Medical Examiner

How to Prepare for Our Pandemic Winter—and the Epidemics to Come

A sign illustrating three wrong ways and one right way to wear a face mask. In the correct image, a figure wears the mask over nose and mouth and gives a thumbs-up.
Grand Central Terminal in New York City on Oct. 21. Spencer Platt/Getty Images

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When Ed Yong covered the 2018 Ebola outbreak in the Democratic Republic of Congo, he saw that the virus forced families to abandon traditional funeral practices for the dead—and that many Western observers regarded these rituals as “silly superstitions that should easily be thrown to the wayside.” Now, as the U.S. prepares for a pandemic winter, many Americans will make similar choices around holiday rituals they hold sacred. On Thursday’s episode of What Next, I spoke to Yong, a science writer at the Atlantic, about what we’ve learned about SARS-CoV-2, why medicine alone won’t save us, and how the 2020 election will determine the path forward. Our conversation has been condensed and edited for clarity.

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Mary Harris: You’ve written about how, now that we’re eight months in, we know a lot more about the coronavirus. But knowing so much can actually be misleading because so many people have contracted it so suddenly that you just see everything that can go wrong with this virus, and it makes it seem almost more powerful than it is. I’m wondering if you can talk a little bit about that—how we need to pay attention to the most salient things.

Ed Yong: I don’t think any other disease in history has been subject to such intense scrutiny by so many researchers in such a short time. There are other things that we know more about because they’ve been around for much longer. But the fact that COVID-19 didn’t even exist probably this time last year and we now know a lot about it is testament to the sheer amount of research effort. But two things: Firstly, there are millions of cases. A lot of people have got this, so rare events, like things that only show up one in a thousand times, are actually quite common. And two, we’re paying a lot of attention to it, so we’re seeing things that this virus is doing that we would otherwise not notice for more familiar infections.

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We’re talking about stuff like people having sudden heart attacks and strokes. We’re talking about long-haulers and how common it might be for this disease to last a long time and have lots of lingering effects.

Yeah, absolutely. The wide number of organ systems that this virus seems to hit. The fact that some people, a very small number of people, have been reinfected even though they had already encountered the disease. These traits are actually not uncommon to other viruses. We just don’t pay them enough attention.

Take the heart issue: About 20 known viruses, including quite familiar ones like influenza, can cause viral myocarditis, which is inflammation of the heart. Now, most of those cases resolve on their own, some proportion lead to long-term problems like scarring, and some proportion will progress to a fatal heart problem. But it’s hard to say what numbers of people go into those three buckets because typically doctors only see viral myocarditis in the third group, the people with the most severe problems, who then get some kind of medical scan. But now, because we care a lot about COVID-19 and reasonably so, people are scanning the hearts of folks who might have very mild or even no symptoms, and they’re seeing signs of myocarditis. Now, is that going to progress? What does that mean? We actually don’t know because we just don’t have the denominators, and we don’t have a baseline comparison for how normal viruses behave.

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I think that there are two ways of looking at this, and they’re both right. One is we shouldn’t totally freak out and believe that COVID-19 is utterly unlike everything else we’ve seen before. It is certainly worse than the flu. It is certainly a problem. But it’s not like this completely alien, supernatural virus. But also, this should give us pause. It should make us think maybe there are things about other viruses that have gone unnoticed and that we should pay more attention to. And the long-hauler phenomenon is the classic example of this.

There have been lots of cases of chronic illnesses that can be triggered by viral infections that have been neglected and dismissed for a very long time. If we had paid more attention to those, maybe we’d be in a better position to understand what is happening to COVID-19 long-haulers and be able to prevent or treat that phenomenon.

The death rate from COVID seems to be going down. Do we know why that’s happening?

It’s almost certainly because doctors are just getting better at treating it—and that’s not really because of medicines. Despite the huge amount of effort that’s gone into testing all kinds of drugs against this virus, I think the only one with really solid evidence is dexamethasone. It’s a steroid. It reduces mortality rates among the most severe patients. …

Besides that, I think just the general practice of medical care—like how you treat your patients when they come into the ICU, regardless of, like, the magic drug that you give them—that has just got better. And there are some other factors, like on average the demographics of people who are getting infected are skewing younger. But yes, people who are hospitalized with COVID now have a higher chance of survival than people who were hospitalized back in March. And that reflects our better medical understanding.

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There is a catch, though, which is that if this improvement hinges on the better ability of doctors to treat the virus, doctors are really exhausted right now. We are into the third surge. Hospitalizations are rising. Hospitals are once again filling. We are getting the same kinds of stories [as] in March of health care workers without adequate PPE and who are just very, very stretched. And those health care workers have been very stretched for months, like since the spring. And the one thing about this current surge which really worries me is that unlike the previous ones, which were concentrated in certain areas—the Northeast initially, the South after that—this third surge is all over the place. It is over a very wide geographical swath of the U.S., which means that unlike previous surges, where doctors from less-hit areas could travel and help out people in hard-hit areas, it’s going to be very difficult to send and mobilize reinforcements this time round. And that should really concern us.

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It sounds like you’re saying don’t go home for the holidays.

What I’m saying is that going home for the holidays, where you have different generations of people mixing for long periods of time in close contact indoors, probably without masks, talking a lot to each other, is going to be dangerous, not just for you but for your loved ones. There are ways of trying to reduce that risk, but the risk is there. What I’m really trying to say, above all else, is that people should be able to make informed decisions. And a lot of folks are still operating on this idea that 6 feet away—magically protected. Scrubbing down surfaces—magically protected. That is not the case. If you want to take actions that actually keep yourself safe, staying outdoors, reducing contact time, wearing masks, all of these things are probably going to make more of a difference. …

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Contrary to Mark Meadows, the [White House] chief of staff, it’s not impossible to control a contagious virus. And to be clear, the world has managed to control highly contagious viruses before. Waiting for treatments—it does reflect this widespread and especially American mindset of waiting for the biomedical savior to fix everything. Treatments for viral diseases are very, very hard to do and typically produce incremental benefits on top of just general, solid medical care.

I think the focus on treatments while seemingly deciding to allow the virus to run rampant not only reflects this magical thinking, but also this split between the biological and social sides of medicine that has happened for much of the 20th century. If you look at the things that have really made a difference this pandemic, it’s things like masks, physical distancing, these things that rely on the behaviors of people. It relies on us tolerating a certain amount of inconvenience to protect each other’s health. It’s not a drug, it’s not a vaccine, but it makes a huge difference. And we undervalue that, like we call these things “nonpharmaceutical interventions,” which again betrays that biological bias.

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We think of them as sort of not scientific enough.

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Right. We think of them as the B-list interventions—like there’s the pharmaceutical ones, which are going to save the day, and then the nonpharmaceutical ones, which get their own miscellaneous category. Flip that. In terms of the effect that these things have had on pandemic outcomes this year, it’s completely the opposite.

I feel like we have to talk about the election and what’s going to happen. In your article this week, you basically said, if you think about this last year of the Trump administration as a kind of experiment to see how Trump would handle a pandemic, this is a failed experiment and you wouldn’t want to run it again.

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I think it is worth pointing out four things that are pretty inarguable. One, Trump has mishandled the pandemic very badly. His approach has been extraordinarily lax and has contributed to the deaths of hundreds of thousands of Americans. Number two, Donald Trump seems to be completely incapable of learning from his mistakes—and he has made many. But his rhetoric is still the same, even after he himself has fallen sick with this very virus. Number three, the pandemic is going to continue, so whoever sits in the White House Jan. 22 will still have to deal with it. And finally, number four, perhaps most importantly, there will probably be another major epidemic in the next four years that whoever is president in that term will also have to deal with. And how can I say that for sure? Well, every recent president has had to deal with some major epidemic, because these things are upon us. This is an era where new diseases are going to emerge and old diseases will reemerge.

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So you’re saying it’s not just our pandemic winter, but our pandemic future.

Yeah. I mean, hopefully most of those things are not going to create a pandemic, but this is an age of epidemics.

Have you seen anything in Joe Biden’s plans or people he potentially would want to hire that makes you think he’ll handle it better?

Yes. He has talked about a national mask mandate, which I think is a good idea because we have seen that masks can make a difference in stopping people who are infected from spreading this virus. One of the things that I am encouraged by is that he has also talked about the importance of paid sick leave, which is the kind of social intervention which is often being forgotten during this pandemic and that, I think, is as important as the biomedical stuff like new drugs.

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A lot of people simply haven’t been able to take the actions that will keep themselves and their loved ones safe this year because they have had to just go to work. They work in essential jobs, low-paid jobs, and they simply can’t afford to stay at home and isolate in the way that people with more privilege have been able to. And I think rolling out things like paid sick leave will give people the choice to protect their lives without sacrificing their livelihoods. And I think that actually makes a huge difference to our ability to control the spread of this virus.

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