If a Pandemic Spreads, and No One Tests for It, Does It Still Exist?

According to the Johns Hopkins Center for Systems Science and Engineering, there are more than 400 confirmed cases of COVID-19 in the US at the time of this writing (the evening of Saturday, March 7th, 2020). According to the CDC’s website, there are 164. Why this discrepancy? As the MIT Technology Review summarized: “The first testing kits from the Centers for Disease Control had a simple fault, and red tape prevented other labs from creating their own.” This recent article from The Atlantic outlines the extent to which Federal/CDC incompetence has only deepened in the week since the first community transmission was confirmed in the US. Based on this genetic analysis of the SARS-CoV-2 (to which I’ll hereafter refer as simply: the virus) spreading in Washington State, STAT opines that “Washington State risks seeing [an] explosion in coronavirus cases without dramatic action”; Governor Jay Inslee declared a state of emergency in Washington State a week ago; Governor Gavin Newsom declared a state of emergency in California Wednesday evening; and now, here in New York State, Governor Cuomo has declared a state of emergency today as the total number of identified cases of COVID-19 (hereafter: the disease) in New York has roughly doubled for each of the past three consecutive days.

As a doctor friend of mine put it, succinctly, “It’s a giant fuck up.”

I’d take things one step further and say: we’re fucked, but it’s a little more complicated than that. From the time that the spread of the disease was recognized in Wuhan in December (and corporate media in the US launched a massive campaign of gloating about undeniable Chinese mismanagement of the outbreak), we should have been preparing for its inevitable arrival in the US. Instead, teens (and the US Internet) engaged in a lot of overblown hysteria, even more racism than usual was perpetrated, and we, collectively, went about our business as usual. We had three months to prepare, and evidently, we did almost nothing. If my pronouns are necessarily a bit vague here, I don’t think that makes them any less accurate, as all signs now are that we’re deep into a full-blown national epidemic and only barely realizing that it’s upon us.

What have our responses been? As I wrote previously, hysteria and profiteerism. N95 masks and Purell are sold out everywhere (and were selling for obscene markups on eBay until the platform banned their resale “to Stop Coronavirus Price Gouging”); everyone is evidently watching Contagion; and shares of Zoom Video (ticker symbol: ZM) have risen (against the implosion of US financial markets amidst virus-driven hysteria) in the past week, as have shares of Zoom Technologies (ticker symbol: ZOOM; an unrelated Chinese company) along with them. Many Americans reported that they would not drink Corona beer, while “the company that markets Corona beer in the U.S., shot back… the question: If 38% of Americans say they wouldn’t buy Corona beer “under any circumstances,” how are sales up 5% in the U.S.?”

None of this changes the fact that “more than half” of US states have reported cases of the disease, and the official numbers no doubt reflect a drastic – trusting my gut, as our President has been on these matters lately, I’m estimating a minimum of 10x – undercount. Meanwhile, including the incumbent, three (white, male) candidates for president, all in their 70s, are crisscrossing the country addressing large crowds and shaking hands with countless strangers as a pandemic especially dangerous to elders rips through the population. The 2020 Census – which will determine a great deal about the future of our democracy – starts this week, and – on top of all the Administration’s vicious, racist attempts to undermine it – people are now afraid to interact with strangers or leave their homes. Our authoritarian-minded President has thus far embraced his oft-invoked spirit of denialism relative to the disease, but he could just as easily announce his own state of emergency and assume all the emergency powers that would entail. In short, we face the most consequential election of my lifetime as we pass the do-or-die mark in our desperate struggle against global climate, ecological, social, and political crisis, and we’re sailing in a leaky ship into a perfect storm.

Am I afraid of the disease personally? Not particularly, but I certainly don’t want to get sick. Do I fear its potential consequences? I’m terrified. And you should be too.

To dispel a few more myths before I conclude (given that I myself misjudged this situation at first, in my expectation that it would, like SARS, be contained), this disease is not “just like the flu”; estimates have put the death rate in this unfolding pandemic anywhere from 1.4% to 3.4%. (Not to give any credence to the President’s “hunch”, but I suspect the actual rate is at the lower end of this range owing to how many mild cases of the disease have simply been missed. In the US, it took the deaths of a dozen or more elders in a nursing facility near Seattle to rouse us from our complacency, and I suspect that further genetic analyses will confirm that the virus was spreading in New York, California, and elsewhere well before its spread was recognized.) The seasonal flu, on the other hand, typically has a death rate around 0.1%, though it’s worth noting that the strain of flu that was responsible for the pandemic 100 years ago had a death rate closer to that of our present virus. [Note from March 12, 2020: I mistakenly referenced here the crude mortality rate for the influenza epidemic (~2.7%), but it’s case fatality rate was likely much higher (probably closer to 10%); in the case of COVID-19, estimates of the case fatality rate range, as mentioned herein, between from ~0.6% to 3.4%. Apologies for this error – although the core point stands; our present pandemic is far more dangerous than the seasonal flu – and thank you to our friend, Dr. N.H., for passing this along.]

I’ll let the headlines speak for themselves in mentioning excellent coverage of the pandemic by The Intercept (Cronyism and Conflicts of Interest in [President]’s Coronavirus Task Force), Democracy Now! (“Pence Is Not a Medical Expert”: Is the… Admin Ready to Stop a U.S. Coronavirus Pandemic?), and Laurie Garrett in Foreign Policy ([The President] Has Sabotaged America’s Coronavirus Response).

As with climate crisis, so with pandemic: We’ve waited until it’s too late to do anything at all, and now that the crisis is upon us – and as the rich and the kleptocrats, for the most part, shelter themselves and ask how, from this, they can profit – we’re panicking and scrambling to salvage from the worst-case scenario, something less bad. It’s a worthy goal, and (on the climate side), what I see as my life’s work. But relative to the virus, we should at least be realistic. If we were serious about containing it, we would have confronted capitalism month’s ago, at least in a limited way. Air travel, cruise ships, and tourism more generally have all been major, often intersecting, vectors for the global spread of the disease. Why did we continue flying, cruising, and touring as the virus rapidly circumnavigated the globe?

Here in New York, most of us continue to go about our daily lives. Is there something brave about this? Or something idiotic, or at least foolhardy? I think we need to confront the fact that we’ve already made a choice: That although this disease is quite different than the seasonal flu (in that it is something like 10x more deadly, and that, unlike the flu, it does not seem to impact children much at all; like the flu, however, it is contagious even when people are asymptomatic), we will treat it in much the same fashion. We will take basic precautions – including handwashing, covering our sneezes, and perhaps even temporarily avoiding social practices like hugging and shaking hands – but we will otherwise continue to go about our daily lives. We certainly won’t subject ourselves (or be subjected by our elected officials) to anything like the draconian city-wide quarantines which were mandated across much of Hubei Privince by the (authoritarian) Chinese Communist Party. As a byproduct, many people will die – most, but not all, of them those with underlying risk factors related to age, immune compromisation, or respiratory infirmity – and many more will get sick, but, in the end, this disease is not ebola, and this film, as we’re imagining it, is not Outbreak, or 12 Monkeys, or even Contagion. If anything, this pandemic is a sign of the new normal, so perhaps our approach is reasonable after all? Harm reduction, but let’s not kid ourselves that we can stop it?

Reasonable or not, it’s the bed we’ve made, so now we sleep in it. My hope is that, from the experience of one global crisis, those of us who do not fall victim to the disease will learn valuable lessons – about how to confront future outbreaks, and about the need to act before it is too late – and redouble our efforts, starting yesterday, to confront the other global crisis, much larger still, of Earth’s climate and ecology, which looms over the very possibility of a human future.

Postscript: My partner pointed me to this Business Insider piece suggesting that extensive testing in South Korea indicates a death rate as low as 0.6%, likely owing to their capture of the mild cases mentioned above, but perhaps also to the excellence of their response and health systems.