We know what pandemics look like in the movies: sudden-onset symptoms, rapid transmission, chaos at hospitals and ports of entry … and, pretty soon, roving bands of armed survivors looting burned-out gas stations and picking off the weak. But it doesn’t have to be that way. Chances are the next pandemic will start out slow-moving. And there’s a lot we can do to prevent it from turning apocalyptic.
For starters, we can listen to public health experts. On a recent episode of How To, Charles Duhigg spoke to someone who studies pandemics for a living: Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security. Inglesby challenged Hollywood-inspired misconceptions about pandemics and laid out what people should and shouldn’t do in the face of an infectious disease outbreak. Some highlights of their conversation, condensed and edited for clarity, are transcribed below.
DON’T head for the hills.
When you hear about a potential pandemic, you should shelter in place, if for no other reason than that it’s going to be really hard to know if a pandemic has actually started.
Inglesby: It’s not going to be a moment where there’s no pandemic, and then suddenly there’s a terrible pandemic and all is lost. Even early on in big outbreaks, there are many moments of possible intervention, and there’s going to be a lot of isolating people and potential quarantine if they can identify individuals who were directly exposed. With infectious diseases, things mount slowly over time. It takes perhaps four days, seven days, for someone to get symptoms from the person they were infected by, as opposed to what you might see in zombie movies, where someone’s bitten and then they’re a zombie. That doesn’t happen: Illnesses take a while to come on.
DO have supplies.
Inglesby: Families should have a few days’ supply of water and food in their basements so that they can take care of themselves for a little while. Have a plan on how you’re going to communicate. The problem with pandemics is the time course is always different. The pandemic that happened in 1918 took a year and a half to move around the world.
DON’T grab a gun.
Inglesby: If we all end up in our homes with guns, then nothing will work. We won’t be able to get anything to anyone. You basically would have to imagine scenes of complete lawlessness and a complete breakdown of social order.
My hope and my sense of what the science says is that that is not typically how human beings react in emergencies. There obviously is going to be a wide variety of responses, but I think in general there are going to be a lot more good responses than bad. So I’d say that if we get to that point in a pandemic, things have completely broken down and we have all sorts of [other problems] that I don’t think a gun’s going to help with.
DO help the sick.
Inglesby: I don’t think society is going to completely break down and become tribal to the point of families taking care of each other and fighting off others. I’m not saying that somebody who’s obviously very sick should be brought back into your home. What I would say is we should plan to do what we’d hope someone would do for our kids, if they were a kid out there who looks sick. Calling the ambulance, wearing the right kind of mask and gloves, if you can.
It’d be a big mistake to not do anything because then that person is going to go around and infect other people. And then it grows, and then the risk to your family is higher. So it’s in everyone’s interest to try and get sick people cared for and not walking around infecting others. Back in 1918 when we had the pandemic influenza, people knew that they were exposed to risk, and we didn’t have medicines or vaccines to take care of people. People were treated in very large settings. They were taken care of in gymnasia. There were volunteers who had no medical training who would care for those people, at risk to themselves.
So I think that we would do the best that we could.
The other thing is if this disease sickens a third of us or half of us, and 1 percent of those people die, the other people who recover, they’re immune. They’re ready. They can help people at that point.
DON’T isolate yourself.
Inglesby: Pandemics are going to move around the country. They’re going to move around the world. That’s the whole definition of a pandemic. Every year, a third of the world gets sick from influenza. It doesn’t stay just in the city and then spare a rural location or a farm. And I don’t think it’s possible for almost anyone to stay entirely isolated for a year or 18 months. They need to be part of society to make it.
On the one hand, polling in past outbreaks in the United States shows that the American public strongly supports closing borders to try and prevent disease from getting in. On the other hand, we know from science and public health that closing borders never ever has worked. And the consequence of closing a border is that you interrupt the movement of scientists and people who can try and help. If you do take that action and then the United States gets a case, do you then risk the rest of the world saying, “We will now shut you out of moving your people and goods around the world?” It’s a cascade. It’s like a domino effect.
We can do sensible screening at airports. We can isolate people early. We can crash on vaccine development, although it’s still going to take us probably years. But we shouldn’t take what we think is politically, instinctively, the right move without understanding that public health and science shows that it’s never helped before—and it could really hurt us.
DO call your legislators—before pandemic strikes.
Inglesby: If you have a concern about pandemic in the future, and what would you do, and would you be able to get a vaccine and medicine, call your legislators to say, “Hey, I’m tracking this issue. I pay attention to this. I want you to support medicine and vaccine development and science around infectious disease to make sure we don’t deal with this.” That’s a good thing. People sometimes despair and say, “What is my voice going to do in a world that’s so chaotic and politics is so broken?” I do think that relatively small numbers of people calling a legislator’s office makes a difference.