Читать книгу Epidemic Leadership - Larry McEvoy - Страница 15

Until COVID-19 shattered our veneer, many of us thought of epidemics as relics of the past, or at least something not particularly relevant to our day-to-day lives. We have an annual influenza epidemic, and in the twenty-first century we've already had epidemics of diseases with strange names: SARS, MERS, Zika. Ebola, the virus lurking in the equatorial forests of Africa, rose up and killed 11,310 people in Guinea, Liberia, and Sierra Leone between 2014 and 2016.¹ That was then, though, we thought. It was so long ago and far away in an age when yesterday can be quickly forgotten. Our world kept whirring in a blur of Facebook posts, hypershort media cycles, and a million things to do and distract before COVID arrived. Possessed of our computers and networks, vaccines and antibiotics, constant video feeds and big data, it was tempting to see the deadly power of epidemics as old furniture in remotely historic eras—if we were even thinking about epidemics at all.

There were, indeed, catastrophic and legendary eruptions of disease in the past. Across history, infectious plagues have certainly decimated humanity—the biblical plagues, the Black Death, the flu epidemic of 1918. Smallpox, now officially eradicated, killed as many as 300 million people in the twentieth century alone,² despite the fact that vaccination against it began in the early 1800s. Unknown millions of people native to the Western Hemisphere died after Columbus brought the disease to the New World in 1492.³ Those sweeping sixteenth-century North American epidemics, while hinted at by later smallpox outbreaks, remain largely invisible to our subsequent awareness as they weren't recorded. Instead, vastly reduced populations of Indigenous people defined the modern view of the Western Hemisphere's human numbers as more Europeans arrived later to a vastly underpopulated continent.⁴

Bubonic plague, the infamous Black Death, entered Europe in 1347 after the disease inserted itself into a year-long siege between the Mongol King Jariberg and Italian merchants at the outpost of Cappra. Once it reached mainland Europe, 25–50 million people died in five years, thought to be 50 percent of Europe's population at the time. Then, as now, adjacent unrest and violence flared up, as antisemitic sentiment and brutality boiled to the surface. Over 200 Jewish communities were massacred; 2000 Jewish people were burned alive in Strasbourg alone on Valentine's Day, 1349.⁵

COVID may have surprised us, but it shouldn't have. We had warning that epidemics were looming. For some years, epidemiologists, scientists, and military planners have been warning us of the destabilizing power of epidemics moving through our populations. Time Magazine's 2017 cover declared, “We Are Not Ready for the Next Pandemic,” and Bill Gates's now-famous TED Talk reviewed our urgent need to prepare for an era when tiny, anonymous microbes would sweep across our social stability and wreak upheaval. Before COVID arrived among us, Ebola, SARS, MERS, Zika, and H1N1 had already created significant havoc in the first fifth of the twenty-first century.

Epidemiologists tell us there are more epidemics ahead. Even now, while we grapple with logistic, economic, and political dimensions of the most widespread global health threat we have seen, policy makers, militaries, governments, health agencies, and intelligence capacities around the world are thinking about how to mitigate the devastation of “Disease X,” the hypothetical viral pathogen poised to destabilize civilization. They contemplate the odds and possibilities of the kind of things that spawn horror movies—World War Z, Outbreak, Contagion all being examples of out-of-control instability that deadly epidemics bring. Can you imagine a virus that moves like COVID-19 and has Ebola's death rate of 50 percent? Those future superpathogens and their destructive fallout are what haunt the epidemiologists and military planners.

Approximately 1.67 million viruses are known to human science, for example. Over 250 of those infect humans, but scientists calculate there are between 631,000 and 827,000 viruses that can potentially infect humans.⁶ In conditions of disruption and chaos—rapid environmental changes, degraded sanitation and nutrition, infrastructural decay, and social instability—such viruses are more likely to break out of their native environments, where they are locked into a kind of lattice that prevents them from causing human harm, into human populations. When these viruses do break out, they're lethal and expensive. Our pre-COVID twenty-first-century epidemics of SARS, Ebola, and Zika have all cost thousands of lives and tens of billions of dollars. The economic cost of COVID, of course, has been staggering. In a Journal of the American Medical Association article published in October of 2020 and based on the assumption that COVID-19 would be under control by the Fall of 2021, the authors estimated the cost of the epidemic at 16 trillion dollars.⁷ That article was published before a number of the subsequent unknowns inherent in epidemics popped up—the vaccines, the mutations, the distribution delays. However accurate or inaccurate the estimate, the underlying point is clear: disease-ridden societies cannot prosper.

Viruses are particularly fantastic epidemic starter material, and Disease X refers specifically to viral pathogens, but epidemics don't have to be viral. Bacteria like streptococcus, the ubiquitous bug that infects human throats and causes the familiar childhood strep infection, and microscopic animals called protozoans, responsible for malaria, for example, can all move rapidly through human populations with devastating effect.

Those are just biological epidemics. We also now know epidemics can be behavioral and social, following the same organizing rules as purely biological ones. Authors such as Nicholas Christakis and James Fowler, who wrote a wonderful book called Connected: The Surprising Power of Our Social Networks, and Damon Centola, who wrote How Behavior Spreads: The Science of Complex Contagions, have revealed how behavioral epidemics both follow the rules of biological epidemics and also run counter to them in some ways. Although there are similarities and differences, the epidemics themselves are quite real.

These “believe-and-behave” epidemics are moving through our population with sinister effects. Opioid addiction is a classic example, but racism, antivaccine thinking, disinformation, QAnon, and online hate speech all follow the rules of epidemic spread within our human populations, apparently undaunted by our conventional efforts to stop them. Our social communities inherently unleash or corral ideas, insights, bias, and behaviors—voting tendencies, sexual practices, culinary recipes—much the way ecosystems unleash, stabilize, or inhibit infectious diseases.

Our communication technology has emerged as the double-edged sword to traffic both the profound evolution of ideas and the tragic deconstruction of social discourse. We once thought of epidemics as punishment from the Divine and then learned to triumph over them with vaccines and drugs. We now live in a world where the design of social media platforms both complicates our response to societal challenges and spawns whole clouds of thought and opinion, amplifying particular bits of information and—more ominously—disinformation. We have a measles vaccine, for example, that works well and can stop the disease of measles, a disease both highly contagious and significantly damaging. Unfortunately, we have a parallel epidemic of antivaccine thinking that undermines valid science and exploits vulnerable populations as effectively as any virus, leaving them swept with measles at a time when we have an effective vaccine to prevent it. Online, you can find both cogent scientific comment about the various COVID vaccines and maddeningly false but heavily trafficked myths about them. We've built a world where epidemics are inevitable and primed to be more explosive and more divisive.

We also know that where there is one epidemic, it's often riding on the coattails of another, or, if not, it spins off another one because of its own effects. Scientists call such pairings and linkages syndemics. Chlamydia and gonorrhea ride together, coexisting because of their similar method of sexual transmission. Similarly, COVID and obesity synergize in the United States, mixing to create a multiplying effect of severe illness, side effects, and death more pronounced than either would alone in the short term.⁸

Epidemics of skeptical mindsets and harmful behaviors have commingled amid COVID—those who thought the disease was a hoax were much more likely to flout practices that would limit its impact and spread, thereby unwittingly multiplying the phenomenon they didn't think was real. Because we do not pay so much attention to them when they're small and fragile, epidemics seem to just pop up, ooze under our doors, and grow. Once they get bigger and more widespread, they are much harder to reel back. Worse, epidemics spawn secondary epidemics. They literally multiply their own numbers and the numbers of problems they create.

We all want these epidemics to stop, to go away and never come back. But they don't. We have managed to eliminate a few, smallpox being the poster child for disease eradication, but most are stubborn and relentlessly reappearing. Influenza is a classic example, returning every year when the time is right. Equipped with maddeningly adaptive changes in its DNA sequencing that allow it to slip past both our engineered barriers—the annual version of the flu vaccine and our advocacy programs for getting a flu shot—and our bodily surveillance—our individual immune systems—it is relentless among us. There are other epidemics on which we have made great progress only to be foiled by an additive perceptual epidemic that has mitigated our efforts to stop the disease itself, as is the case with measles and antivaccine sentiment.

We've seen all these intertwined realities with COVID, and the take-home message for leaders is less about COVID itself, bad as it is, and more about the pattern of epidemic action in our social identity, large and small. We now know more about how epidemics rise, propagate, and abate, but the patterns are as timeless as biology, and they are not going away. The epidemics I was battling were not new to me or to science on my overwhelming night in the emergency department. We had been seeing gonorrhea, chlamydia, and influenza for years; we had also been seeing obesity, diabetes, domestic violence, and opioid use advancing across our populations.

It turns out epidemics are not just past and present; they are also future. Epidemics are not rare; they're common. Epidemics are not hypothetical; they're real. Born of disruption, they launch from a thousand places and cause more disruption. Epidemics aren't just throwing us into chaos but depend on and benefit from that chaos to rise and move. With our dense and redundant networks of travel, trade, and communication, we've built a world in which they will rise and rise again. They can and will be devastating.