Since Warzel’s column, another unknown has become known: How does this pathogen kill us?
Different countries are showing different trajectories and what doctors call case fatality rate (CFR). The CFR is worked out as a percentage of confirmed infected cases. Going by numbers, Germany, has a CFR of approximately 3 per cent; Italy’s, on the other hand, has gone above 13 per cent. It’s the same within the US. According to Vox, “As of April 20, Michigan had reported a CFR of 7.6 percent, compared to Oregon’s 3.8 percent.”
There’s yet another difference: Why have Iraq, Afghanistan and Pakistan shown less cases or, if you are going to quibble over low testing as the reason for that, low CFR of the confirmed infected cases compared to Iran? If Pakistan, India and Bangladesh (which has the lowest number of cases in South Asia and a very low CFR) have some kind of herd immunity, why is the CFR high among South Asians in the US?
While epidemiologists, mathematicians and economists continue to churn out models, trying their best to figure out a smart dance around this pathogen, doctors realise that the initial clinical findings about the symptoms might not be very useful. For instance, fever, dry cough and shortness of breath, the three telltale signs, do not always tell the whole story. In fact, until less than a month ago, hospitals and clinics were turning away people if they didn’t have fever. Since then, as per the Journal of the American Medical Association, nearly 70 per cent of the infected people who were ultimately hospitalised did not have fever.
Doctors now concede, even if grudgingly, that this virus is behaving in unexpected ways. Carl Zimmer, an American science journalist, tweeted on April 19, “is there any other virus out there that is this weird in terms of its range of symptoms?”
Understanding these unpredictabilities is vital to any response and, more so, criticism of what approach is best for a country. Objective science and mathematical curves perform an important function, but as I noted last week in this space, they speak in a universal language that is internal to their architecture. That language is not “shaped by historical legacies, political culture and social mores,” in addition to other unknowns about the pathogen itself.
State and society responses are. As Orhan Pamuk noted in his op-ed for NYT, fear and resentment lead to externalising the epidemic: it has come from somewhere else. Fear also makes us feel alternately lonely and wanting to be part of the community. Religious practices can matter. Pamuk says “historically it had always been harder to convince Muslims to tolerate quarantine measures during a pandemic than Christians, especially in the Ottoman Empire.”
Be that as it may, there’s another way of looking at these pandemics and I got lucky a week ago while researching for literature on pandemics when I chanced upon historian William McNeill’s Plagues and Peoples. The book first came out in 1977, but the primary thrust of its arguments remains unchanged. (I am almost 260 pages down and it’s fascinating!)
The motif that runs through McNeill’s work is somewhat simple: Sapiens are part of the earth’s ecosystem “and participate in the food chain whereby we kill and eat various plants and animals, while our bodies provide a fair field full of food for a great variety of parasites.”
For McNeill, this means that “No conceivable change in the earth’s ecosystem will alter that fundamental condition of human life, even though changes in our knowledge and behavior can and will continue to alter the incidence of disease and the array of what we eat.”
This line of argument has since become common among ecologists and sustainable development advocates. Last month, William Rees, professor emeritus of human ecology and ecological economics at the University of British Columbia, wrote an article captioned, The Earth Is Telling Us We Must Rethink Our Growth Society.
Rees wrote: As the pandemic builds, most people, led by government officials and policy wonks, perceive the threat solely in terms of human health and its impact on the national economy…However horrific the COVID-19 pandemic may seem, it is merely one symptom of gross human ecological dysfunction. The prospect of economic implosion is directly connected. The overarching reality is that the human enterprise is in a state of overshoot.”
At the heart of human endeavour lies the paradox: regression is latent in our progression. We believe that we can conquer nature. And in some ways we have. In 1884, Robert Koch identified the cholera bacillus; in 1976, WHO succeeded in eliminating smallpox. Amazing, we would say. But as McNeill reminds is, this “was assuredly one of the most drastic disturbances of older ecological balances ever achieved by human beings.”
Humans are ‘great’ at changing ecological balances, as Harari noted in Sapiens. But nature reacts to those changes and “infectious diseases have begun to come back [to show us] that we remain caught in the web of life — permanently and irretrievably — no matter how clever we are at altering what we do not like, or how successful we become at displacing other species.”
The paradox I spoke about earlier is owed to Sapiens being the only species in the animal kingdom that can, and continually desires, to create surplus. Other animals in the food chain act to survive, biologically. The predators attack when they are hungry; they mate when they have to reproduce. For them, life doesn’t go beyond that. For Sapiens, life has meaning beyond mere biological functions. In his 1997 work, Guns, Germs, and Steel, Jared Diamond argued that the shift to agriculture and storage of food allowed more leisure time to people who could dedicate themselves to ideas beyond the immediate, biological requirements of the hunter-gatherer. Also, agricultural societies led to population densities and more frequent exchange of ideas and creation of technology.
Whatever the reason, Sapiens create symphonies, faberge eggs, skyscrapers, make war, loot and kill, send space probes and so on. The desire to create surplus is at the heart of all the good and the evil we see in this world. But regardless of the good and evil, the ability and desire to generate surplus also results in the paradox I refer to.
Creating surplus also translates into the burden we put on the earth. As Rees says, “We are using nature’s goods and life-support services faster than ecosystems can regenerate. There are simply too many people consuming too much stuff… Gaian theory tells us that life continuously creates the conditions necessary for life. Yet humanity has gone rogue, rapidly destroying those conditions.”
McNeill said the same thing in 1977: “Perhaps one can say that biological evolution has, in effect, been overtaken and accelerated beyond all precedent by human intervention in natural processes, guided and directed by modern science on the one hand, and driven by multiplying human numbers on the other.”
Corollary: while we fight this pandemic, our efforts to produce a vaccine and our mathematical curves to determine how it will impact us could blind us to the more fundamental problems that inform our existence. Addressing them is no more a fringe issue confined to ‘alarmist’ ecologists and ‘idealist’ tree-huggers. It is nature’s way of signalling to us the law of the food chain. If we enlarge “human capabilities for changing natural balances among competing life forms,” we should be prepared for nature’s countervailing capabilities.
Darwin be praised.
The writer is a former News Editor of The Friday Times. He reluctantly tweets @ejazhaider