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Living Through the Pandemic: A Review One Year Later

The author of a new book on the coronavirus discusses how political expediency and an immature public have impaired America’s ability to meet the challenges and what we have learned as a country and what we have not.

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A year into the modern pandemic era, it seems reasonable to ask, what have we learned? And what should we have learned? I found answers to those questions in a wide-ranging interview with Nicholas Christakis, the author of Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live. Christakis is the Sterling Professor of Social and Natural Science at Yale University, with appointments in the departments of sociology, ecology and evolutionary biology, statistics and data science, biomedical engineering, and medicine. In short, he is a Renaissance man of these coronavirus times and uniquely able to capture the reality of the pandemic one year later.

In the spirit of “help is on its way,” we discussed the efficacy of vaccines as well as its possible effects for the future. They are necessary but not sufficient. Christakis contends political expediency and an immature public have impaired America’s ability to meet the challenges of the pandemic, insufficiencies that have resulted in social breakdown and an unmet yearning for meaning.

The author lays out what a rational response would have looked like and his Swiss Cheese defense plea, modelled loosely on military’s approach to what it calls defense in depth.

Christakis also argues the lived experience of the pandemic’s effects reflects poorly on the country’s reliance on employer-provided health insurance and that may augur well for single-payer universal health care.

The author is pessimistic that any long-term learning will result from this pandemic but, despite that, he remains generally optimistic for and about human beings.  

The following interview has been edited for clarity, length and readability.

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Why This Book? Why Now?

Our conversation began by exploring Christakis’ motivations for writing Apollo’s Arrow.

Governing: Your latest book, Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live, is among the best on this subject. Historian Niall Ferguson describes it as a magisterial piece of work. You present hard concepts in clear ways. What was your motivation?

Nicholas Christakis: It was right across home plate for me. I knew the topic well. In some ways, I had prepared for years to write about it. I was motivated by the desire to advance the public understanding of science. People seemed so completely unaware, and our political leaders collapsed.

We can talk about this on the right or the left, but the failings on the right were worse because they were in the White House. That's a bad place to have problems when there's a national calamity. I couldn't believe all the BS that was circulating last February and March. My epidemiology colleagues couldn’t understand why people didn't see what was happening. That was the motivation. It was a labor of love.

Governing: Apollo’s Arrow (published on Oct. 1, 2020) leaves unsettled the question of whether we will get a vaccine in time? 

Nicholas Christakis: What I wrote is that it doesn't really matter whether we get a vaccine. I said it was unlikely that we would get a vaccine quickly enough to make a difference. That is still the case. 

When I was writing the book, there were over a hundred vaccines in development. Several clinical trials were already afoot. Bill Gates said he was very optimistic. I thought it was likely we would have a successful vaccine in the first quarter of 2021. It came three months earlier, which is miraculous.

But the problem we’re having is in manufacturing, distributing and administering the vaccines. I said it would take about a year for that to happen. Meanwhile, the virus would spread, and we would reach herd immunity by the end of 2021, either artificially with vaccines or naturally by spread. I think we're on that course now.

The lethality of this pathogen exists in an awkward sweet spot. It's just deadly enough to really harm us but not deadly enough that we took it seriously. There’s no God-given reason this particular pathogen isn't like the bubonic plague. It could have completely destroyed us. It could be like MERS, which killed 30 percent of those infected. If you combined the contagiousness of COVID with the lethality of MERS, our country would have been undone. It would have been like the Black Death. This is precisely why sophisticated people like Bill Gates and Tony Fauci have been worrying about this for a long time.

Because we’re a rich country, our government has been rightly treating this as a national security problem for decades. We have a great stake in not being brought low by a pandemic. That’s why I was so disgusted with our complete collapse. It's shameful how poorly we’ve handled it as a government and as a nation. The citizens also bear some responsibility.

Governing: Imagine a death rate of one out of 10, as we had with the yellow fever epidemic in Philadelphia in 1793. Shouldn’t this serve as an emphatic wake-up call?

Nicholas Christakis: Exactly. We could have been facing those kinds of fatality rates. The CDC has been releasing national plans for pandemic preparedness every three years for decades. We have tremendous expertise in the government. The problem is that we didn’t follow those plans because it was not politically expedient. As Kissinger said, "Politicians rarely get credit for crises averted." We now know that the president was briefed in December by the NSA. That’s good to know, because otherwise I had better information than the rest of the United States.

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Paul Schnaittacher


Nicholas Christakis (Photo: Paul Schnaittache, All rights reserved)


 

Political Expediency and a Public Not Up to Pandemic Challenge

In January 2020, the epidemiologists I know were very concerned. On Jan. 25, China put a billion people under lockdown. That's when I woke up. You might forgive the politicians saying, "Well, this is China. Who really knows?" But when Italy, a rich Western democracy, collapsed in February, every politician who took his or her job seriously, and every government official in the United States, should have been focused on this.

There were two problems there. First of all, it was a difficult messaging challenge. You've got to go out in February and say, "No one has died among our 300 million people, but if we don't take action, hundreds of thousands will die." People will think you're crazy. I can say that, but if you're a politician, it's hard. I acknowledge that. But that's where leadership comes in. That's where you have to get up and say, "Here's why I think this. Let me remind you of high school mathematics, where we learned about exponential growth. We're on the flat part right now, but it's going to get bad. Here's an expert, Tony Fauci, who is now going to brief the nation."

The second thing is that the American people need to become more mature. The pandemic struck us at a moment in our history when we were particularly weak. The incompetence of our politicians is almost a reflection of the functioning of our democracy. Our democracy is so good that if the American people want to elect people who will lie to them, we can do that. We do that all the time. Nothing stops us. We're a representative democracy and so that's what we get. We deserve these people. The politicians were lagging the public, but it's not like the public was clamoring for more pandemic preparedness.

It's like what's happening in Texas right now. On the one hand, Texas citizens probably would have been irate if extra taxes were put in place to winterize the grid. No one likes to pay taxes, but that's what a civilized society does. And a good leader says, "Yes, I realize that it's very unlikely, but we're going to set aside 10 million a year for the next 20 years so that we can winterize our grid."

The same thing happened in California. There was a strategic stockpile of ventilators, created by a previous governor 20 or 30 years ago. But with ventilators, you need to heat and cool the building. You need to test them periodically. They need lubrication and maintenance and software upgrades. This all costs money. Five years ago, whoever was in power decided that there was no need to maintain this stockpile. There hadn’t been a pandemic in 15 years, so they cut this maintenance from the budget.

It's not just that we're polarized. There's an immaturity where people don't realize that there are trade-offs and shades of gray. Most adults have learned this lesson in their personal lives by the time they're our age. But as a people, we seem to want to have our cake and eat it too. We want to have a strategic ventilator reserve but not have to pay for it. The people in Texas are outraged that they don't have heat and water, but what did they think would happen? This is concerning to me. And I see this demonization of people with disparate political beliefs that is ridiculous. I have many friends across the political spectrum. I love arguing with my conservative friends. I like the spirit of compromise, and I like to think that most people are like me. But increasingly, I don't think that's true.

Social Breakdown and the Search for Meaning

Governing: Yuval Harari in Homo Deus and Steven Pinker in Enlightenment Now are both glib in their assertion that we've graduated out of the epoch of plagues. What you show in Apollo’s Arrow is that not only is this not true, but we really got off easy this time. The mortality rate is low. We’ve seen only tiny little bits of social breakdown.

Nicholas Christakis: I’m a little worried, and I’ll tell you why. During times of plague, people search for meaning. Religion rises during times of plague. Some people, like health-care and essential workers, find new meaning in occupational choices and practices. People stuck at home tend to become reflective about what matters to them. Death is walking the streets. It's very typical.

This was a factor in the Black Lives Matter movement. It wasn't just that there've been decades of police brutality, which American citizens rightly reject. It wasn't just the particularly brutal killing of George Floyd. And it wasn't just that people were out of work. Nor was it just that people were cooped up at home and wanted to break loose. It was also that people were searching for meaning. Those protests were framed in terms of justice. People could justify the violence and arson and looting to themselves in that setting.

Then fast forward to the insurrection at the Capitol. What amazed me is that so many of those people were unmasked when they went into the Capitol. They made no effort to hide their identity, which tells me that they probably framed what they were doing as patriotism. That insurrection had meaning for many of the participants. It was wrongheaded, in my opinion. Ransacking the United States Capitol is just not something we do. Nevertheless, that situation was a symmetrical attempt to create meaning by the right. It also turned violent. We might have escaped social breakdown, given the timing and the vaccine and all of that, but it was by the luck of God, by just a hair's breadth.

A Mulligan for the Coronavirus: What a Do Over Could Have Looked Like

Governing: Jonathan Swift in Gulliver's Travels says that man is not a rational animal. Rather he is capax rationis, capable of rationality. What would a rational America have done beginning in January 2020?

Nicholas Christakis: There would have been a mass public messaging campaign beginning at the end of January saying that there was the distinct possibility of a serious pandemic. By February, it would have been communicated as a likelihood. When Italy collapsed, the messaging certainly would have changed. There was absolutely no rational reason to imagine that it wouldn’t happen to us when the bodies were piling up in the streets in Lombardi. There would have been a public call for educating the American people, a call to sacrifice. “Rich people are going to have to pay more taxes. Health-care workers are going to die. Poor people are going to lose their jobs. We're going to suffer. Children are going to be out of schools. Your loved ones will die."

And then, a call to action. We, the American people, must rise to this occasion. Here's how we're going to do it. This is what our scientists are going to do, and this is what our doctors are going to do. This is what our military is going to do in terms of delivering supplies. This is what our manufacturers are going to do. That's what should have been done from a public messaging point to prepare the American people. 

Secondly, there’s the PPE (Personal Protection Equipment). The lack of PPE was a national embarrassment. By the end of January, the feds should have begun commissioning the manufacturing of PPE. There were news reports that the Chinese were buying up PPE. We should have been manufacturing them as a nation. The nation, the governors, the government should have been doing this.

Testing is another thing. It was embarrassing that the CDC screwed up the testing. A stupid mistake in lab cleanliness contaminated one of the three tests, and we compounded that with bureaucratic goofs. Every elite hospital in the country could have made their own tests if we allowed them to. There are reasons not to – inconsistency, for example - but it's an emergency. We should have had an empowered presidential committee. We're a rich, great nation. You knock some heads together, you get the thing fixed within a week. But no, it was inconvenient for the president. He didn't want to do any of that, politically or otherwise, and so nobody was tasked with fixing this problem.

There was a ridiculous amount of disorganization. We had no testing. We still don't have adequate testing, which is another embarrassment. We don't have any kind of surveillance. We have to rely on the Brits to tell us about new variants. We have no system in place to connect the detection of different variants with the outcomes. This is crucial.

Toward a Swiss Cheese Defense

Governing: Should we have completely locked down in house?

Nicholas Christakis: This is hotly debated, and there are many different approaches. I argued in a piece in the Wall Street Journal for what is called the Swiss cheese model.

You have to think in terms of layers of defense. In the national defense sector, they call this defense in depth. Each layer of defense is good, but not perfect. It has holes in it, like a slice of Swiss cheese. Masking is a layer. Testing is a layer. School closure is a layer. Border closure is a layer. Quarantining and testing and tracing is a layer. Handwashing is a layer. Vaccines are a layer. Each is imperfect, each has its holes. Even vaccines are only 95 percent effective. If the virus is trying to get through one of these layers and hits a hole, it gets through. Otherwise, it hits cheese and bounces back. Intuition tells you that if you stack three or four slices of Swiss cheese, the random holes won't overlap. By the third slice, you have an impervious layer. It’s a good analogy that was conceived by psychologist James Reason in the 1990s to talk about nuclear power and airplanes. You need layers of defense with non-overlapping fallibility in order to prevent complex systems from collapsing.

What Have We Learned? Prospects for Single-Payer Health Care

Governing: Does the pandemic declare that we have to have a single-payer universal health-care system?

Nicholas Christakis:  I say in the book that the stupidity of having our health-care system organized around people's employment is really made manifest when you have this type of global calamity where everyone's getting sick at the same time. Furthermore, our interconnectedness as a society has made it manifest. In other words, I care whether the homeless person has access to vaccines. A contagious disease clearly illustrates why it's in my interest that you have access to health care. If you don't get the proper access, I could die.

Some of that may happen. I do think I hinted at that in the book.  Right now, people are still in the crouch.  As we raise our heads up, some of these arguments will be made by activists and politicians, and they'll find a more receptive audience. The same goes with sick leave for temporary workers. If you don't show up, you don't get paid. That's not a good strategy when there's a contagious disease. I don't want you coming to work if you have a contagious disease.

We Haven’t Learned the Lesson of the Pandemic

Governing: At this point, it looks like we’re going to dodge this bullet. You would think that we would say, "We got caught flatfooted. We must make sure this can never happen again." Do you see that coming? Are we going to grow up?

Nicholas Christakis: Oh, no. The collective memory will vanish. The memory will still return to the historians and the epidemiologists. They will know. They knew this time, but the man on the street didn’t know. I'm very worried that we will do all the right things but not learn enough to be ready next time. We'll have a commission. There'll be reports, and we'll make investments in public health, and if we're struck again in five or ten years, which could happen because these things are stochastic, we'll be better prepared. But if it reverts to the previous pattern of every 50 to 100 years, they'll do the same stupid things 50 years from now.

Governing: Apollo’s Arrow is enlivened with quotations. At the end, you use Albert Camus’ assertion that “. . . there are more things to admire in men than to despise."

Nicholas Christakis: I love human beings. The title of my prior book, Blueprint: The Evolutionary Origins of a Good Society, suggests that we evolved to be good. We evolved to have capacities for love and friendship. I’ve studied the evolutionary biology of friendship. I've been studying social networks for years. It's very weird that we have friends. We form long-term relationships. We don't just mate with each other like sexually reproducing animals. We befriend each other. We form long-term, non-reproductive unions with other members of our species. This is very rare in the animal kingdom. It's fascinating. We act altruistically toward genetically unrelated individuals. We adopt children who are unrelated to us. We give money to strangers on the street. Thoreau talks about friendship as a miracle of nature. Fundamentally, I'm optimistic and very bullish about our species. But that does not mean I'm blind.

Stay with Governing this week for Clay's review of Apollo's Arrow. The companion podcast will also include the highlights from the interview.

You can hear more of Clay Jenkinson’s views on American history and the humanities on his long-running nationally syndicated public radio program and podcast, The Thomas Jefferson Hour, and the new Governing podcast, The Future In Context.

Clay S. Jenkinson is the editor-at-large of Governing. He is a humanities scholar, historian and founder of the Theodore Roosevelt Center. He can be reached at cjenkinson@governing.com or on Twitter at @ClayJenkinson.
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