SAĞLIK & TIP & HASTANELER & PSİKOLOJİ & SOSYOLOJİ & KİŞİSEL GELİŞİM & FELSEFE

How
the Pandemic Will End


The U.S. may end up with the worst COVID-19 outbreak in the
industrialized world. This is how it’s going to play out.


Editor’s
Note: The
Atlantic
is making vital coverage of the coronavirus available to
all readers. Find the collection here.


Three months ago, no one knew that SARS-CoV-2 existed.
Now the virus has spread to almost every country, infecting at least 446,000
people whom we know about, and many more whom we do not. It has crashed
economies and broken health-care systems, filled hospitals and emptied public
spaces. It has separated people from their workplaces and their friends. It has
disrupted modern society on a scale that most living people have never
witnessed. Soon, most everyone in the United States will know someone who has
been infected. Like World War II or the 9/11 attacks, this pandemic has already
imprinted itself upon the nation’s psyche.







A global pandemic
of this scale was inevitable. In recent years, hundreds of health experts have
written books, white papers, and op-eds warning of the possibility. Bill Gates
has been telling anyone who would listen, including the 18 million viewers
of his TED Talk
. In 2018, I wrote a story for
The
Atlantic
arguing that America was not ready for the pandemic
that would eventually come. In October, the Johns Hopkins Center for Health
Security war-gamed what
might happen
if a new coronavirus swept the globe. And then one did.
Hypotheticals became reality. “What if?” became “Now what?”




So,
now what? In the late hours of last Wednesday, which now feels like the distant
past, I was talking about the pandemic with a pregnant friend who was days away
from her due date. We realized that her child might be one of the first of a
new cohort who are born into a society profoundly altered by COVID-19. We
decided to call them Generation C.

As we’ll see, Gen
C’s lives will be shaped by the choices made in the coming weeks, and by the
losses we suffer as a result. But first, a brief reckoning. On the Global Health
Security Index
, a report card that grades every country on its pandemic
preparedness, the United States has a score of 83.5—the world’s highest. Rich,
strong, developed,
America is supposed to be the readiest of nations. That illusion has been
shattered. Despite months of advance warning as the virus spread in other
countries, when America was finally tested by COVID-19, it failed.



“No matter what,
a virus [like SARS-CoV-2] was going to test the resilience of even the most
well-equipped health systems,” says Nahid Bhadelia, an infectious-diseases
physician at the Boston University School of Medicine. More transmissible and
fatal than seasonal influenza, the new coronavirus
is also stealthier
, spreading from one host to another for several days
before triggering obvious symptoms. To contain such a pathogen, nations must
develop a test and use it to identify infected people, isolate them, and trace
those they’ve had contact with. That is what South Korea, Singapore, and Hong
Kong did to tremendous effect. It is what the United States did not.




As
my colleagues Alexis Madrigal and Robinson Meyer have reported
, the Centers
for Disease Control and Prevention developed and distributed a faulty test in
February. Independent labs created alternatives, but were mired in bureaucracy
from the FDA. In a crucial month when the American caseload shot into the tens
of thousands, only hundreds of people were tested. That a biomedical powerhouse
like the U.S. should so thoroughly fail to create a very simple diagnostic test
was, quite literally, unimaginable. “I’m not aware of any simulations that I or
others have run where we [considered] a failure of testing,” says Alexandra
Phelan of Georgetown University, who works on legal and policy issues related
to infectious diseases.


With
little room to surge during a crisis, America’s health-care system operates on
the assumption that unaffected states
can help beleaguered ones
in an emergency. That ethic works for localized
disasters such as hurricanes or wildfires, but not for a pandemic that is now
in all 50 states. Cooperation has given way to competition; some worried hospitals
have bought out large quantities of supplies, in the way that panicked
consumers have bought out toilet paper.

Partly, that’s
because the White House is a ghost town of
scientific expertise. A pandemic-preparedness office that was part of the
National Security Council was dissolved in 2018.
On January 28, Luciana Borio, who was part of that team, urged the
government
to “act now to prevent an American epidemic,” and specifically
to work with the private sector to develop fast, easy diagnostic tests. But
with the office shuttered, those warnings were published in The Wall
Street Journal
, rather than spoken into the president’s ear.
Instead of springing into action, America sat idle.



Rudderless,
blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19
crisis to a substantially worse degree than what every health expert I’ve
spoken with had feared. “Much worse,” said Ron Klain, who coordinated the U.S.
response to the West African Ebola outbreak in 2014. “Beyond any expectations
we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins
Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi,
the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the
industrialized world.”




I.
The Next Months


Having fallen
behind, it will be difficult—but not impossible—for the United States to catch
up. To an extent, the near-term future is set because COVID-19 is a slow and
long illness. People who were infected several days ago will only start showing
symptoms now, even if they isolated themselves in the meantime. Some of those
people will enter intensive-care units in early April. As of last weekend, the
nation had 17,000 confirmed cases, but the actual number was probably somewhere
between 60,000 and
245,000
. Numbers are now starting to rise exponentially:
As of Wednesday morning, the official case
count
was 54,000, and the actual case count is unknown. Health-care
workers
are already seeing worrying signs: dwindling equipment, growing
numbers of patients, and doctors and nurses who are themselves
becoming infected
.


Italy and Spain
offer grim warnings
about the future
. Hospitals are out of room, supplies, and staff. Unable to
treat or save everyone, doctors have been forced into
the unthinkable
: rationing care to patients who are most likely to survive,
while letting others die. The U.S. has fewer hospital beds per capita than
Italy. A study
released by a team at Imperial College London concluded that if the pandemic is
left unchecked, those beds will all be full by late April. By the end of June,
for every available critical-care bed, there will be roughly 15 COVID-19
patients in need of one. By the end of the summer, the pandemic will have
directly killed 2.2 million Americans, notwithstanding those who will
indirectly die as hospitals are unable to care for the usual slew of heart
attacks, strokes, and car accidents. This is the worst-case scenario. To avert
it, four things need to happen—and quickly.




Read:
All the president’s lies about the coronavirus

The first and
most important is to rapidly produce masks, gloves, and other personal
protective equipment. If health-care workers can’t stay healthy, the rest of
the response will collapse. In some places, stockpiles are
already so low
that doctors are reusing masks
between patients
, calling for donations from the
public
, or sewing their own
homemade alternatives
. These shortages are happening because medical
supplies are made-to-order and depend on byzantine
international supply chains
that are currently straining and snapping.
Hubei province in China, the epicenter of the pandemic, was also a manufacturing
center of medical masks
.


In the U.S., the Strategic National
Stockpile
—a national larder of medical equipment—is already being deployed,
especially to the hardest-hit states. The stockpile is not inexhaustible, but
it can buy some time. Donald Trump could use that time to invoke the Defense
Production Act, launching a wartime effort in which American manufacturers
switch to making medical equipment. But after invoking the act last Wednesday,
Trump has failed to actually use it, reportedly due to
lobbying
from the U.S. Chamber of Commerce and heads of major corporations.


Some manufacturers
are already rising to
the challenge
, but their efforts are piecemeal and unevenly distributed.
“One day, we’ll wake up to a story of doctors in City X who are operating with
bandanas, and a closet in City Y with masks piled into it,” says Ali Khan, the
dean of public health at the University of Nebraska Medical Center. A “massive
logistics and supply-chain operation [is] now needed across the country,” says
Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That can’t
be managed by small and inexperienced teams scattered throughout the White
House. The solution, he says, is to tag in the Defense Logistics Agency—a 26,000-person
group that prepares the U.S. military for overseas operations and that has
assisted in past public-health crises, including the 2014 Ebola outbreak.




This
agency can also coordinate the second pressing need: a massive rollout of
COVID-19 tests. Those tests have been slow to arrive because of five separate
shortages: of masks to protect people administering the tests; of
nasopharyngeal swabs for collecting viral samples; of extraction kits for
pulling the virus’s genetic material out of the samples; of chemical reagents
that are part of those kits; and of trained people who can give the tests. Many
of these shortages are, again, due to strained supply chains. The U.S. relies
on three manufacturers for extraction reagents, providing redundancy in case any
of them fails—but all of them failed in the face of unprecedented global
demand. Meanwhile, Lombardy, Italy, the hardest-hit place in Europe, houses one
of the largest manufacturers of nasopharyngeal
swabs
.


Some shortages
are being addressed. The FDA is now moving quickly to approve tests developed
by private labs. At least one can deliver results in less than an hour,
potentially allowing doctors to know if the patient in front of them has
COVID-19. The country “is adding capacity on a daily basis,” says Kelly
Wroblewski of the Association of Public Health Laboratories.


On March 6, Trump
said that “anyone who wants a test can get a test.” That was (and
still is) untrue
, and his own officials were quick to correct him.
Regardless, anxious people still flooded into hospitals, seeking tests that did
not exist. “People wanted to be tested even if they weren’t symptomatic, or if
they sat next to someone with a cough,” says Saskia Popescu of George Mason
University, who works to prepare hospitals for pandemics. Others just had
colds, but doctors still had to use masks to examine them, burning through
their already dwindling supplies. “It really stressed the health-care system,”
Popescu says. Even now, as capacity expands, tests must be used carefully. The
first priority, says Marc Lipsitch of Harvard, is to test health-care workers
and hospitalized patients, allowing hospitals to quell any ongoing fires. Only
later, once the immediate crisis is slowing, should tests be deployed in a more
widespread way. “This isn’t just going to be: Let’s get the tests out there!”
Inglesby says.




These
measures will take time, during which the pandemic will either accelerate beyond
the capacity of the health system
or slow to containable levels. Its
course—and the nation’s fate—now depends on the third need, which is social distancing.
Think of it this way: There are now only two groups of Americans. Group A
includes everyone involved in the medical response, whether that’s treating
patients, running tests, or manufacturing supplies. Group B includes everyone else,
and their job is to buy Group A more time. Group B must now “flatten the curve”
by physically isolating themselves from other people to cut off chains of
transmission. Given the slow fuse of COVID-19, to forestall the future collapse
of the health-care system, these seemingly drastic steps must be taken
immediately
, before
they feel proportionate, and they must continue for several weeks.


Persuading a
country to voluntarily stay at home is not easy, and without clear
guidelines from the White House
, mayors, governors, and business owners
have been forced to take their own steps.
Some states have banned large gatherings or closed schools
and restaurants. At least 21
have now instituted some form of mandatory quarantine, compelling people to
stay at home. And yet many citizens continue to crowd
into public spaces
.


In these moments,
when the good of all hinges on the sacrifices of many, clear coordination
matters—the fourth urgent need. The importance of social distancing must be
impressed upon a public who must also be reassured and informed. Instead, Trump
has repeatedly played
down the problem
, telling America that “we have it very
well under control
” when we do not, and that cases were “going to be down
to close to zero
” when they were rising. In some cases, as with his claims
about ubiquitous testing, his misleading gaffes have deepened the crisis. He
has even touted unproven
medications
.




Away
from the White House press room, Trump has apparently been listening to Anthony
Fauci, the director of the National Institute of Allergy and Infectious
Diseases. Fauci has advised every president since Ronald Reagan on new
epidemics, and now sits on the COVID-19 task force that meets with Trump
roughly every other day. “He’s got his own style, let’s leave it at that,”
Fauci told me, “but any kind of recommendation that I have made thus far, the
substance of it, he has listened to everything.”


But Trump already
seems to be wavering. In recent days, he has signaled that he is prepared to
backtrack on social-distancing policies in a bid to protect the economy.
Pundits and business leaders have used similar rhetoric, arguing that high-risk
people, such as the elderly, could be protected while lower-risk people are
allowed to go back to work. Such thinking is seductive, but flawed. It
overestimates our ability to assess a person’s risk, and to somehow wall off
the “high-risk” people from the rest of society. It underestimates how badly
the virus can hit “low-risk” groups, and how thoroughly hospitals will be
overwhelmed if even just younger demographics are falling sick.


A recent analysis
from the University of Pennsylvania estimated that even if social-distancing
measures can reduce infection rates by 95 percent, 960,000 Americans will still
need intensive care. There are only about 180,000 ventilators in the U.S. and,
more pertinently, only enough respiratory therapists and critical-care staff to
safely look after 100,000 ventilated patients. Abandoning social distancing
would be foolish. Abandoning it now, when tests and protective equipment are
still scarce, would be catastrophic.




Read:
America’s hospitals have never experienced anything like this

If Trump stays
the course, if Americans adhere to social distancing, if testing can be rolled
out, and if enough masks can be produced, there is a chance that the country
can still avert the worst predictions about COVID-19, and at least temporarily
bring the pandemic under control. No one knows how long that will take, but it
won’t be quick. “It could be anywhere from four to six weeks to up to three
months,” Fauci said, “but I don’t have great confidence in that range.”


II. The Endgame


Even a perfect
response won’t end the pandemic. As long as the virus persists somewhere,
there’s a chance that one infected traveler will reignite fresh sparks in
countries that have already extinguished their fires. This is already happening
in China, Singapore, and other Asian countries that briefly seemed to have the
virus under control. Under these conditions, there are three possible endgames:
one that’s very unlikely, one that’s very dangerous, and one that’s very long.


The first is that
every nation manages to simultaneously bring the virus to heel, as with the
original SARS in 2003. Given how widespread the coronavirus pandemic is, and
how badly many countries are faring, the odds of worldwide synchronous control
seem vanishingly small.


The second is
that the virus does what past flu pandemics have done: It burns through the
world and leaves behind enough immune survivors that it eventually struggles to
find viable hosts. This “herd immunity” scenario would be quick, and thus
tempting. But it would also come at a terrible
cost
: SARS-CoV-2 is more transmissible and fatal than the flu, and it would
likely leave behind many millions of corpses and a trail of devastated health
systems. The United Kingdom
initially seemed to consider this herd-immunity strategy
, before
backtracking when models revealed the dire consequences. The U.S. now seems to
be considering it too.




Read:
What will you do if you start coughing?

The third
scenario is that the world plays a protracted game of whack-a-mole with the
virus, stamping out outbreaks here and there until a vaccine can be produced.
This is the best option, but also the longest and most complicated.


It depends, for a
start, on making a vaccine. If this were a flu pandemic, that would be easier.
The world is experienced at making flu vaccines and does so every year. But
there are no existing vaccines for coronaviruses—until now, these viruses
seemed to cause diseases that were mild or rare—so researchers must start from
scratch. The first steps have been impressively quick. Last Monday, a possible
vaccine created by Moderna and the National Institutes of Health went into early
clinical testing. That marks a 63-day gap
between scientists sequencing the virus’s genes for the first time and doctors
injecting a vaccine candidate into a person’s
arm
. “It’s overwhelmingly the world record,” Fauci said.


But it’s also the
fastest step among many subsequent slow ones. The initial trial will simply
tell researchers if the vaccine seems safe, and if it can actually mobilize the
immune system. Researchers will then need to check that it actually prevents
infection from SARS-CoV-2. They’ll need to do animal tests and large-scale
trials to ensure that the vaccine doesn’t cause severe side effects. They’ll
need to work out what dose is required, how many shots people need, if the
vaccine works in elderly people, and if it requires other chemicals to boost
its effectiveness.




“Even
if it works, they don’t have an easy way to manufacture it at a massive scale,”
said Seth Berkley of Gavi. That’s because Moderna is using a new approach to
vaccination
. Existing vaccines work by providing the body with inactivated
or fragmented viruses, allowing the immune system to prep its defenses ahead of
time. By contrast, Moderna’s vaccine comprises a sliver of SARS-CoV-2’s genetic
material—its RNA. The idea is that the body can use this sliver to build its
own viral fragments, which would then form the basis of the immune system’s
preparations. This approach works in animals, but is unproven in humans. By
contrast, French scientists are trying to modify the existing measles vaccine
using fragments of the new coronavirus. “The advantage of that is that if we
needed hundreds of doses tomorrow, a lot of plants in the world know how to do
it,” Berkley said. No matter which strategy is faster, Berkley and others
estimate that it will take 12 to 18 months to develop a proven vaccine, and
then longer still to make it, ship it, and inject it into people’s arms.


It’s likely,
then, that the new coronavirus will be a lingering part
of American life
for at least a year, if not much longer. If the current
round of social-distancing measures works, the pandemic may ebb enough for
things to return to a semblance of normalcy. Offices could fill and bars could
bustle. Schools could reopen and friends could reunite. But as the status quo
returns, so too will the virus. This doesn’t mean that society must be on continuous
lockdown until 2022. But “we need to be prepared to do multiple periods of
social distancing,” says Stephen Kissler of Harvard.




Much
about the coming years, including the frequency, duration, and timing of social
upheavals, depends on two properties of the virus, both of which are currently
unknown. First: seasonality. Coronaviruses tend to be winter infections that
wane or disappear in the summer. That may also be true for SARS-CoV-2, but
seasonal variations might not sufficiently slow the virus when it has so many
immunologically naive hosts to infect. “Much of the world is waiting anxiously
to see what—if anything—the summer does to transmission in the Northern
Hemisphere,” says Maia Majumder of Harvard Medical School and Boston Children’s
Hospital.

Second: duration
of immunity. When people are infected by the milder human coronaviruses that
cause cold-like symptoms, they remain immune for less than a year. By contrast,
the few who were infected by the original SARS virus, which was far more
severe, stayed immune for much longer. Assuming that SARS-CoV-2 lies somewhere
in the middle, people who recover from their encounters might be protected for
a couple of years. To confirm that, scientists will need to develop accurate
serological tests, which look for the antibodies that confer immunity. They’ll
also need to confirm that such antibodies actually stop people from catching or
spreading the virus. If so, immune citizens can return to work, care for the
vulnerable, and anchor the economy during bouts of social distancing.




Scientists
can use the periods between those bouts to develop antiviral drugs—although
such drugs are rarely panaceas, and come with possible side effects and the
risk of resistance. Hospitals can stockpile the necessary supplies. Testing
kits can be widely distributed to catch the virus’s return as quickly as
possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it
unawares again, and thus no reason that social-distancing measures need to be
deployed as broadly and heavy-handedly as they now must be. As Aaron E. Carroll
and Ashish Jha recently
wrote, “We can keep schools and businesses open as
much as possible, closing them quickly when suppression fails, then opening
them back up again once the infected are identified and isolated. Instead of
playing defense, we could play more offense.”

Whether through
accumulating herd immunity or the long-awaited arrival of a vaccine, the virus
will find spreading explosively more and more difficult. It’s unlikely to
disappear entirely. The vaccine may need to be updated as the virus changes,
and people may need to get revaccinated on a regular basis, as they currently
do for the flu. Models suggest
that the virus might simmer around the world, triggering epidemics every few
years or so. “But my hope and expectation is that the severity would decline,
and there would be less societal upheaval,” Kissler says. In this future,
COVID-19 may become like the flu is today—a recurring scourge of winter.
Perhaps it will eventually become so mundane that even though a vaccine exists,
large swaths of Gen C won’t bother getting it, forgetting how dramatically
their world was molded by its absence.




III.
The Aftermath


The cost of
reaching that point, with as few deaths as possible, will be enormous. As my
colleague Annie Lowrey wrote,
the economy is experiencing a shock “more sudden and severe than anyone alive
has ever experienced.” About one in five people in the United States have lost working hours
or jobs
. Hotels are empty. Airlines are grounding flights. Restaurants and
other small businesses are closing. Inequalities will
widen
: People with low
incomes
will be hardest-hit by social-distancing measures, and most likely
to have the chronic health conditions that increase their risk of severe
infections. Diseases have destabilized cities and societies many times over,
“but it hasn’t happened in this country in a very long time, or to quite the
extent that we’re seeing now,” says Elena Conis, a historian of medicine at UC
Berkeley. “We’re far more urban and metropolitan. We have more people traveling
great distances and living far from family and work.”


After infections
begin ebbing, a secondary pandemic of mental-health problems will follow. At a
moment of profound dread and uncertainty, people are being cut off from
soothing human contact. Hugs, handshakes, and other social rituals are now tinged with danger.
People with anxiety or
obsessive-compulsive disorder
are struggling. Elderly people, who are
already excluded from much of public life, are being asked to distance
themselves even further, deepening their loneliness. Asian people are suffering
racist insults,
fueled by a president who insists on
labeling
the new coronavirus the “Chinese virus.” Incidents of
domestic violence
and child abuse are likely to spike as people are forced
to stay in unsafe homes. Children,
whose bodies are mostly spared by the virus, may endure mental trauma that
stays with them into adulthood.




Read:
The kids aren’t all right

After the
pandemic, people who recover from COVID-19 might be shunned and stigmatized, as
were survivors of Ebola, SARS, and HIV. Health-care workers will take time to
heal: One to two years after SARS hit Toronto, people who dealt
with the outbreak
were still less productive and more likely to be
experiencing burnout and post-traumatic stress. People who went through long
bouts of quarantine will carry the scars of their experience. “My colleagues in
Wuhan note that some people there now refuse to leave their homes and have
developed agoraphobia,” says Steven Taylor of the University of British
Columbia, who wrote The Psychology of Pandemics.


But “there is
also the potential for a much better world after we get through this trauma,”
says Richard Danzig of the Center for a New American Security. Already,
communities are finding new ways
of coming together,
even as they must stay apart. Attitudes to health may also change for the
better. The rise of HIV and AIDS “completely changed sexual behavior among
young people who were coming into sexual maturity at the height of the
epidemic,” Conis says. “The use of condoms became normalized. Testing for STDs
became mainstream.” Similarly, washing your hands
for 20 seconds
, a habit that has historically been hard to enshrine even in
hospitals, “may be one of those behaviors that we become so accustomed to in
the course of this outbreak that we don’t think about them,” Conis adds.




Pandemics
can also catalyze social
change
. People, businesses, and institutions have been remarkably quick to
adopt or call for practices that they might once have dragged their heels on,
including working from home,
conference-calling to accommodate people with disabilities, proper sick leave,
and flexible child-care arrangements. “This is the first time in my lifetime
that I’ve heard someone say, ‘Oh, if you’re sick, stay home,’” says Adia
Benton, an anthropologist at Northwestern University. Perhaps the nation will
learn that preparedness isn’t just about masks, vaccines, and tests, but also
about fair labor
policies
and a stable and equal health-care system. Perhaps it will
appreciate that health-care workers and public-health specialists compose
America’s social immune system, and that this system has been suppressed.

Aspects of
America’s identity may need rethinking after COVID-19. Many of the
country’s values have seemed to work against it
during the pandemic. Its
individualism, exceptionalism, and tendency to equate doing whatever you want
with an act of resistance meant that when it came time to save lives and stay
indoors, some people flocked to bars
and clubs
. Having internalized years of anti-terrorism messaging following
9/11, Americans resolved to not live in fear. But SARS-CoV-2 has no interest in
their terror, only their cells.


Years of
isolationist rhetoric had consequences too. Citizens who saw China as a distant,
different place, where bats are edible and authoritarianism is acceptable,
failed to consider that they would be next or that they wouldn’t be ready.
(China’s response to this crisis had its own problems, but that’s for another
time.) “People believed the rhetoric that containment would work,” says Wendy
Parmet, who studies law and public health at Northeastern University. “We keep them out,
and we’ll be okay. When you have a body politic that buys into these ideas of
isolationism and ethnonationalism, you’re especially vulnerable when a pandemic
hits.”




Graeme
Wood: The ‘Chinese virus’ is a test. Don’t fail it.

Veterans of past
epidemics have long warned that American society is trapped in a cycle of panic
and neglect. After every crisis—anthrax, SARS, flu, Ebola—attention is paid and
investments are made. But after short periods of peacetime, memories fade and
budgets dwindle. This trend transcends red and blue administrations. When a new
normal sets in, the abnormal once again becomes unimaginable. But there is
reason to think that COVID-19 might be a disaster that leads to more radical
and lasting change.


The other major
epidemics of recent decades either barely affected the U.S. (SARS, MERS,
Ebola), were milder than expected (H1N1 flu in 2009), or were mostly limited to
specific groups of people (Zika, HIV). The COVID-19 pandemic, by contrast, is
affecting everyone directly, changing the nature of their everyday life. That
distinguishes it not only from other diseases, but also from the other systemic
challenges of our time. When an administration prevaricates on climate change,
the effects won’t be felt for years, and even then will be hard to parse. It’s different
when a president says that everyone can get a test, and one day later, everyone
cannot. Pandemics are democratizing experiences. People whose privilege and
power would normally shield them from a crisis are facing quarantines, testing
positive, and losing loved ones. Senators are falling sick.
The consequences of defunding public-health agencies, losing expertise, and
stretching hospitals are no longer manifesting as angry opinion pieces, but as
faltering lungs.




After
9/11, the world focused on counterterrorism. After COVID-19, attention may
shift to public health. Expect to see a spike in funding for virology and
vaccinology, a surge in students applying to public-health programs, and more
domestic production of medical supplies. Expect pandemics to top the agenda at
the United Nations General Assembly. Anthony Fauci is now a household name.
“Regular people who think easily about what a policewoman or firefighter does
finally get what an epidemiologist does,” says Monica Schoch-Spana, a medical
anthropologist at the Johns Hopkins Center for Health Security.

Such changes, in
themselves, might protect the world from the next inevitable disease. “The
countries that had lived through SARS had a public consciousness about this
that allowed them to leap into action,” said Ron Klain, the former Ebola czar.
“The most commonly uttered sentence in America at the moment is, ‘I’ve never
seen something like this before.’ That wasn’t a sentence anyone in Hong Kong
uttered.” For the U.S., and for the world, it’s abundantly, viscerally clear
what a pandemic can do.


The lessons that
America draws from this experience are hard to predict, especially at a time
when online algorithms and partisan broadcasters only serve news that aligns with their
audience’s preconceptions
. Such dynamics will be pivotal in the coming
months, says Ilan Goldenberg, a foreign-policy expert at the Center for a New
American Security. “The transitions after World War II or 9/11 were not about a
bunch of new ideas,” he says. “The ideas are out there, but the debates will be
more acute over the next few months because of the fluidity of the moment and
willingness of the American public to accept big, massive changes.”




One
could easily conceive of a world in which most of the nation believes that
America defeated COVID-19. Despite his many lapses, Trump’s approval rating has
surged. Imagine that he succeeds in diverting blame for the crisis to China,
casting it as the villain and America as the resilient hero. During the second
term of his presidency, the U.S. turns further inward and pulls out of NATO and
other international alliances, builds actual and figurative walls, and
disinvests in other nations. As Gen C grows up, foreign plagues replace
communists and terrorists as the new generational threat.

One could also
envisage a future in which America learns a different lesson. A communal spirit,
ironically born through social distancing, causes people to turn outward, to
neighbors both foreign and domestic. The election of November 2020 becomes a
repudiation of “America first
politics. The nation pivots, as it did after World War II, from isolationism to
international cooperation. Buoyed by steady investments and an influx of the
brightest minds, the health-care workforce surges. Gen C kids write school
essays about growing up to be epidemiologists. Public health becomes the
centerpiece of foreign policy. The U.S. leads a new global partnership focused
on solving challenges like pandemics and climate change.


In 2030,
SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.

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