Epidemics Reveal the Truth About the Societies They Hit

BOLOGNA, Italy—I am sitting in the middle of this northern Italian city, two hours’ drive from the Lombardian towns that have been quarantined. At this precise moment in time, Bologna has not produced a single instance of the new coronavirus. One or two people with the disease, known as COVID-19, have been moved into the hospital here from other regions, but nobody around me, or anywhere near me, is ill. Yet at the American university where I am a guest lecturer, we speak of little else.

Perhaps this is because we don’t know what to think: Most of us have never grappled with a swift-moving, incurable disease, even one that is not very lethal. We aren’t old enough to remember the Spanish flu. We have become used to the idea that there are always vaccines, or medicines that have been tested. Now we are told—on train announcements, on signs, in emails—to wash our hands, a precaution that feels neither sufficient nor reassuring. Meanwhile, the University of Bologna, the oldest academic institution in Europe, has been shut. Museums are closed. Soccer matches and conferences are canceled. The medieval streets, witness to plenty of past epidemics—Black Death killed half the city in 1348—are strangely empty, as people heed warnings and stay home. About half of my colleagues think these measures are a gross overreaction. The other half fear that they don’t go far enough.

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Part of the problem is that the danger cannot be seen: “A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream that will end,” Albert Camus wrote in The Plague. This, of course, very much describes the current situation: Many people cannot bear the idea that something invisible can change their plans. Published in 1947, The Plague has often been read as an allegory, a book that is really about the occupation of France, say, or the human condition. But it’s also a very good book about plagues, and about how people react to them—a whole category of human behavior that we have forgotten.

In the novel, a part of the quarantined town “continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debates?” Their modern equivalents in the city of Milan have already launched a #Milanononsiferma—“Milan doesn’t stop”—hashtag campaign. Other cities have followed. Social media is full of Italian business owners and hotel managers denouncing the government for its unnecessary precautions.

But invisibility also creates uncertainty, and uncertainty can be manipulated so that it serves other ends. One of Camus’ characters is a priest, for example, who uses the plague to increase his flock: He tells his congregation that the epidemic is God’s way of punishing unbelievers. In modern Italy, the first person to seek to manipulate the anxiety created by the coronavirus was Matteo Salvini, the Italian far-right leader who immediately called for the government to shut the country’s borders, stop all public meetings, and keep people home.

Salvini would no doubt have pressed this point further had it not begun, almost immediately, to backfire. The virus first appeared in Lombardy and Veneto, the two Italian provinces where his party, the Northern League, is strongest. When Salvini realized that a shutdown would inflict the worst economic damage there, he switched to a different argument: a call on the government to “defend Italy and Italians” from African refugees. There is no evidence that African refugees are carrying the virus, but the bigoted link between foreigners, impurity, and disease is a very old one. Marine Le Pen, the French far-right leader, has also called on France to shut the border with Italy, even though that, too, is nonsensical, as the first French cases seem mostly to have come from elsewhere.

I am due to fly to London in a few days, and have been carefully watching the British right-wing tabloids, to gauge their level of hysteria. So far, it has been relatively low—they are distracted by Prime Minister Boris Johnson’s engagement to his pregnant girlfriend—which means that the planes will continue flying. Once they focus on the virus, I am certain that there will be calls to block all contact with Italy, and I am certain that this tabloid-dependent British government will heed them.   

But not everyone will behave badly. Camus’ story also has heroes, though these aren’t the sort of heroes found in most other novels. Instead, the heroes are the doctors, the volunteers who help them, and even a civil servant, Monsieur Grand, who seeks to deal with the plague by recording it, measuring it, and keeping track of what has happened: “This insignificant and self-effacing hero who had nothing to recommend him but a little goodness in his heart and apparently a ridiculous ideal. This would be to give the truth its due, to give the sum of two and two as four.” Grand, Dr. Rieux, and a few others try to use science, transparency, and accuracy to contain and control the disease and to save as many people as possible, without giving in to hysteria or despair: “It may seem a ridiculous idea, but the only way to fight the plague is with decency.”

These are the kinds of people who will be the heroes in our era, too. The scientists and public-health scholars who immediately put out information about numbers and cases; the research teams that immediately began to work on vaccines; the nurses and doctors who immediately decide to remain inside quarantined regions, as many did in Italy, as well as in Wuhan, China. Not all of their judgments will be correct, and they will not always agree with one another: There is no precise way to determine which quarantines and cancellations are prudent and which are unreasonable, given the potential economic effects on the one hand, and the real desire to slow the spread of the epidemic on the other. In Italy, there have already been a few public squabbles among virologists who have different estimates of how bad the disease will be.

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But at least they have the public’s interest at heart. Here is a rule of thumb to use in the coming weeks: Judge politicians by how much and how clearly they defer to the people who give the sum of two and two as four. What you want is accurate information, not politicized information. And the more the better. After four years of hearing, in the words of a British politician, that “we’ve had enough of experts,” this is the moment when the value of expertise has suddenly become crystal clear. Suddenly, facts matter.

Epidemics, like disasters, have a way of revealing underlying truths about the societies they impact. The Chinese have already paid a high price for the secretiveness of their system, and for the top-down bureaucratic culture that led many, initially, to conceal the disease. By contrast, one of the reasons Italians aren’t panicking more is that they have confidence in the public-health system, and indeed the system in the broader sense of the word, despite Salvini and his disinformation campaigns. Italy has already tested many thousands of people for the virus—testing is free, of course—which is one of the reasons the numbers are so much higher there than elsewhere. People know this, and repeat it to one another, sometimes joking about it (“We Italians are too honest”) but it is a source of pride. Few others in Europe, so far, are testing that widely. And, of course, the U.S. is not doing anything of the sort.

In the U.S., I am afraid we might learn that neither our public-health system nor our “system” more broadly understood how to build feelings of trust. Even though we have the highest-tech health-care system in the world, even though we have the best surgeons and the best equipment, we have not created a public-health culture that induces confidence. The hospital system has been pared down to the bone; there is no extra capacity, and everyone knows it. If people have to pay to be tested, then many may refuse. If people have to be quarantined, they may escape.

Worse, instead of seeking to halt conspiracy theories, it is possible that our government will create them. The president has already called the coronavirus a “hoax” and indulged in different kinds of magical thinking. In one single speech about the coronavirus, Trump stated that “it’s going to disappear. One day—it’s like a miracle—it will disappear”; that “you know, it could get worse before it gets better”; that “we’ll see what happens, nobody knows.” If people heed him, we will be able to count the cost of that dishonesty and that magical thinking and measure it, in the numbers of deaths, in the spread of disease, in the numbers of people who ignore quarantines or precautions.

Though this is not the worst kind of epidemic imaginable, it’s good that we are learning these things now, because the novel coronavirus may turn out to be just a dry run. Wildfires seem more lethal now because more people live in areas that are close to forests that frequently burn; many new diseases are also the result of human expansion all over the planet. Like SARS or Ebola, COVID-19 seems to be another disease that has jumped from the animal kingdom to the human and then traveled quickly because of trains, cars, airplanes, and people clustering in public places.

As David Quammen wrote in Spillover: Animal Infections and the Next Human Pandemic, these diseases remind us of “the old Darwinian truth (the darkest of his truths, well known and persistently forgotten) that humanity is a kind of animal, inextricably connected with other animals: in origin and in descent, in sickness and in health.” Even when these kinds of viruses recede or disappear, they do not necessarily go away. They can mutate, they can harbor in other animals, and they can reemerge.

That, too, was predicted by Camus’ Dr. Rieux. He knew that “the plague bacillus never dies or disappears for good, that it can lie dormant for years and years in furniture and linen chests; that it bides its time in bedrooms, cellars, trunks, and bookshelves; and that perhaps the day would come when, for the bane and the enlightening of men, it would rouse up its rats again and send them forth to die in a happy city.” We might get lucky this time, but we should use the opportunity to prepare ourselves, mentally as well as medically, for the epidemic that comes next—and for the one after that.