one type of plague, and there have been many throughout history: viral, bacterial, parasitical—with varying degrees of lethality, transmissibility, and impact. 

“Holy mother of God!” was the title of one of the first emails sent by an international epidemiologist about COVID-19, way back in December in what now feels like just not another year but another era. He had a prescient glimpse of what this new virus, likely spreading among those infected but not yet sick, could mean in this time of fast worldwide travel and dense cities, buildings, and modern life. That this virus arose from animals in crowded unsanitary conditions and quickly “went viral” worldwide was no surprise to those who had followed the research and history of recent pandemics. In fact, we’d be surprised if this hadn’t happened at some point. We’ve been warned over and over, and one could have bet on what is happening now coming tragically true. But our preparedness and response has been shown to be insufficient, if not dismal.

Masked – Painting by Cynthia Fletcher

So now we have left the era of BC—Before COVID—and are newly entered into AD—After Denial. As of this writing, more than 120,000 Americans have died in a few months, with no end in sight. Much of the nation has been on some degree of restriction to interrupt the spread of the virus, with varying successes, with huge and disruptive economic impact. And now the tricky and contentious process of “reopening” is underway, with great risk of repeating bad precedent from the worldwide influenza pandemic a century ago, when later resurgences of the virus were worse than the first. Chances are that COVID-19 will become an endemic—permanent or at least regularly recurring—part of modern life, even when a vaccine is developed. And in much of the world the spread and impact look to already be even worse. In baseball terms, I’d say we are in about the 2nd inning of this contest—if we’re lucky.

Added to this is the “infodemic”—a pandemic of misinformation about where and how the virus originated and who was responsible and might profit from it, as exemplified in an entirely nonscientific video titled “Plandemic.” Much of it is a sad replay of conspiracy fantasies circulating in the early AIDS era, all shown to be nonsense. Add to this a stream of bizarre speculation and pronouncements from the White House on down to the most scurrilous corners of the Internet, leading to anti-mask demonstrations in the streets and even death threats to health authorities. This, too, has become a hallmark risk of modern life; the vast network of digital connection that was supposed to unite humanity all too often seems to have the opposite effect, almost regardless of what the topic at hand might be. We are now in what has already been called a “post-truth” pandemic. That’s not good.

And now, yet another long-endemic American disease has again erupted, that of racial strife. Recently, San Francisco was put under evening curfew due to violence erupting in response to another killing of a black man by a policeman. It’s a tragic and terrible scenario on all counts. It’s also happened over and over—but all too often with some degree of “justification.” Back in 1968, Martin Luther King warned that “Riot is the language of the unheard.” That same riotous year, President Johnson uncannily reflected: “What did you expect? When you put your foot on a man’s neck and hold him down for three hundred years, and then let him up, what’s he going to do? He’s going to knock your block off.” Clearly, those protesting police brutality and those doing the opportunistic looting are overwhelmingly separate groups. But Dr. King also lamented that they too often get conflated, and that each looter likely brings about another vote for bigotry. One thing for sure: slavery and the genocide of Native Americans are our nation’s original sins, and neither have been truly confronted, let alone healed.

So here we are. I’ve been asked to write about our current predicament(s)—a daunting task—and I’ve been stuck on what to say. Then, on an otherwise quiet evening, two cars drove past my house with music blaring, an unusual occurrence here. But what struck me most were the songs playing. Both were vintage reggae anthems. First came Bob Marley’s “So Much Trouble in the World,” a plaintive lament the title chorus of which I have had in my ears since he released it in 1979. “You see men sailing on their ego trips / Blast off on their space ships / Million miles from reality / Don’t care for you don’t care for me,” he sang, eerily, as just recently a private company celebrated yet another space launch. But the next musical car really made me sit up; it was broadcasting the famous 1977 anthem “Equal Rights” by Marley’s even more militant brother in the original Wailers group, Peter Tosh, who sang “Everyone is crying out for peace / No one is crying out for justice / I don’t need no peace / I need equal rights and justice.” Just the other day I saw marchers with signs reading “NO JUSTICE – NO PEACE.”

I am admittedly uncomfortable talking or writing much about this disease of hatred and inequality. I’m a privileged and pale man, asked here to write about the COVID epidemic, about which I do know a fair amount (that’s my job). But these three pandemics are so intertwined it would be willful blindness to ignore any of them. COVID is exposing and highlighting the chronic inequalities and ongoing tragedies of civilization worldwide, with those already disadvantaged being hit hardest, and then having the least access to healthcare and food and other essentials to survive it. Poverty is a pre-existing condition for poor health. Even in my relatively affluent state of California, hunger and unrest are growing. And even before COVID-19 arose here, California’s outgoing Governor Jerry Brown, long a deep thinker, warned that, after decades of expansion, we faced “darkness, decline, uncertainty, and recession.” People scoffed then, but they aren’t scoffing now.

Searching for the Upsides

Many people are looking for “silver linings” to this triple pandemic. I am divided about such speculation, as so much suffering and death is the first direct impact of any pandemic, soon followed by economic deprivation. But one can hardly blame them; the future looks dire, and despair is painful. Protests are, in part, a way out of that, a desperate demonstration of the unwillingness to give up. But many are remarking that the current mass actions feel “different,” and that many more people of all kinds are active and committed. If that translates into positive action, there is reason for hope. Conservative Nobel economist Milton Friedman once noted that, “Only a crisis, actual or perceived, produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around.” And what might some such ideas be now? Here are just three, and likely they are not the kind Friedman would favor: (1) inequality, economic and racial, are long-neglected shames of our nation and world and must be corrected; (2) environmental protection and justice are crucial to a healthy and sustainable future; and (3) vastly expanded public health resources and interventions are an integral part of addressing all of these needs.

So let’s try for at least some positivity, some glimmers of hope, and maybe even optimism. Epidemics have reordered our societies and our ideas before. What might we see in the hopeful category, beyond the crucial surge in increased awareness of what we face? What might translate into lasting positive change? 

  • Climate change is an existential threat to humanity; carbon emissions have declined dramatically due to the pandemic, but not nearly enough to reverse the coming calamity, and there is great doubt that even the recent decline will be sustained. But perhaps this wind of “correction” will at least show that it can be done, in fact, that it must be done, and some form of a truly workable and wide-ranging “green new deal” will move forward.
  • Deforestation and other forms of vast environmental destruction are not only an ongoing threat to biodiversity, a livable climate, and many humans, but a primary factor in the spread of previously localized infections. Perhaps these connections will be more broadly recognized and the destruction slowed.
  • Public health resources have long been neglected, for in that realm “success often means that nothing happens,” and thus prevention is undervalued. Veteran science journalist Laurie Garrett recently observed that, at Harvard, the medical school is huge and gleaming while the School of Public Health is a relative dump. This was my perception there, too. But the even bigger discrepancy is what we spend on “defense” and other archaic but profitable priorities. Perhaps this pandemic will at last correct some of those counterproductive priorities and waste. And while vaccination for preventable diseases had frighteningly declined during this pandemic thus far, a heightened appreciation of the crucial role of vaccination could result in the longer term.
  • In medicine itself, a huge surge in research and collaboration to fight COVID is underway, with results already vastly faster, on at least some fronts, than ever before. Clinically, advances in intensive care and in ethical decisionmaking are being spurred as well, with one highlight being an overdue appreciation for the relatively new domain of palliative care. On a broader scale, the needs for a much better—in all ways—healthcare system are being highlighted, with renowned experts already predicting positive movement coming on that front. More people seem to be appreciating the sacrifices that many frontline healthcare and other workers make in their “essential” roles. Also, the wasteful overuse of antibiotics, long known as a contributor to worse outbreaks of harder-to-treat infections, is also being newly scrutinized.
  • Those who lament our species’ mistreatment of other animals might be heartened by the sudden wide awareness of how modern agriculture, and “wet markets” in Asia and beyond, so increase our pandemic risks, with new actions to decrease those epidemiological risks and ethical horrors. Food and water are life, and we need much better, greener, more equitable ways to produce and provide them. This includes a reform of industrial agriculture, especially meat production, to be less ecologically disastrous, healthier for consumers, and more humane. And heavy meat-eating itself is an eco-disaster that many more are questioning.
  • About racial issues, again, I am reluctant to speculate much. I’ve already seen too much of what looks like “virtue signaling” here, from both corporations and individuals, and don’t want to add to that. But our nation’s racial history is undeniably tragic and shameful. Systemic racism is real. So is its widespread denial. True improvements, though there have been some, have been slow to progress. In recent years we seem to have regressed, although some of it is just higher exposure. But already there are changes proposed in allowable police tactics and training, and a movement for much more, such as improved education, health care, and dismantling of the “prison industrial complex.” I asked a black woman in my extended family what she thought of the largely white marches in our area, and she replied, “Finally. It’s about time. If it were only people like me out there we’d be dismissed once again.” 

These are just a few fronts; there are undoubtedly more. A positive revolt in the leadership of some major nations could be forthcoming, as it has become undeniable that we have had some of the worst possible figures in charge at the worst possible time. A heightened commitment to the three ideas mentioned above—fighting inequality, committing to environmental quality, and prioritizing public health—would be a good start. Not to mention a general belief in science as a force for improving the world. Even FORBES magazine is speculating about a less rapacious form of capitalism coming out of this crisis. Again, elected leaders who are not morally ill would help, too—in fact that’s crucial, and if many of the protesters in our street vote, that itself might represent a huge improvement in our prospects.

On a more personal level, I have been heartened by countless smaller, local, human gestures, from spontaneous neighborhood helping circles assisting the most vulnerable, to lines to donate blood and to volunteer at food banks, to support for those in need financially, and more, including more efforts at “correcting” misinformation. There are actions that we all can take in our own realms and spheres of influence. As a semi-essential worker, I’ve been lucky enough to be able to hand out thousands of masks to doctors and other clinicians from my garage. Everyone is grateful, though it’s a shame this has even been necessary. Again, perhaps these shortages won’t recur as everybody sees how important it is to protect our “frontline” workers of all types.

Unavoidable Uncertainty—and Hope?

My friend and renowned eco-teacher, Joanna Macy, speaks of a “great turning” towards a better, sustainable, ethical way of civilized life. I truly hope she is right about that coming, however slowly. The revered writer Arundathi Roy recently wrote that the current pandemic “offers us a chance to rethink the doomsday machine we have built for ourselves. Nothing could be worse than a return to normality.” On both a personal and societal level, we might get some clarity about what is truly “essential” for a good life, a good community, and even for nation and planet. Some of the more fortunate among us, who can afford it, might learn something about slowing down the hectic pace of modern “productive” living to reorient towards what makes life most worth living—including helping others however we might be able to do so. Just about every spiritual teacher I know of has told us that’s where it’s at. In some ways, for at least some people, a New Normal might even become an improvement.

“One of the penalties of an ecological education is that one lives alone in a world of wounds,” warned pioneering naturalist Aldo Leopold, even before the climate crisis became clear. This can be true for an epidemiological education as well. One sum impact of this triple pandemic is unprecedented uncertainty, on virtually all fronts. We honestly don’t know what’s coming, and just have to live and work within that uncertainty, anxiety-producing though it may be. Being alone in that is not inevitable, though, and in fact it is essential that people band together to improve the future. “The way earthly things are going, anything can happen” sang Marley in his same, unfortunately timeless “So Much Trouble” song. That’s certainly how it feels at this point. Not really knowing what the future might bring has always been our lot, but never before on this scale and at this level of complexity. We are now in the age of radical uncertainty, with unprecedented consequences to actions we do, or do not, take—but also a lack of real control over what might happen.

All three of these pandemics—viral, misinformational, and racist—will no doubt be with us for a long time, to varying degrees. And to be honest, there are other threats looming and likely. That is unnerving, not to say terrifying. I’ve been of an semi-apocalyptic mindset most of my life—my undergraduate thesis was titled “Bad Bugs Bite Back,” about, yes, pandemics. I take no satisfaction in our current predicament. I also harbor no theories about “What it all means,” other than in the biological sense. Our nation’s unofficial poet laureate, Bob Dylan—, he of the only Nobel Prize for rock lyrics—recently speculated that COVID-19 is “a forerunner of things to come… an invasion for sure,” and that “Extreme arrogance can have some disastrous penalties. Maybe we are on the eve of destruction.” 

Dylan is, no doubt, right about arrogance, and humility should be our lot. But I hope Dylan is wrong about destruction. Every day I remind myself of one of the most famous of all books set in epidemics, The Plague, by yet another Nobelist, Albert Camus.  His 1947 novel is widely seen to be about not only an epidemic but also the fascism and other horrors of World War II. I first read it in school, and recently again, and was reminded that Camus had his narrator, a doctor, conclude that, while plague (and the evil that men do) “never dies or disappears,” it is also crucial to note “what we learn in times of pestilence: That there are more things to admire in men than to despise.” I’ve long mostly believed that, too, and often even more so with respect to women. So, at a minimum, I’m holding on tight to that conviction. And will call it hope.

Steve Heilig is a veteran public health professional, healthcare ethicist, editor, environmentalist, educator, and Commonweal staff member, who has influenced law and policy at the local, state, and national levels and received the California Medical Association’s annual award for contributions to public health. He is part of Commonweal’s Resilience Project.