After the 2011 nuclear catastrophe in Japan, I spent a few years speaking and writing to my circle of influence—however large or small it was—about the long-term harm that 20th century civilization was inflicting on future generations. I’ve had such concerns all my life, but when I started writing about them in 2011, I actually developed a large circle of people to share my concerns with.
As taught in indigenous American cultures, the future generations we must care for are said to be the next seven generations, but that might just be a euphemism that means “forever.” The nuclear age has taught us the concept of the deep future, thanks to the 100,000-year problem of long-term parking for nuclear waste, with its attendant damage to the molecular building blocks of life—damage that is inflicted by the routine operations, spills, and catastrophes of the nuclear weapons and nuclear energy complex. The nuclear legacy goes with other forms of future harm such as fossil fuel burning, ozone depletion, chemical pollution, and plastic accumulation in the oceans.
The people who plan and “regulate safety” for these polluting technologies have always assured us that they do as much as possible to limit the risks and harm, but they also say there is a necessary trade-off. There will be blood, so to speak. Living within the technological order has always been a matter of deciding how many “statistical deaths” would be acceptable. X amount of radiation released over a population of 300 million people will produce Y number of cancers. X amount of nuclear warheads will expose Y amount of people to workplace exposures and releases of radionuclides from weapons plants into the surrounding environment. Y will never be zero because “we need the energy for our way of life,” or “we need the weapons for our national security.”
The same reasoning applies to other forms of pollution. Hundreds of millions of people have given their passive assent to these “acceptable trade-offs” so that they don’t have to face uncomfortable questions about their complicity in the economic and political status quo. We have never heard people denouncing their neighbors for driving cars, saying such things as, “My child has asthma. She might die because of people like you driving their cars. Just stay home, murderer!” Or, “My father is old and has emphysema. How dare you drive that car? Don’t you know air pollution causes four million premature deaths every year?”
People have never said such things because everyone drives cars, uses some form of motorized transport, or benefits from the motorized delivery of food. Until a decision was made to make us all terrified of a virus, there was a common sense understanding that a circular firing squad would solve nothing.
But now we have SARS-CoV-2 to deal with and suddenly everyone is hyper-aware of the risks involved in living in this world we’ve made. Anyone who wants to carry on as before, or anyone who worries that the reaction to the virus will do more harm than the virus, is accused of having callous disregard for the lives of others. Because he may be asymptomatic and spreading the virus unintentionally, he is as deadly as the virus itself. He might as well be the virus according to this new fear-based logic. If this is true, then we must admit we’ve all been contagious pathogens for a very long time. William S. Burroughs wrote about this in his science fiction decades ago when he conceived of social and pyschological ills as a contagion he called “the virus power.”
It was at first feared that the new virus had a fatality rate of around 4%, but recent research suggests it is in the range of 0.1-0.5% or less, which means that the mortality rate is similar to that for influenza, and we always lived without fear and drastic counter-measures when influenza strains were pandemic. And it must be stressed that this is a comparison of the mortality rate. It is not the same as saying the corona virus is just like the influenza virus in every other way. I’ve noticed that many righteous scolds telling skeptics such things as, “This is not the flu! Get that into your thick heads, people. This virus is something unprecedented.” Then in the next sentence they’ll remind you that it’s going to be just like the 1918 FLU pandemic, with a deadly second and third wave in the months and years ahead.
Apart from the people toting machine guns and screaming that they want the freedom to go out and get a haircut, there are many rational people (immunologists and virologists among them) who have tried to explain that there are some good reasons for wanting to minimize that damage caused by an over-reaction to the corona virus.
First, the strict confinement policy may have had little effect. In May, the governor of New York had to confront the fact that 66% of recent cases appeared in people who had been confining themselves. Second, confinement may be weakening people’s immune systems and depriving them of chances to have aerobic exercise and sunshine, which have proven positive effects on immunity. The confinement strategy may have been one step forward, two steps back, but we’ll never know. Its effects will be unprovable, but the political leaders responsible for them will insist they saved lives. Third, economic paralysis will make unemployment rise to 30% or higher, hinder the treatment of other public health problems, and cause all the well understood harms that result from poverty: stress, addiction, malnutrition, chronic disease, crime, and suicide. We could be idealistic and say we are going to make sure our governments act to prevent these effects from occurring, but this is unlikely to happen on short notice in most parts of the world. The confinement, and the economic pain it caused, was one of the obvious causes of the outburst of protests that erupted after the murder of George Floyd on May 25, 2020. The sudden rush of people back into the streets may have negated the outcome the confinement was supposed to have prevented.
Hundreds of medical experts are calling for a different approach than confinement, and criticizing what has been done so far. In Northern Ireland, Dr. Anne McCloskey made this assessment on April 20, 2020:
… early identification of Covid cases by testing those with symptoms, and then tracing and isolation of contacts could have made a real difference. But the lack of systems, equipment and most importantly the vision to implement the programme meant valuable weeks were lost… So the relentless media images of mass graves, competition for ventilators, acres of intensive care beds manned by soldiers and students do not reflect reality… it is now estimated by people working on the ground that at least half of the excess deaths may be due to the lockdown itself, and the fear it generates, as well as to suspension of much of the vital work which the health service always does… Lockdown is not, of course, as is its supporters imply, a question of saving human life versus mere money… The inevitable catastrophic drop in economic activity, the millions pushed into unemployment, unable to pay rents or feed their families, the small businesses closed which will never open again, the fall in tax revenue to pay for our health service and welfare provision-all of this is not outcome neutral… As always, the poor and less able will be disproportionately affected. Many will die and many more will have their lives changed forever… We also know that countries where hygiene measures, social distancing, contact tracing and isolation of the vulnerable are being used are having comparable medical outcomes to those who have opted for total lockdown.
The virus is a force of nature, a natural disaster that is going to do its damage in slow or fast motion. We can run, but we cannot hide, or perhaps we can hide in our homes, but we can’t outrun it when we decide to return to life outside.
Some say that Sweden’s relaxed strategy was a mistake, but we won’t know until the pandemic is over and total harm can be quantified in Sweden and its neighboring countries. Perhaps Sweden has taken a heavier hit up front but will suffer less later on. New Zealand, on the other hand, has kept itself untouched by the virus, but for how long? New Zealand’s prime minister has been held up as a model the whole world should have followed, but another way of looking at her policy is this: New Zealand is selfishly waiting for the virus to “burn through” other countries, letting herd immunity develop elsehwere. Then it will let foreigners in once again when the virus is extinct. Other countries are doing the heavy lifting, so to speak.
It is unavoidable that people will have to resume life as it was, and it is unavoidable that the virus will continue to affect the most vulnerable people. Confinement was the right thing to try for a while when the virus was less well understood, but it is clear that confinement cannot be repeated indefinitely. I doubt political leaders imagined confinement would last longer than a month, but they just didn’t think about what they would do a few weeks later when the virus hadn’t disappeared. Now they are being told there is no vaccine on the horizon and no end in sight until two or three waves of the pandemic come over the next few years.
It is obvious that some strategy other than confinement will be necessary. It is obvious that that strategy involves improved health care and better protection of the vulnerable while the majority of the population is allowed to live again. The majority can still be advised to take precautions and do more to improve their health.
And for my friends on the left, I have to add that a desire to go back to work does not necessarily mean one has been a fake leftist and closet fascist all along, eager to submit to capitalist exploitation and forego this great opportunity to strike and usher in a “just economy.” People going back to work means food gets delivered, surgeries are performed, children learn to read, workers can eat. People take pride in doing their jobs and paying their bills from what their labor earns. Most people work for small businesses or in the public sector—segments of the economy which don’t need to be targeted for radical reform. Overhauling the capitalist structure that has created wealth inequality and private ownership of the commanding heights of the economy is an issue quite separate from deciding whether Main Street can re-open.
But let’s imagine that a socialist revolution could emerge out of this crisis. It’s not likely to happen because it would have to emerge from nothing. There are no large, popular revolutionary groups comparable to the Bolsheviks or Mao’s army, and no signs that military officers and rank-and-file soldiers are ready to pledge their allegiance to the non-existent movement. But let’s imagine it happened. What then? There couldn’t suddenly be a “just economy” delivering all essential goods and services to citizens as they just stayed home and waited indefinitely for the corona virus to vanish from the earth. Wealth could be seized and dollars could be distributed to the needy waiting at home for their grocery money and rent, but those dollars would quickly lose their value if there were no people producing goods and moving them to where they were needed. As Marx said, all value comes from labor, not from the dollar bills themselves. We couldn’t have one half of the population just staying home while the other half worked to produce what the home-bound basic income recipients wanted to buy. There would be huge resentments against this new class of freeloading young pensioners. The new socialist leaders would soon be extolling the virtues of getting back to work, just like Louverture, Lenin and Mao did in their time. Every citizen would be mobilized and told to be ready to sacrifice for the cause. From the moment it seizes power, every revolution has to prepare to fight the counter-revolution.
Devising the best strategy that doesn’t involve confinement of the healthy brings us back to the long-term problems discussed above. It should be obvious by now that the shocking number of deaths caused by a virus this year resulted from a situation that was baked into the system a long time ago. Nuclear and chemical contamination got into people in utero, in their early developmental years, and throughout their lives. To cite just one example, see the Wikipedia page on xenoestrogens to ponder the numerous man-made chemicals that have generated what scientists refer to as “hormonal chaos.”
Genetic damage to soldiers who witnessed nuclear tests was passed on to their descendants. The catastrophe was created in the early 20th century and has rippled through all subsequent generations. Even though we cannot confirm all mechanisms of damage and all their complex causes and effects, we know there has been a strange degeneration in fitness. We see people dying at a younger age than their parents. Photos from the 1940s of people in Times Square show few obese people. This is not to blame the victims. People didn’t ask to be served a staple diet of glyphosate and fructose corn syrup in their food supply.
In addition to the chemical and radiological contaminants we have been exposed to, social and economic arrangements have toxic effects. We evolved to be hunter-gatherers living in small communities in which all children were always together with all adults. In urban environments we are literally animals in a zoo deprived of our natural environments. Studies such as the Adverse Childhood Experiences Study, published a quarter century ago, confirmed the lifelong damage caused by childhood trauma. The worse the trauma, the worse the chronic disease throughout a lifetime.
I had this vision of publishing the book with the title only—The Myth of Normal: Illness and Health in an Insane Culture—and have everybody just write their own experience into the book—just put empty pages in it. I’m not sure my publisher would go for that. – Gabor Mate, “Coronavirus, Trauma & Self-Isolation Mental Health: How Stress Impacts Your Life,” London Real, April 2020, 1:08:10~
So now we are very shocked that a virus has come along that hastened the deaths of people who have the worst chronic health problems. While we now cry about how unfair it is that people are going to die because of this virus, we should humbly take note that our protest was long absent and long overdue. The majority of people thought little about the ultimate causes of chronic health problems, and they refused to support radical alternatives for solutions. They are very concerned about global warming, but they won’t vote for the Green Party, which isn’t even a very radical alternative. They preferred to participate in a political system that is thoroughly controlled, left to right, top to bottom, by the economic interests that created the crisis and let if fester for decades. They voted for the “lesser evil” and berated anyone who refused to do the same.
I hesitate to say some of the things I’ve expressed here because I know I will be called loathsome for not caring about the “frontline” medical workers who have seen patients dying, or died themselves. I know the sudden wave of death caused by the virus has been horrible in some places, and I know the virus is not a hoax or “just like the flu.” There is something especially virulent about it, but it’s not the bubonic plague, either. It didn’t increase the overall rate of death significantly, or most people’s risk of dying this year, yet the fear itself lowered immunity in many of the virus’ victims. The reaction to it has set in motion a social catastrophe that most people seem strangely oblivious to. The looming disaster should be apparent now, but no one seems too concerned. The UN warns that massive starvation will result from the economic paralysis, but this is a back-page story. The news anchors quickly get back to fear-mongering about the risk that you or someone you love is going to die of pneumonia in the near future.
I wish I could bring my eighty-year-old grandfather back to life in this present moment. He passed away in 1987, age eighty-something, but I would like to ask his eighty-year-old self if he would be happy to see the economy shut down so that his risk of a deadly viral infection could be reduced. I would explain to him that the law firm he inherited from his father and nurtured throughout his life would likely go bankrupt in the coming months. Even though he was at that age retired and not dependent on income from the firm, I think he would find the notion absurd and abhorrent. How could he want unemployment and financial ruin for his former staff and the partners whom he sold the firm to? Even if I could explain to him the wonders of Zoom meetings, the plan to quarantine the healthy would make no sense to people who lived through two world wars and the 1918 pandemic. It doesn’t make sense to me, either.
Some people who read this are bound to say, “Well, you’re not a doctor. This isn’t your field.” So, yeah. I’m not a doctor. I’m not giving medical advice here. I’m speaking as a sixty-year-old from my own life expriences, as an old man who has to deal with the risk the virus poses to me and my family. I’m concerned with social policy and radical solutions, with people taking stock of the real challenges and dangers of the world they inhabit. For those who find my argument lacking merit, I end with an excerpt from an interview with epidemiologist Dr. David L. Katz, the man whose essay inspired the strange title of this blog post. He has something to say about how the corona virus should be assessed against the chronic disease risks and dangers that are always with us.
Biographical details: Trained in internal medicine, clinician for thirty years, founded and directed Yale University’s Yale Griffin Prevention Research Center, board certified specialist in preventive medicine and public health, co-authored multiple editions of a leading textbook on epidemiology and public health, career-long interest “in doing everything possible to add years to lives and life to years.”
This study [Covid-19 Antibody Seroprevalence in Santa Clara County, California] aimed to generate an estimate of how many people in Santa Clara County have been infected with the virus, and the way to find out is to try to see whether they have developed antibodies to SARS-Cov2. So we had a sample of residents in Santa Clara County evaluated for the presence of antibodies, and the sample was 3,300 people who came to be tested. We estimated that, based on what we saw, between 2.5 and 4.2 percent of the population of the county has antibodies, which is an indication that they were infected with the virus a while ago.
We estimate [extrapolating from our sample] the number of people who have been infected varies from 48,000 to 81,000 versus the number of documented cases that would correspond to the same time horizon around April 1st, when we had 956 cases documented in Santa Clara County. We realized that the number of infected people is somewhere between 50 and 85 times more compared to what we thought, compared to what had been documented immediately. That means that the infection fatality rate, the probability of dying if you are infected, diminishes by 50 to 85 fold because the denominator in the calculation becomes 50 to 85 fold bigger. Our data suggest that Covid-19 has an infection fatality rate that is in the same ballpark as seasonal influenza. It suggests that even though this is a very serious problem, we should not fear it. It suggests that we have solid ground to have optimism about the possibility of eventually reopening our society and gaining back our lives sooner rather than later, with full control and a data-driven approach.
My interest from the start in the pandemic has been what I now call “total harm minimization.” As people who are interested in public health, we’re always concerned about social determinants. One of the leading predictors of all key health outcomes, all-cause mortality, and total chronic disease risk is social determinants: poverty and access to food, services, and critical goods. It was pretty clear early on that the pandemic response could basically dismantle supply chains and the provision of services. That would fall disproportionately hard on the people who were marginal to begin with. So the big picture right at the start was this virus can kill people and social upheaval can kill people, not necessarily the same people, although there’s considerable overlap. And what we want to do with public policy is gather the data to know who’s at risk for all of the fallout, both the direct harms of infection and the indirect arms of economic collapse, of social upheaval, and we want to minimize the sum of the two. So I call that “total harm minimization.” That’s the campaign.
… [We are] mired in a viral pandemic, [yet] the big public health focus of our time is lifestyle practices that translate into variable risk for chronic diseases that are the single greatest burden in the modern world. Most people succumb to premature death from heart disease, cancer, stroke, diabetes. Diabetes was pandemic long before coronavirus was pandemic. Really the only difference between pandemic chronic disease and pandemic contagion is the timeline. In fact, these chronic diseases kill millions of people around the world every year, but because it plays out slowly, we tend to be fairly oblivious to it. That’s an interesting story in its own right, and it’s the paleo-anthropologists who best explain it.
Our perceptions of time and risk are best expressed in the fight-or-flight response. This basically was burned into our DNA when we were struggling to survive on a savanna and when the threats we had to worry about played out in seconds or minutes. They were threats like tooth-and-claw and fang-and-venom, and they had nothing to do with years and decades, which is the timeline for chronic disease. So we’re incredibly oblivious to the massive toll of human misery and premature death from chronic diseases: diabetes, heart disease, cancer etc.
The first thing we needed to do when we saw the coronavirus coming from far away was decide how can we protect people vulnerable to severe infection. We had two options, and I wrote about these. One was horizontal interdiction. Keep everybody away from everybody else and the bug. The other was vertical interdiction, which was to establish risk tiers, identify who is at high risk of severe infection, who is not, and make sure we keep the high-risk people away from the virus. There are two advantages in doing either of those things. One is people who are at elevated risk of severe infection or hospitalization, needing a ventilator, or dying avoid all of that. And since we don’t have a concentrated population needing intensive medical care all at once, we avoid overwhelming the medical system. I would have convened all of the relevant experts in policy to determine if we can do vertical interdiction from the start. First of all, do we know reliably enough who is at elevated risk, or do we still have lots of doubt? And do we wonder if what’s true in South Korea will be true in the United States because our health is different? If we think we can do an elegant-from-the-start vertical interdiction, just protect those at high risk. If we’re confident we can do that, well let’s start there. So I would have done that, but I also would have been prepared to concede that’s too elegant. It’s a step too far. We’re not that organized. We’re not that sure who is at risk. Let’s start out with horizontal interdiction, and while we’re doing that, let’s gather the data we need in America. Let’s do everything we can to source test kits both for infection and immunity. Let’s get out into the population.
… We needed to think about gathering data, and then as we were protecting, one way or another, people at high risk of severe infection from exposure, we needed to start gathering data so that we knew who in this country was at lower risk, who could afford to go out to the world, who already is making antibodies and might be in the vanguard of leading us toward herd immunity. And then we basically need a plan for a plan.
I think one of the most distressing elements in all of this is that all that we seem to be hearing about are extreme positions. So flatten the curve indefinitely, which kind of translates to “hunker in a bunker and hope there’s a vaccine before you die of something else.” And for older people, who may very well die of something else, if this takes eighteen months or two years, or three years, before ever again being able to hug their grandchildren, that’s really distressing. I think that distress is a major health concern. If we leave people to shelter in place with anxiety, uncertainty, dread and doubt, we are going to propagate an epidemic of mental health decline. There will be depression and anxiety, and some people will turn to substances, and there will be ill health effects from that, and they will be grave.
… I think the American public deserve to know right at the start that if there wasn’t a fully baked plan yet, there was a plan to have a plan. We didn’t get that. It’s been very clear from the earliest days of this pandemic. Even the data out of China tell the same story—that there are massive risk differentials and they relate to age. They relate a little bit to sex because men are at greater risk of this virus than women, but they really relate especially to baseline health status. So people with a significant burden of chronic disease are at much increased risk for severe infection from coronavirus. That suggests that, potentially, the protections that we mediate through public policy—the ways we try to keep people and the virus apart maybe shouldn’t be a one-size-fits-all strategy.
Maybe there is an optimal balance to strike between preserving critical goods and services supply chains and critical elements in the workforce among people who are at relatively low-risk for severe infection. It won’t be zero, but we’re used to that. Life involves risk. We go out every day and we face some risk of something bad happening, so nobody’s going to get a guarantee here that you aren’t going to get a severe infection, but we can identify the population where that risk is at a familiar level, the kind of risks we all accept every day, maybe down at the level of the risk of flu being a severe infection.
. John Ioannidis, “Dr. John Ioannidis Announces Results of COVID-19 Serology Study,” Journeyman Pictures, April 19, 2020. The article discussed is: Eran Bendavid et al, “Covid-19 Antibody Seroprevalence in Santa Clara County, California,” April 2020.
. Divya Ramaswamy, “Coronavirus New York Shock: Two-Thirds Of Recent Patients Infected While Staying At Home,” International Business Times, May 5, 2020.
. Eric Mack, “Study: Exercise Proven to Help Avoid Serious COVID-19 Cases,” Newsmax, April 17, 2020.
. Sheldon Krimsky and Lynn Goldman, Hormonal Chaos: The Scientific and Social Origins of the Environmental Endocrine Hypothesis (Johns Hopkins University Press, 1999).
. Dennis Riches, “Revelation: I am the alpha, the beta and the gamma,” Personal Blog, March 1, 2016.