Weekly Lessons -2 n Learning To Lead
“As always, from the start we knew it could be bad. A novel coronavirus had emerged in China and threatened to become a pandemic. But what would that be like? How many people might sicken and die? How long would it last? What is it like, day to day, month to month, to be in a pandemic? (We did not yet imagine “year to year.”)
This is what I wrote, in collaboration with colleagues, in a story published in The Washington Post on March 3, 2020, when the United States was still more than a week away from shutting down and the World Health Organization hadn’t yet slapped the label “pandemic” on the unfolding crisis:
“The spreading coronavirus is shaping up as a pandemic of potentially historic proportions, possibly on the scale of the global outbreak of influenza in 1957 but unlikely to be as catastrophic as the Spanish flu of 1918, according to projections by infectious disease experts who are still struggling to understand this novel pathogen.”
We got the “historic proportions” right, and it’s statistically accurate that covid-19, the disease caused by the coronavirus, has been less deadly per capita than the Great Influenza of 1918. But it has been much worse than the mostly forgotten influenza pandemic of 1957. And what makes me cringe a little when I read the top of that story is the tone. The forecast, in retrospect, was emotionally sterile, failing to capture the scale and intensity of the suffering to come. In hindsight, maybe our first words in that story should have been “Uh-oh.”
We didn’t imagine the myriad ways, beyond its pathogenicity, that the virus could be disruptive: the economic shutdowns, school closures, lost livelihoods, lonely hospital deaths, drive-by funerals, anxiety, depression — all of it cascading upon us in ways that drove us apart politically and culturally. And this happened because of a virus, SARS-CoV-2, that was not terribly lethal compared with what might be lurking out there in an animal reservoir, waiting to jump into humans. That’s why some people have said we’ve been going through a “starter pandemic.” In that coldblooded formulation, this was just practice for the Big One.
Over four decades as a journalist, I’ve covered a lot of disasters, occasionally in person but more often from the comfort of a cubicle, taking feeds from reporters in the field or calling scientific experts who can explain what’s going on. I’ve written about earthquakes, wildfires, tornadoes, the killer tsunamis of 2004 and 2011, the BP oil spill (and wrote a book about that one), the West Africa Ebola outbreak, the opioid epidemic and two space shuttle tragedies — plus some potential disasters, like a giant rock from space slamming into Earth, or the Yellowstone caldera erupting. Conceivably there’s a morbid streak to my journalism, and what I need more than an editor is a therapist.
But all this death and destruction does leave me with some thoughts about disasters and what we can learn from them — whether they’re caused by a pathogen, a violent natural event or a technological accident. What follows are some lessons from the pandemic that I’ve cobbled together, based on what scientists and disease experts have told me and my colleagues over the past two years. This time, I’ll try to avoid making any predictions.
Lesson 1 Past performance does not predict future results
“Maybe it won’t be so bad” was a rational thought early on. Previous experiences suggested this new virus might be containable. Another coronavirus, causing the disease SARS (severe acute respiratory syndrome), emerged in China in 2002 and reached several other countries, including Canada, killing nearly 1 in 10 people known to be infected. But SARS was not very transmissible and was snuffed out in 2003. The official global death toll: 774.
In 2012, another coronavirus, MERS (Middle East respiratory syndrome), emerged in Saudi Arabia and killed about a third of people known to be infected. But again, this coronavirus typically is spread directly from camels to humans and does not spread easily from person to person.
Against that backdrop, some officials and scientists hoped the novel coronavirus would be manageable. “I think we epidemiologists were self-blinded,” William Schaffner, a Vanderbilt University School of Medicine professor, told me. “We knew all about SARS, and we knew all about MERS, and those were deadly viruses that were difficult to transmit. Here came covid: It was from the same virus family; we expected far too long that that virus would behave similar to SARS and MERS.”
Or covid might have been like the 2009 influenza strain (“swine flu”) that briefly threw everyone into crisis mode when it threatened to generate a devastating pandemic. In fact, the virus did spread globally, but turned out to be fairly punchless. Non-disasters, particularly after lots of hype, have a lingering effect.
“I reckon were it not for swine flu, a pandemic declaration would be pretty imminent,” Harvard epidemiologist William Hanage emailed a colleague on Jan. 28, 2020. “But the flak for not having a handle on severity before calling the pandemic burned a few people.”
The mistake is a common one we all make as we go through life: assuming this time will be like last time. Or hoping so. Call it Last-Timeism.
Here’s an example from a different arena: In 2003, NASA launched the space shuttle Columbia into low Earth orbit. During the launch a chunk of foam had peeled off a strut attached to the huge external fuel tank and walloped the underside of the orbiter’s left wing.
There was an obvious risk that such an event could damage the spacecraft and endanger its reentry to the atmosphere. But the engineers and officials who contemplated the foam strike had seen such foam strikes before and nothing disastrous had happened. No astronaut ventured on a spacewalk to inspect the exterior of the spacecraft. NASA didn’t use spy satellites to scrutinize the exterior for potential damage. Columbia burned up upon reentry. The official NASA webpage describing the 113th space shuttle mission includes a simple, brutal summary: “Loss of Vehicle and Crew.”
Lesson 2 Evolution is real, nature is inventive, and we live at the indulgence of things we cannot see
Nature is inexhaustibly creative. It’s the ultimate laboratory. Or maybe the right metaphor is the ultimate kitchen. Nature is constantly trying out new recipes and throwing stuff against the wall to see what sticks.
The origin of SARS-CoV-2 remains murky. Lab leak? There’s no hard evidence of it. Most virologists think it probably came from an infected animal sold at a market — which was the likely origin of the earlier SARS virus. Secrecy and obstructionism in China have impeded the investigation. The mystery of the origin may never get solved to everyone’s satisfaction.
What’s not that mysterious at this point is the virus itself. SARS-CoV-2 is now among the most studied viruses. Global databases have tracked its evolution. Never before has the scientific community seen so vividly the way natural selection lures new, behaviorally distinct strains from a vast viral pool.
There are four other coronaviruses that infect humans and cause roughly 30 percent of “common colds.” Coronaviruses circulate naturally in bats, which are incredibly diverse and abundant in the natural world, functioning as a huge reservoir of potentially zoonotic viruses. Zoonosis is a process in which a virus jumps from one species to another. That’s how flu emerged, somewhere in the misty past. And HIV sometime in the 1920s.
SARS-CoV-2 doesn’t mutate very fast, but when a virus begins spreading among millions of people, with each person functioning as a separate experiment in viral replication, the virus has abundant opportunity to improve itself and become more “fit.” Which this one did.
In the spring of 2020 a theoretical biologist named Bette Korber, at Los Alamos National Laboratory, concluded that one mutation, named D614G, had become so common in genomic sequences that it must be conferring some kind of advantage — that this was evolution in action. The scientific community was generally skeptical. But Korber was right: The virus was evolving! Soon almost every virus sample uploaded to the global database contained D614G.
Since then, the virus has proved to be far more mutable than we initially assumed. It’s “pantropic.” It can infect an incredible array of animals. It now infects white-tailed deer that are ubiquitous in America.
The latest variant, omicron, came out of nowhere on the family tree of the virus. One theory is the virus jumped from a human into an animal and mutated within that animal before jumping back into the human population.
Much of our early coverage treated the virus as a static agent, a constant that you could plug it into an equation. But it’s a variable. Because evolution.
Benjamin Neuman of Texas A&M University is not just a virologist, he’s a coronavirologist — a member of the small international committee that gave SARS-CoV-2 its name. He will tell you that it’s impossible to know how many potentially zoonotic viruses are circulating in the animal kingdom.
“Viruses are basically uncountable — a swirling, ever-evolving cloud,” he wrote me in a recent email. “All I can say is that every time someone samples a new group of bats, they find a host of new SARS-like viruses, and a few unexpected viruses.”
As I write, the omicron wave has swept the world. Will there be another variant? Probably. We seem to be on the road to omega. But you can’t interrogate a virus and ask it what it’s going to do next. You can’t look at a package of mutations and understand how they’ll change the virus. Even laboratory tests won’t tell you for sure what’ll happen in the real world as the virus pinballs through a complex immunological landscape. You have to wait and watch.
Lesson 3 Don’t be paralyzed by the uncertainties. Act fast.
In a crisis you have to act — despite the uncertainties and the doubts. At times U.S. and other world leaders were a step slow in their pandemic response because they were waiting for more conclusive data.
China, of course, bears much of the responsibility for the slow global response. China was not transparent in the initial days. It punished doctors who sounded the alarm. China’s leaders do not want bad news to reflect unfavorably on the regime.
Officials with the World Health Organization could have been faster to declare a Public Health Emergency of International Concern. They punted on that on Jan. 23, 2020, citing the absence of confirmed cases of human-to-human transmission outside of China. A week later they acknowledged the obvious: We were all in trouble. At that point the virus had seeded itself in 18 countries.
Flights were still coming into the United States from China at the end of January, before President Donald Trump instituted a travel ban. One traveler who had been in China during the outbreak, and whose family members had been in Wuhan, told me he walked off the plane in Detroit and was surprised that — despite all the headlines about this highly contagious virus — no one from the government was there to screen the arriving passengers. He went home and quarantined for two weeks voluntarily.
Jeffrey Shaman, an epidemiologist at Columbia University, was among the first experts to perceive the nature of the virus. Shaman and his colleagues crafted an epidemic model that suggested the official case count was a small fraction of the true number of infections. Subsequent research revealed the virus’s killer app: It could spread asymptomatically.
“I think it’s going to be pandemic, and it’s going to spread around the world — and there’s nothing we can do about it,” Shaman told me in February 2020, long before the U.S. government or the WHO said anything so dramatic.
An early warning also came from a University of Nebraska Medical Center doctor named James Lawler. He had done some back-of-the-envelope calculations, based on known cases in Wuhan and elsewhere, and concluded the United States needed to prepare for a disease burden roughly 10 times that seen in a typical flu season. By his rough calculation, which he presented to the American Hospital Association that February, the virus would kill about 480,000 over the course of a year in the United States.
“The epidemic was much larger than people were letting on,” Lawler told me. “It became clear, this is the Big One.”
Lawler didn’t just sit in his office; he flew to Japan as part of an expedition of American disease experts charged with going onboard the virus-ravaged Diamond Princess cruise ship and finding out what the hell was going on. Lawler and fellow physician Michael Callahan interviewed Americans isolated in their cabins and discovered that even the people who remained hunkered down were getting infected. This virus, they realized, wasn’t like SARS. It was a different creature entirely — less deadly but far more contagious. They placed a phone call to officials in Washington and said we were all in for a world of hurt. Back in the States they briefed officials at the Centers for Disease Control and Prevention in person.
But the CDC seemed to Lawler and Callahan to be slow to respond. They viewed the public health agency as too academic, too focused on getting the science nailed down to a high degree of statistical significance.
“They value certainty more than anything else. Which is fine in day-to-day public health, but in an emergency, speed is the most important thing,” Lawler says.
Lesson 4 Follow the science, but don’t expect it to tell you what to do
Though tediously and tendentiously pro-science, I roll my eyes when a politician vows to “follow the science.” Partly this is because of the tendency by people to employ the word “science” as if it were Things We Know — an easily accessed repository of facts, answers, inviolable truths, rather than a process for investigating the world. Many people declaring that they “follow the science” are just virtue-signaling, contrasting themselves with the charlatans who spout pseudoscience and conspiracy theories.
But the big problem with that phrase — and in recent weeks many commentators finally seem to have caught on to this — is that science can’t decide the hardest policy questions. You can say all day long that you follow the science, and it won’t tell you when to let kids go back into a classroom rather than keep them in remote learning. Science can’t tell you if you should visit your aging, isolated mom, or dare to give her a hug.
Scientific research can help inform such decisions, but risk calculations are three-dimensional chess — a game few of us are good at, in the same way we’re not so great at risk analysis in general. Driving the risk of coronavirus virus infection to zero is implausible. Living is risky. (During the pandemic I have often said — and I am sure this is not as profound as the tone of my voice suggests — “Do you know what the mortality rate for human beings is? One hundred percent.”)
For so many of the sticky questions during this pandemic, there has been no right or wrong answer. The correct answer is: It depends.
That can be unsatisfying. Science journalism, like science itself, does a lot of its labor on the edge of the knowable, in foggy realms. My colleagues and I joke that our stories can often be boiled down to three words: “We don’t know.”
Lesson 5 Pandemics are political events
Top officials in the United States believed they were prepared for a pandemic and even had densely researched reports saying so. We were ready. Then SARS-CoV-2 showed up and embarrassed us. This was a national face-plant.
The smart way for leaders to respond to a pandemic is to calculate the scope of the threat; communicate the dangers clearly to the general public; roll out tests to provide timely surveillance of the pathogen; track viral mutations through extensive genomic sequencing; share public health data seamlessly among local, state and federal agencies; find common strategies to contain the virus and mitigate the disease; and, finally, develop vaccines.
Well … we did develop vaccines.
The virus arrived with terrible timing (unless you are the virus, in which case the timing was serendipitous). In an election year, as epidemiologist Celine Gounder recently noted, the pandemic was guaranteed to become a political wedge issue. This has become a nation that could argue from dawn to dusk about whether there is really such a thing as gravity.
“Anything that was threatening to the American public, the economy, the society, public health — it could have been anything — I think it would have been politicized,” she told me.
The person who has borne the brunt of this is Anthony S. Fauci. I asked him in late December what the big lesson of the pandemic has been.
“Goodness gracious,” he answered, “when you have a historic pandemic of such devastating lethality and morbidity — we already have 830,000 [deceased] Americans — we still have this level of divisiveness in this country that is not allowing us to have a unified, World War II approach.”
[Anthony Fauci is up against more than a virus]
We’ve had more of a Civil War approach. Some people argued the virus wasn’t sufficiently deadly to justify the efforts to suppress it. Open up, they said. Protect the most vulnerable and let everyone else live their normal lives. Except they said this before there were vaccines, and without a plausible mechanism for segregating the population by vulnerability. “Tantamount to homicide” is how epidemiologist Hanage describes that strategy.
The downplaying of virus severity was unofficial government policy in the Oval Office throughout much of 2020. Trump was frequently … unhelpful. The president spoke dismissively of the virus in the same way he would a Republican primary opponent. CNN documented 38 occasions between February and October 2020 when Trump said the virus was going to disappear or was in the process of disappearing. He said “It’s going to go away” so often it was like an incantation. On Feb. 26, 2020, when there were 15 confirmed infections in the country, Trump told the country: “The 15 within a couple of days is going to be down to close to zero. That’s a pretty good job we’ve done.” The number of test-confirmed infections in the United States is now north of 77 million.
Give his administration points for Operation Warp Speed. Give Trump points for agreeing with Fauci, Deborah Birx and his other medical advisers in March 2020 that the country needed to go into shutdown mode to crush the epidemic curve. First it was for 15 days, then another 30. He may not have liked doing it, but during that first coronavirus wave Trump trusted the experts who worked for his government.
But Trump then damaged the national response by undermining those very same experts, feeding the suspicions of his base that there was something phony about this pandemic — that they were being had.
Research shows that the countries that fared best in the pandemic (and we are not on that list) enjoyed high levels of public trust in government. Trump’s rise to power leveraged distrust in government, the scientific establishment and the news media. A significant chunk of the public believes lies about the vaccines, lies about the virus, lies about Fauci, and lies about the reliability of the scientists and doctors who have been trying to save lives. Trump is not solely to blame for that. But this denial of reality has cost lives.
So many of the problems with the U.S. response to the virus have been in the category of communication. A change of presidential administrations has not resolved that. The CDC’s guidance on issues like masking, quarantine and testing has been confusing at times. Officials have had to backtrack on statements about the rarity of post-vaccination infections. President Biden’s much-hyped July 4 White House event to signal imminent independence from the virus was photobombed by the delta variant. To my ear, the Biden administration has sometimes deployed a scolding tone on vaccination, as if shaming people would make them roll up their sleeves. I doubt vaccine holdouts changed their minds when Jeff Zients, coordinator of Biden’s covid-19 task force, said people who have been vaccinated have “done the right thing” but those who haven’t are “looking at a winter of severe illness and death for yourselves, your families and the hospitals you may soon overwhelm.”
Disaster response must factor in human nature. People are generally going to do what they’ve done for the past couple million years, which is prioritize what they perceive to be their own interests and those closest to them.
In a free country, the public is not a dial in the hands of the government. Freedom even includes the right to make bad decisions. Which brings up the next lesson:
Lesson 6 We are living in the Misinformation Age
No one professes to be “anti-science.” But some people adhere to their own brand of science, their own personally curated data set, which often has no relation to the universe we actually inhabit.
“Whenever there is fear, lack of information, and scarcity, misinformation will fill the void, and some will seek to make a profit financially or politically off that misinformation,” Gounder wrote in an email.
[Five tactics used to spread vaccine misinformation in the wellness community, and why they work]
Typically this misinformation is conjoined with paranoia of a sort, in which experts not only cannot be trusted to, say, protect you from a pandemic, but they might have actually created the pandemic in the first place! The purveyor of misinformation promises to save you from malign forces. You are told that it is not enough to be suspicious of expert wisdom: You must reject it entirely, and see it as a nefarious effort to rob you of your freedom, or profit from the selling of drugs, or promote socialism.
Misinformation is a business model. The business is best when the misinformation is at its most devious, framed in the language of science so that it sounds like it might be true. And then away we go, unmoored from reality — sailing on the great Sea of Bunk.
Lesson 7 Pandemics end psychologically before they do biologically
A pandemic is caused by a pathogen but is experienced as a social, cultural, political and psychological event. As such it can intensify or wane somewhat independently of what the virus is doing.
We’ve seen that in recent weeks with the omicron wave receding. Does that mean the pandemic is over? Hush your mouth. We’ve seen how tricky this virus is. As I write, the BA.2 omicron sub-lineage is gaining traction, and (see Lesson 2) the no-longer-novel coronavirus has probably not run out of what the experts refer to as evolutionary space.
But this pandemic has become much less of a disruption in everyone’s life, even though the virus continues to circulate. Pandemics don’t end suddenly. Instead, the mask slips lower on the face, dropping below the nose, then the mouth, and then the mask is no more than a chin guard, and is finally cast away — even as the virus is still putting people in the hospital or the graveyard.
As I write this paragraph in early February in a Starbucks in Florida — where the Republican governor has prohibited mask mandates — the employees are masked, but zero of the 21 customers are. The cream and sugar are still behind the counter, so you can’t doctor your own coffee. It’s semi-pandemical.
Lesson 8 The pandemic exposed us — including our chronic inequities
The pandemic has exposed the inequities that run through our society. It’s provided a clear lesson in privilege.
If you’re in a racial or ethnic minority, you’re far more likely to have died of covid-19 in this country than if you’re White or Asian. A Post analysis last fall showed that, among people ages 40 to 64, 1 in 1,300 Whites and Asians had died in the pandemic, compared to 1 in 480 Blacks, 1 in 390 Hispanics and 1 in 240 Native Americans.
And the pandemic has not been a leveling event. It has exacerbated inequities, and not simply because Silicon Valley billionaires got even richer. I’m haunted by something Stefan Baral, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, has said consistently about the measures taken to combat the spread of the virus: They were overwhelmingly in the interest of the privileged sectors of society who could continue to work from home.
[Voices From the Aisles: The people who have kept America’s grocery stores open]
“We have done best in protecting the lowest risk communities while our interventions have done the least for higher risk communities,” he said by email recently. “I wanted us to provide resources to people that needed them to protect themselves, their households, and their communities. But we didn’t do that. Instead, we closed restaurants for indoor dining, but made sure food would get delivered to us. We ‘shut down’ cities all while making sure that we would be perfectly comfortable in our homes with all utilities running, commodities available, and everything delivered to our homes. I’m not sure what it’s been — but it is not the public health that I trained in.”
Lesson 9 We need to reinvest in this thing people call ‘public health’
You’ve heard the term “public health.” It is not an idea, a concept, an aspiration, but an enterprise. It’s something you do. Public health is our Army, Navy, Air Force, Marines and Coast Guard in the war against disease, malnutrition, mental illness and so on.
The pandemic has brought to light the underinvestment in public health, because, as everyone in the public health world will tell you, its achievements are often invisible: outbreaks that didn’t become epidemics, people who didn’t get lead poisoning, mothers and babies who survived childbirth. This imperceptibility of success is one reason public health advocates have been attacked over masking and other “non-pharmaceutical interventions” during the pandemic. The pushback has intensified in this midterm election year as conservative candidates make their opposition to public health interventions a central theme of their campaigns.
“No one is ever congratulated when the steps we took prevented something,” Mercedes Carnethon, an epidemiologist and professor of preventive medicine at Northwestern University’s Feinberg School of Medicine, told me. “People say, ‘I did something for nothing. It never happened.’ ”
When government budgets get tight, the bean counters find it easy to cut the public health budgets. Gounder points out that we’re in a century defined by information, Big Data, advanced technologies, and yet that’s not the century that your average county health department is living in. She writes: “While other industries live in the world of Big Data, public health has been left behind to languish in the world of faxes and manual data entry into spreadsheets. Underinvestment in public health tools will remain our Achilles heel no matter how sophisticated our biomedical science.”
Compared with our peer countries, the United States has a “health disadvantage.” We’re just not a very healthy country. Obesity, heart disease, lung disease, diabetes, etc., magnify the lethality of any virus and helped SARS-CoV-2 ring up a tragic death toll. To take just that first co-morbidity: According to the CDC, adult men (age 20 and older) in the United States weigh an average of 200 pounds. For women, the average is 171 pounds. Fully 73.6 percent of American adults are classified as “overweight” and 42.5 percent are “obese.”
Lesson 10 We are all in this together
There has been much talk in recent years of building walls. Nationalism is on the rise. The modern world, though, is smaller, more networked, and we have common interests, including the health of the Earth itself — its flora, fauna, its oceans and its atmosphere. The pandemic is just the latest example that America is not an island. The world is knocking at the door.
Earth life evolved in geographic niches, and we’ve metaphorically drained the oceans and leveled the mountains and shrunk the planet down to a single petri dish. There are container ships lined up to get into the twin ports of Los Angeles and Long Beach, and somewhere in there could be the next spotted lanternfly, the next emerald ash borer.
Here’s a conjecture: Our future will be marked by disasters. It’s just a matter of probabilities. There are now so many people and so many of our valuable possessions potentially in the path of calamity. Given enough time, low-probability but high-consequence events become inevitable.
Amid the acute, sudden shocks to the system will be the slow-motion disasters like climate change, ravaged ecosystems, declining biodiversity, and the miseries caused by chronic poverty, disease and conflict.
So we’re in the middle of a very interesting experiment. How will it turn out?
I can answer that!
“We don’t know.”
But certainly we need to link arms across the world rather than be at war with one another. Big problems require collective solutions, collective resilience.
We’re not helpless. We have powerful tools: science and technology. In some ways we emerge from the pandemic stronger. The advances in mRNA vaccine technology, for example, have given us a new and flexible platform for fighting disease.
Listen to Jennifer Doudna, the Berkeley scientist who co-invented the CRISPR gene-editing technology and received a Nobel Prize for it:
“You’ve heard this before, but it’s worth headlining again and again: scientists worldwide in both nonprofit and for-profit organizations have stepped up in extraordinary ways in the face of an unprecedented public health crisis,” she said in an email in early February. The results: effective vaccines produced in record time, new laboratory and in-home tests that detect the virus and the immune response to it, and new technologies that can help us fight future infectious diseases.
“All of these achievements are built around fundamental science that was largely funded by U.S. taxpayers. As a society, we need to continue investing in basic scientific research.”
Anyone feel polarized about that?
Bette Korber, the Los Alamos scientist, points out that within a month of the first appearance of omicron the scientific community was able to publish “incredible science” about it. That’s because researchers had uploaded genomic sequences to a global database, enabling laboratory scientists to create experiments with pseudo-viruses based on omicron. Korber said 8 million sequences have been shared by researchers since the start of the pandemic.
“That was not possible before,” she told me. “It’s a discovery of how to handle and share data, which is so enabling. And that’s new. It’s a beautiful thing.”
SARS-CoV-2 has been adapting to the human species right in front of our eyes in a powerful demonstration of evolution. But human beings are adaptable, too — remarkably so. That’s a major reason there’s nearly 8 billion of us.
We can reason. We can learn. I like our odds.
by Dudley M. Brooks