With a range from the tropics to the poles both north and south, and an ever-growing population, homo sapiens have demonstrated themselves the most adaptable, four-limbed species on planet Earth, and the most emotionally complex.
Shaped by love and hate, driven by a desire for power and a gift for generosity, we live lives mixed with happiness and fear with the latter one of the most powerful of influences.
Fear of failure. Fear of loss. Fear of the other. Fear of death. And fear these days of an invisible pathogen.
There is an interesting paradox here in that the species needs fear. Lacking anything to fear, humans will invariably create something with which to frighten themselves.
But when subjected to living in fear, we have time after time accepted the danger and found ways to adapt to it in the way the species has found ways to adapt to everything.
The “Blitz” – Adolph Hitler’s attempt to bomb Britain into surrender in 1940 – is a classic example.
“For eight consecutive months, every dawn brought a new terrible toll – more bodies, more craters in the street, more buildings reduced to rubble and more fires.
“People emerged from air raid shelters, from under railway arches or merely from under the stairs, to see if their homes were still standing, or if their neighbors were still alive. Then they dusted themselves down and went to work.”
Four years later when the Allies tried to bomb Germany into submission, the story was the same. Historian Richard Overy in a later examination of this “strategic bombing” campaign designed to end the war without the need for the bloody, boots-on-the-ground, Allied invasion of Europe summarized the bombing as a costly and brutal failure.
As in Britain earlier, the Germans adapted to death from the sky. When the bombs stopped raining down, they crawled out of their shelters, counted their dead and went back to work because that is what the species has done for tens of thousands of years.
Flatten the curve
And now we are in the midst of a global Blitz of a new but old sort with the arrival of the previously unknown SARS-CoV-2 virus, a deadly spawn of raw nature of the sort that we thought we’d driven from our safe, urban lives.
A hundred years has passed since a deadly pathogen like this decimated the species. Plenty of new viruses came along in between – Ebola virus disease (EVD) in 1976; human immunodeficiency viruses (HIV) in 1983 with the disease they cause, AIDS, already spreading a wave of death through gay communities; severe acute respiratory syndrome, the original SARS in 2002; Zika virus disease in 2007; and Middle East respiratory syndrome, the “camel flu,” in 2012.
Not to mention the various forms of influenza that rose to a pandemic or locally epidemic level over the years: the Asian flu (H2N2) in 1957, the Hong Kong flu (H3N2) in 1968, the bird flu (H5N1) which had scientists in Western Alaska swabbing the butts of ducks for pathogens amid fears of the sort of pandemic raging today, and the swine flu (H1N1) in 2009.
All of these diseases killed people, but none killed the way SARS-CoV-2 has because modern medicine found ways to contain the previous diseases.
Not so this one. It didn’t take long for a few infections in China to blossom into a global pandemic, and as of today the global number of dead totals more than 1.5 million, according to the World Health Organization.
As with most things new and potentially deadly, SARS-CoV-2 scared the bejesus out of most people, and their fears only grew as the mortality rate for those who came down with COVID-19 – the disease caused by the virus – skyrocketed.
The early death rate was indeed terrifying. Of the first 128 people diagnosed with the disease in the U.S, nine died for a case fatality rate of 7 percent.
This was all out of line with any infectious diseases still in the memories of the living. The rate for the pandemic H1N1 – that so-called “swine flu” – that killed tens of thousands in the U.S. in 2009 was but 0.5 percent.
No infectious disease in recent times had come close to killing the way SARS-CoV-2 killed, which led to a search for historic precedents that stretched back to the Spanish flu of 1918-19. It caused an estimated 50 million deaths worldwide of which 675,000 were in the U.S., which then had about a third the number of inhabitants of today.
Some pandemic modelers quickly went to work estimating how many people SARS-CoV-2 could kill in today’s much more populated world and came up with huge numbers.
In mid-March, the Imperial College of London predicted 2.2 million dead in the U.S. unless drastic actions were taken. Many states, including Alaska, promptly went into lockdown.
The rapidly spreading disease and the high early death rates drove fears of a lack of ventilators to provide air to those whose lungs filled with fluid because of the disease. The rising number of infections caused fears hospitals could be overwhelmed.
Unable to do much, political leaders told citizens to stay away from each other to “flatten the curve” of escalating infections to prevent hospitals from overflowing. And this plus the change of season worked to slow the spread.
As summer arrived, and people started moving outdoors, the infection rate began to ease. As it did, people began to get used to COVID-19 because humans have an innate ability to adapt to fear.
Yes, some people were still catching the disease, but not nearly the number of those who caught it were dying. The United States graph from the World Health Organization (WHO) pretty much says it all:
A small number of infections in April and May produced a large number of deaths. And then deaths began decreasing in proportion to infections even as infections began ticking upward.
Had the rate of death seen in March and April continued, the U.S. death toll could now easily be over a half million. It’s about half that.
As of the end of November, 247,000 Americans are reported dead of COVID-19 for an average of about 30,500 per month. That’s a lot of dead people or not all that many, depending on how you look at it.
Still, COVID-19 now ranks as the country’s third leading cause of death. It cannot be compared to the flu as some have tried to do. COVID-19 has now killed about four times as many Americans as flu and pneumonia combined in 2018.
Treatments for those with COVID-19 have improved and continue to improve, but they are not great and as a result, there has been a concentrated focus on non-pharmaceutical interventions – stay-at-home orders, closures of nonessential businesses, school shutdowns, limits on gatherings and mandated face coverings.
Government officials ordered the latter despite limited evidence that masks made any real difference in slowing the spread of the infection. A raging national debate followed. Months later, a definitive answer on maks remains elusive, but the scientific consensus is that given there aren’t many ways to slow the spread of the disease while maintaining a functioning society, masking is at least worth a try.
There is no denying the better alternative to stop the spread is to cut human contacts to a minimum by restricting people to their homes for all but essential activities. That worked well in Alaska in the spring, but humans are social animals, and you can’t keep them locked up forever, especially after they’ve tasted freedom from the disease.
Summer, for better or worse, brought its own COVID-19 protection: fresh air.
One study found people were 18.7 times less likely to catch the disease in an “open-air environment” than a closed space. Another found the homeless were three times safer living in naturally well-ventilated outdoor camps than in indoor shelters.
“Previous studies and infection-control guidelines indicate that the degree of fresh air flow correlates inversely with risk of contracting COVID-19 — i.e., the risk is very low outdoors but higher when people are confined in small, poorly ventilated indoor spaces,” MedPage Today noted in the wake of that report.
Summer made all things better, and people’s fear about COVID-19 began to ease.
International and national sporting events resumed, albeit tightly controlled to try to limit the spread of SARS-CoV-2 if it showed up. And it did.
Athletes caught it, and they recovered. Plenty of average people caught it, as well, and the vast majority of them recovered. There were horror stories about how tough the recovery, and how some people suffered lingering illness.
But as of today, 8.8 million Americans have recovered from COVID-19 according to the Worldometer COVID-19 tracker. They outnumber the dead by more than 30 to 1.
This fact has had a subtle effect on many. All of us are far more likely to know someone who has had the disease and recovered than to know someone who has died.
That makes the disease look less threatening. So, too, the high-profile people who caught it and are now back at work – Cam Newton, the quarterback of the New England Patriots, and Andy Dalton, the quarterback of the Dallas Cowboys; actors Tom Hanks and Hugh Grant; British Prime Minister Boris Johnson; and, of course, President of the United States Donald Trump, who is old and overweight and thus in the category of people considered most likely to be killed by COVID-19.
All of this influences the behavior of many. People have adapted. Many, if not most, now just want to pull on their masks for public places and go on about life as if nothing has happened even as the rate of infection continues to grow and the need is far greater than in the spring to “flatten the curve.”
That idea has for some reason, however, gone out of fashion. When the Municipality of Anchorage issued a “hunker down” mandate for the month of December, the curve wasn’t even mentioned.
There were six pages of “orders,” some of them largely unenforceable – “all individuals must wear masks or face coverings and maintain six feet of physical distancing between all household groups at all gatherings” – or seemingly unenforced – “retail stores…are limited to 25 percent of building occupancy.”
No one appeared to be counting heads at the South Anchorage Costco on Friday to ensure the 25 percent limit was maintained, although the store had been religiously doing so in the spring when the state’s first hunker order was issued.
There was no one monitoring all the Christmas shoppers crowding the South Anchorage Walmart on Sunday. Few inside seemed much concerned about social distancing.
The times have changed. COVID-19 is viewed differently now than it was then. Some of the fear has faded. And the messaging has changed.
There is a lot of emphasis on masking. A lot of people have come to accept it as the COVID-19 equivalent of a seatbelt. From behind their masks, they feel safe among the masked.
Whether or not that is the case is uncertain.
“COVID-19—what have we learned so far?” The Lancet, a respected British medical journal headlined Saturday. Below was a summary of information from an earlier Lancet–Chinese Academy of Medical Sciences conference that included this:
“Holger Schünemann emphasised the importance of being transparent about uncertainty. An example: mask-wearing. Pooling evidence suggests that masks might reduce risks of coronavirus spread by 14 percent. But that evidence is of low certainty. The potential impact of mask-wearing also depends on virus exposure. In areas of low exposure, masks may not be necessary. In areas of high exposure, they may be a wise precaution.”
Schünemann is a widely respected epidemiologist at McMaster University in Canada. If he is right about masks, there are any number of situations in which they are unlikely to do much to stop the spread of SARS-CoV-2.
There are better non-pharmaceutical interventions, and the Municipality of Anchorage, to its credit, employed some of them.
Among other things, it ordered the closure of bars and restaurants for the month, which according to the CDC and a lot of studies has a big impact on the spread of the disease. But such closures cannot last long without those businesses dying, and some patrons have now likely reached the point where they’d rather have the businesses survive and take their chances with the disease.
Some consider this sort of thinking irrational, but it is no more irrational than participation in a handful of extreme sports with considerable risks of injury or death.
A study from FAIR Health – the largest repository of private health-care data in the U.S. – put the death rate for COVID-19 at 0.59 percent for 467,773 patients diagnosed with COVID-19 in this country from April 1 through August 31.
That, it should be noted, was the average death rate for all patients, though the study noted not all patients are the same. The number of patients diagnosed with COVID-19 was about evenly split between those with and without comorbidities, but in the tally of the dead, the patients with comorbidities out-numbered those without by about five to one.
There were similar disparities with age. More than 82 percent of the people diagnosed with COVID-19 were under the age of 60. But nearly 70 percent of the people who died were age 60 and older, and the mortality just kept going down as ages decreased.
Only about 10 percent of those who died were under the age of 50, and that dropped to 3 percent for those under age 40 and just over 1 percent under age 30.
If someone is young and fit, it is not irrational to have a different view of the pandemic than if old and frail. It might be inconsiderate to refuse to give a damn, given that no one has come with a good idea for how to single out the old and comorbid, and then protect them while the disease is spreading like wildfire. But it’s not irrational.
Neither is it irrational for younger Americans to abandon their fears of this disease. But if they do that, how does society get them to cooperate with policies designed to protect the vulnerable?
Among government officials and even more so the media, the answer to that question to date has largely been fear. Examples have been made of the relatively few young people to die. Stories have highlighted the young people who struggled for weeks to recover.
Fear is a great, short-term motivator, but it doesn’t work in the long term when a danger is judged to be permanent. At some point, people simply decide they want to to get on with their lives.
When that happens with COVID-19 is impossible to predict, but the economic pressure on younger Americans, those least likely to have the resources to weather a long economic slump and those most often employed in the service industries now hardest hit by government shutdowns, builds by the day.
When they decide the economic costs are far bigger than whatever fear they have left, what then?
The Spanish flu came at the end of World War I, the “war to end all wars,” so people were much better prepared to deal with daily death than they are now.
In the U.S., the end of the pandemic led into the Roaring 20s, when Americans spent lavishly and lived like there was no tomorrow as the country rushed its way to toward the economic implosion of the Great Depression only a decade later.
The situation was different in Europe. If a study completed for the Federal Reserve Bank of New York by economist Kristian Blickle in June is to believed, the seeds of Nazism were sewn by the Spanish flu, setting the world on the path to a second global war that would make the first look like a limited skirmish.
“…Influenza deaths themselves are correlated with the share of votes won by extremists, specifically the extremist National Socialist (Nazi) party,” Bickle observed. “This effect dominates many other effects and is persistent even when controlling for the influences of local unemployment, city spending, population changes brought about
by the war, and local demographics, or when instrumenting for influenza mortality.
“The results are possibly a consequence of changes in societal preferences following a pandemic….”
Correlation, as has often been noted, is not causation. And Blickle’s study more or less concedes there was so much chaos in Germany after World War I that it is impossible to say definitively what drove the nightmare that was to come.
But one thing about the German history of the time is clear: the middle lost out to a war between right and left. Both the Nazis and the Communists battled for post-war power in Germany.
Two years later, Adolph Hitler led his party to a gain of 95 seats while the Communists added but 23. The 1932 election saw the Nazis finally gain a sizeable plurality as both they and Communists worked to undermine the moderate Social Democrat Party that had led several previous ruling coalitions of the German government.
Less than a year later, the German parliament – the Reichstag – burned. Hitler blamed the Communists and accused them of plotting to overthrow the government. They were banned from parliament.
In March 1933, with the Communists out of the way, Hitler convinced the Centre Party and Conservatives in the Reichstag to join the Nazis in approving the “Enabling Act” which gave him the power to act independent of parliament to save Germany. The rest is history.
How much the Spanish flu helped power the German political tribalism that put Hitler in a position to seize dictiorial powers is impossible to know. But it is clear that pandemic did not help to stabilize the warring political factions in the Weimar Republic.
On that front, the Spanish flu in Germany and COVID-19 in the U.S. seem to bear some similarities. There is no sign of the latest pandemic bringing Republicans and Democrats together on a compromise as to how best to ensure the common good.