April 25, 2020

The Long Game

By Kenneth Ring, Ph.D.

As you will know if you've been an assiduous reader of my previous blogs or, more likely, just an occasional casual visitor to them, I don’t spend much time these days watching the news on TV about the virus. Life is dismal enough without being reminded of how much people in the U.S. and around the world are suffering and how many have already died, not that our President ever seems to spend any time mourning them, but then, as we know, he was apparently born without a gene for empathy. Bill Clinton, he ain’t. Never mind, that's not what this blog is about.

What I was going to say is that last night I made an exception and watched The News Hour on PBS. One of the guests on the program was an infectious disease specialist named Michael Osterholm from the University of Minnesota where, it being neither here nor there, I went to graduate school back in the antediluvian epoch. My memories of Minneapolis in those years were of nine months of brutally cold winters followed by ten minutes of spring, but then this isn't what this blog is about either. To begin with, it’s about what I learned from listening to Dr. Osterholm.

This will be one of those good news/bad news tales. Let's start with the bad news. If you’re reading this, you have an excellent chance -- perhaps as much as a 2/3rd probability -- of being infected with the corona virus. The good news, according to Dr. Osterholm, is that you have an 80% chance of winding up only mildly or moderately sick for a few weeks or maybe not even being aware that you've been infected. In that case, you will be laid up for a short time but then you will fully recover and that will be that. Even if you are in the remaining 20%, there's a 50-50 chance that you will not have to be hospitalized and could be successfully treated by your own doctor. And the best news of all -- perhaps only .5 to 1 percent of people who come down with the illness will die. All in all, I'd say that is pretty reassuring news, assuming that Dr. Osterholm's predictions are accurate, but then, who knows? Still, I think we should take heart from these projections, don't you?

Of course, as Dr. Osterholm made clear, nobody knows what the hell will happen over the coming months or years. At this point, it's all guesswork, even if it may be educated guesswork. But Dr. Osterholm went on to tell us some things that were fairly sobering, if they prove to be true.

We don't know whether this virus will act the way the influenza virus behaves, but if it does, we can expect that it will recur and probably more than once over the next year or more. In that case, there will be periods of waves and troughs. We may have a few months when it will abate to a significant degree, but then, perhaps in the late summer or early fall, it may strike again and this time, it could be even worse than it's been. Dr. Osterholm, using a baseball analogy, said where we are now just in the second inning. It will be a long game. Get used to it. If he and other experts are right about this, we are going to be plagued with this virus for quite a while. Nobody knows how long.

And even if COVID-19 does not prove to be as lethal a virus as many had feared, it could still end up ending the lives of many thousands of people. Dr. Osterholm estimates that ultimately it could kill as many as 800,000 people in the U.S. As of this writing, about 50,000 Americans have died from it. That’s obviously not a small number, but it's only a small fraction of those we can expect to perish, again assuming we can trust this projection. We just don’t know, but we have been warned.

Mulling all this over afterward, I naturally thought about all the people who would die. Most of them would be old folks like me. After all, I'm in my mid-eighties now, and though, so far as I know, I don't have any serious illness or "underlying condition" that makes me particularly vulnerable, my odds of surviving aren't good. After all, I am already suffering from an incurable disease -- aging. If the virus doesn’t get me, my decaying telomeres will. But my own life and death is of no particular consequence in the scheme of things -- even if it is to me -- especially when viewed against the enormous level of suffering that billions of people now living are experiencing and will have to continue to endure.

But then I had another thought. Not about myself, but about other old farts like me. I know you will think me callous but it was a big "So what?" So what if many old people were to die from this virus?  I mean, a lot of these people would die, anyway, wouldn’t they, of so called "natural causes." Or if they were living, might well wish they weren't. After all, if you've already lived into your eighties, as I have, you will have learned that the promised "golden years" are a crock of you-know-what.

For years, I have joked about my own version of "a modest proposal." My idea was that people would live under a definite death sentence. If they survived until they had reached their three score and ten, they would be given a pill that would painlessly ease them into death. This, it seems to me, would have many advantages. First of all, it would save billions of dollars since an enormous amount of money has to be spent in the last years of people's lives on providing them health care and hospitalization. Second, it would free up a great deal of money for younger people since no more Social Security payments or pensions would be necessary after a person reached seventy. Third, most people's productive years are over by the time they reach seventy; the rest is mostly just waiting to die and years of illness, decrepitude and senility in store. Is this any way to run a navy? Do you really want to spend your "senior years" shuffling to the shuffleboard area on yet another cruise with elderly folks like yourself or making a sorry spectacle of yourself with your potbelly and ridiculous-looking Bermuda shorts tottering around on some Floridian gulf course? Or worse yet, did you ever dream when young of spending your last years languishing in a nursing home among the demented and utterly forlorn, the truly wretched of the earth? (If you have ever spent time visiting an ancient loved one in one of these places, you will know what I mean.)

Honestly, when you consider all this, wouldn't it really make sense to spare old people this kind of fate? After all, we weren't meant to live to such great ages. Evolutionarily, we were designed to live only so long as to procreate, pass along our genes, and then get off the stage. Dying in one's forties would normally allow us to accomplish all these things. Now more and more of us just hang around, are burdens to our family, and merely take up space while exhausting limited financial resources. What is the point? 

Hell, if I had died when I was seventy, both the world and I would have been better off. I wouldn't have had to suffer the deliberating effects of my spinal stenosis. My hearing would still have been good, my vision, good enough; I still would have been able to hike, to travel, make love, and enjoy life to the fullest. I wouldn’t have to spend days as I do now when I sometimes walk about the house like a wraith, exhausted and weary beyond belief, trapped in a seemingly interminable bardo of ennui hovering between life and death. Instead of often feeling like cashing in my chips, I would have still been in my chips.

Besides, one thing my years of research on near-death experiences has taught me is that death is nothing to be feared, but is to be looked forward to. Dying may be hard, but death is easy.

When I was first researching NDEs forty years ago, I collected testimonies from NDErs about the effects of their experience on their fear of death. Here's a small sampling of what they told me:
"I had been terrified of death before, it [the NDE] left me with a total lack of fear of death."
"Well, I certainly have no fear of death."
"I’m not afraid of death at all."
"I have no fear of death. I don’t to this day."
"If this is what death is like, then I'm not afraid to go... I have absolutely no fear at all."
"I have no fear of death."
"I'm not afraid of dying. I'm really not afraid and I used to be scared to death."
I collected many such quotes from this research (but there is no point in endlessly listing them here) and all other NDE researchers have reported the same findings.

All this, to be sure, doesn't fully address all aspects of our fears about death. Quite apart from the fear of death, what about the fear of dying?

Of course, NDEs don't do anything to diminish that. It’s understandable to fear dying. If, as Bette Davis famously reminded us years ago, old age isn't for sissies, dying is surely not for the craven. Let’s not kid ourselves; no one looks forward to dying (except those in extreme pain or those who are simply weary of life). And who knows what dying will be like for us? Who can say whether when the time comes, we will die "in character?" Elisabeth Kübler-Ross, the great expert on death, apparently had a very difficult time dying and was very angry. Who knows whether Ken Ring, the guy who spent half his life studying NDEs, won't die like Tolstoy’s Ivan Illich by screaming for three days before his death? It’s a crapshoot and you don’t have the chance to load the dice.

And coming back to our current pandemic, the prospect of dying as a result of having extreme difficulty in breathing and effectively suffocating to death is not exactly an enticing prospect, and many of us will, alas, presumably die in this way. But on the other hand, spending one's remaining time on a ventilator is not exactly an alluring future possibility either. And even if ventilators are no longer in short supply, I can't see availing myself of one. Better to stand aside, Ken, and let some younger person take that route. They still have life to live; you've had yours. Make way, old timer.

Anyway, that's how I’m feeling about things after having pondered Dr. Osterholm's commentary. On the whole, I feel encouraged to know that even if the pandemic will be with us for sometime, the great majority of people who really need to live will survive and eventually thrive and those who don’t would probably have died soon enough anyway. The corona virus, bad as it is now, is not strong enough to bring about even a hint of a Malthusian solution to our over-population problem, so the world will continue on with its usual struggles and problems once this crisis has finally passed its acute phase.

It's still a long game, if not for the likes of me. I'm fine with that. Really. Now you will know why.

April 20, 2020

Doctor Fauci and the Pandemic

By Kenneth Ring, Ph.D.

You’ve seen his face. You’ve heard his raspy voice. But what do you know about the man himself?

I confess I didn't know much about him at all until I read a recent twelve-page profile of him in The New Yorker entitled "How Anthony Fauci Became America's Doctor" (April 20, 2020) by one of its veteran staff writers, Michael Specter, who often writes on medical subjects. Specter was a perfect choice for this piece since he has known Fauci beginning in the mid-1980s and has followed his career closely ever since. Virtually everything that follows, with the exception of a few personal asides and my concluding remarks, is drawn from Specter's article. My hope is that my little blog will stimulate you to look up and read Specter’s profile, but for those of you who don’t read The New Yorker or don’t know much about Fauci from other sources, I can at least provide something of a thumbnail sketch of this remarkable man.

So who is Anthony S. Fauci, the country’s leading and now very prominent expert on infectious diseases? Since I mean to introduce you to the man before briefly discussing his career and especially his role the corona pandemic, let’s begin at the beginning when Fauci was a kid growing up in Brooklyn in the early 1940s.

Perhaps significantly, he made his debut into this world on Christmas eve of 1940, when his parents were living in an area of Brooklyn called Bensonhurst. Oddly enough, a few years later, I spent a summer there myself just before the end of WW II when I was nine years old. I still remember a kid yelling after me, "Hey, California, you wanna play stickball?" Tony might have been living in the same neighborhood then, but even if so, stickball was not to be his game; he would be keen for hoops.

Tony's parents were Catholics, and he would wind up having a thorough and very superior Catholic education, but as a kid he was also busy making deliveries on his Schwinn bicycle for his father, a pharmacist, and playing basketball. But he had an interest in baseball, too, as Brooklyn was then still the home of the Dodgers, affectionately known as "dem bums." Oddly enough, however, Tony was a Yankee fan, and those were the days to be one since as of 1947, they were almost always World Champions for the next sixteen years. Reflecting on those years, he told Specter, "You probably are unaware, but half the kids in Brooklyn were Yankee fans. We spent our days arguing who was better: Duke Snider versus Mickey Mantle; Roy Campanella versus Yogi Berra; Pee Wee Reese versus Phil Rizzuto and on and on. Those were the days, my friend."

They were indeed. I was an ardent Yankee fan myself in those years, after seeing my first big league game at Yankee Stadium in 1945, and grew up worshipping those Yankee idols during that team's glory years. But that's the last thing Tony and I had in common when we were both kids, so let's get back to him and his story.

In 1954, he began attending Regis, a very elite private Jesuit high school on the Upper East Side. It was quite a hike from Brooklyn to 84th and Madison and Fauci estimates that he had spent the equivalent of seventy days of his teen-age life on the various subways and buses he took to get to and from school.

But he loved it there and quickly showed himself to be a very gifted student. And in those days, especially at schools where the teaching regimen was rigorous, the curriculum was very demanding. "We took four years of Greek, four years of Latin, three years of French, ancient history, theology," he told Specter who also observes that at Regis, "he developed an ability to set out an argument and to bolster it with evidence -- good preparation, it turned out, for testifying before Congress."

Let me now simply quote a couple of paragraphs from Specter’s profile that will make it clear how Tony was obliged to give up a career in basketball and to become a doctor instead. This will also help you to see how the boy developed into the man we know today.
At the time, though, Fauci had no interest in becoming a doctor. "I was captain of the Regis High School basketball team," he once told me. "I thought this was what I wanted to do with myself. But, being a realist, I very quickly found out that a five-seven, really fast, good-shooting point guard will never be as good as a really fast, good-shooting seven-footer. I decided to change the direction of my career."
At school, Fauci’s accomplished peers were headed to careers in medicine, engineering, and the law. At home, he was steeped in the humanities: "Virtually all my relatives on my mother’s side -- her father, her brother, and her sister’s children -- are artists." His mother helped tip the balance. "She never really pressured me in any way, but I think I subtly picked up the vibrations that she wanted very much for me to be a physician," Fauci said. "There was this tension -- would it be humanities and classics, or would it be science? As I analyzed that, it seemed to me that being a physician was the perfect melding of both of those aspirations."
Fauci wanted to attend an Ivy League school, but his Jesuit teachers wouldn’t permit it! He would have to choose a Catholic institution, and his choice was to go to Holy Cross in Worchester, Massachusetts. But as he did at Regis, Fauci was to thrive there. He enrolled in a program called Bachelor of Arts -- Greek Classics -- Premed. "It was really kind of bizarre," he recalled. "We did a lot of classics, Greek, Latin, Romance languages... We took many credits of philosophy, everything from epistemology to philosophical psychology, logic, etc. But we took enough biology and physics and science to get you into medical school."

Fauci was now bound for medical school at Cornell, but in those years he had to spend summers working construction jobs. And here again, I can’t resist quoting another delightful anecdote from Specter’s article:
One year, he found himself assigned to a crew that was building a new library at Cornell Medical College, on the Upper East Side. "On lunch break, when the crew were eating their hero sandwiches and making catcalls to nurses, I snuck into the auditorium to take a peek," Fauci recalled in 1998, at the medical school’s centennial celebration. "I got goose bumps as I entered, looked around the empty room, and imagined what it would be like to attend this extraordinary institution. After a few minutes at the doorway, a guard came and politely told me to leave, since my dirty boots were soiling the floor. I looked at him and said proudly that I would be attending this institution a year from now. He laughed and said, ‘Right, kid, and next year I am going to be Police Commissioner.'"
Fauci graduated first in his class in 1966, which of course was during America's involvement in the Vietnam War. At that time, every new physician had to select some form of military service. Public Health Service was one of the options, and Fauci went for that. The dye was cast.

Fauci in the five decades since as the country’s leading infectious disease expert has gone on to have a storied career, garnering more laurels than a dozen Olympic champions, and Specter’s profile provides many such accolades. You will need to read Specter’s article to follow the course of Fauci’s career, but he provides a very full account of Fauci’s involvement with the AIDS crisis, which came to his attention in 1981 and consumed much of his time for the following decade. Did you know he made fundamental contributions to the understanding and treatment of AIDS? I didn’t. That part of his story is fascinating. He went from being a stickler for rigorous testing to becoming an advocate and activist for people suffering from AIDS. "I went to the gay bathhouses and spoke to them. I went to San Francisco, to the Castro District, and I discussed the problems they were having, the degree of suffering that was going on in the community, the need for them to get involved in clinical trials, since there were no other possibilities for them to get access to drugs. And I earned their confidence."

Larry Kramer, one of the most important AIDS activists, had spent years vilifying Fauci, but after Fauci confessed his errors and joined the cause they became friends. Each of them came to value the other’s contributions to medicine greatly, so much so that Kramer ultimately gave Fauci his highest accolade, calling him, "the only true and great hero" among government officials in the AIDS crisis.

I wish I had time to review Fauci’s career, but this is a blog, not a real essay, so I must move things along. But if what I have written so far has made you curious to learn more about this extraordinary man, who, pushing eighty, still works 18 hours a day, and who has been the one indispensable figure in helping us understand the current pandemic, I can only urge you again to consult Specter’s article or other sources of information about Fauci. For now, before we turn to his role in the COVID crisis, let it suffice for me to quote just two brief appraisals of Fauci’s importance.

David Baltimore, a Nobel laureate and a pioneer of molecular biology, told Specter, "Tony is unique, in that he has such credibility with politicians that he’s been able to insert hard facts into the conversation. That has been wonderful for our country and the world." According to David Relman, a microbiologist at Stanford University who for years has advised the government on biological threats, "Tony has essentially become the embodiment of the biomedical and public-health research enterprise in the United States. Nobody is a more tireless champion of the truth and the facts. I am not entirely sure what we would do without him."

The public seems to agree with these assessments, too. According to a recent poll, 78% of Americans approve of Fauci's handling of the pandemic while only 7% disapprove. Contrast that with Trump’s ratings where 65%, according to the latest poll I’ve seen, disapprove of the President's performance during this crisis.

Indeed, rather like Ruth Bader Ginsberg, Fauci has seemingly become in a very short time, something of a cultural icon, as Spectator amusingly recounts:
These days, nearly everyone has heard of Fauci. Pandemic-memorabilia entrepreneurs have put his face on bottle openers, coffee mugs, and bumper stickers: "In Dr. Fauci we trust." The National Bobblehead Hall of Fame and Museum has produced a seven-inch likeness of him, partly to raise money to produce protective gear for medical workers. There’s a Facebook group called Dr. Fauci Speaks, We Listen, and another called Dr. Fauci Memes for Social Distance Teens. A petition has circulated to nominate him as People’s "sexiest man alive."
But let’s get serious now and turn our attention back to the pandemic. As we have been made well aware now, we should have seen this coming. Virtually every reputable epidemiologist and virologist anticipated one or more as a certainty, not an if, but a when. Fauci, too, had warned that we should have been prepared for one, certainly much better prepared than we were, as he has admitted.

We have been preparing for the wrong war. "We spend many billions of dollars every year on missile-defense systems," Seth Berkley, a medical epidemiologist who leads the Global Vaccine Alliance," told Spector. "And yet we will not spend pennies on the dollar to prepare for a catastrophe that is far more likely to affect us all."

The Nobel Prize-winning molecular biologist Joshua Lederberg, another expert on infectious diseases, wrote years ago that "We live in evolutionary competition with microbes -- bacteria and viruses. There is no guarantee that we will be the survivors." We just haven’t been paying attention to the invisible threat to humanity's future, but we have been forced by circumstances to wake up, and to pay urgent heed to what Fauci and other experts have been telling us for years.

Fauci himself has long advocated the development of a universal influenza vaccine, which would provide lasting defense against all strains. "Similar to tetanus, a universal flu vaccine probably would be given every ten years," he said. "And, if you get one that is really universal, you can vaccinate just about everyone in the world." But such a vaccine would cost hundreds of millions of dollars to develop and test. Still, we now spend many billions on defense, which really means war preparedness and serving the interests of arms manufacturers and the military. How much will Congress be willing to appropriate to defend us from our real enemy?

Spector himself is not optimistic.
Even Fauci’s current value as a scientific adviser has been limited by the President's contempt for expertise. Trump's coronavirus kitchen cabinet consists of people like his son-in-law, Jared Kushner, who has no medical knowledge or experience managing crises -- yet has been appointed to direct the response to the biggest medical emergency since the influenza pandemic of 1918. Trump has also turned for advice to Dr. Mehmet Oz, who for years has endorsed worthless treatments and used his television show to promote notorious quacks. Trump even seems to think that his trade adviser, Peter Navarro, should debate Fauci about the value of specific drugs. When Navarro, who has a doctoral degree in economics, was asked about his medical qualifications, he said, "I have a Ph.D. And I understand how to read statistical studies, whether it’s in medicine, the law, economics, or whatever."
The President, clearly, is more focused on "re-opening the economy" and bolstering his chances for re-election than in following the advice of his public health experts like Fauci whom he seemingly only grudgingly listens to and is doing his best to sideline. And that's where we seem to stand now, trying to contain a virus in a kind of ad hoc half-assed way that we were woefully unprepared for and that the President seems to want to wish away by a kind of magical incantation.

But if after all this, if we will have failed to learn that we must make a massive investment in public health in order to be much better prepared for the next pandemic than we were for this one, the voices of experts like Dr. Fauci will again be voices in the wilderness. We cannot afford to let that happen.

April 12, 2020

Coping with COVID in the Age of Ken

A Blog for Easter

By Kenneth Ring, Ph.D.

I don’t ZOOM. Hell, at 84 and with a severe case of spinal stenosis, I can barely walk these days. An outing for me -- or perhaps I should say, an inning -- involves my roaming, although usually with a sudden sense of urgency, from my office to my bathroom, where, needless to say, bathing is not my objective. These days, frankly, it is not even possible any longer. The last time I tried to bathe, I noticed that though I could descend into the tub, I could no longer arise. This led to a certainly perplexity, which was followed by a piercing cry for help I later discovered had emanated from my own throat. Fortunately, a neighbor to whom I had presciently given a key to my house heard my piteous wail of distress and rescued me from my watery predicament. Of course, I tried to conceal my privates and prevent them from becoming public, but was told in no uncertain but still in unnecessarily harsh terms, I thought, that given what I was fruitlessly attempting to hide wasn't worth the trouble. It was even intimated that a whole hand would not be necessary; a mere thumb would do.

But I digress. Last I looked I was discussing my failure at ZOOMing. Actually, failure is a bit too severe a term since I never even tried to ZOOM my way through the virus. After all, though I don’t think my mug is unsightly (even if I no longer seem to score high on the ogle meter), why should I think my friends would like to waste their eyes looking at the decrepit old wreck that I've become? Since many have not seen me for a long time -- and then there are quite a few of my "friends" from here and abroad I have made without their ever having met me in person -- I prefer that they remember or imagine me as I was during my prime rather than in my currently definitely sub-prime years. Visually, then, "I vant to be alone." Let me exist simply in the form of words on a screen that conceals my face. Even old men have their vanity.

But all this jejune folderol is really beside the point, which despite what it may seem, I actually have one in mind. It’s about not just how I am coping with the virus (I will get to that), but what thoughts living under the COVID cloud have occasioned in me.

For one thing, the pandemic has expanded time while it has also shrunk my horizon. And I'm sure what's true for me has been true for many. I mean, consider: Before the pandemic hit with its mandatory requirements for self-isolation, most people were busy with their lives out in the world. People, like all primates, are not only social animals but we are busy creatures and when we are busy, time flies. But now that we are immured in our houses or apartments, time has slowed to a crawl. Figuratively speaking, we have time on our hands now. What to do with all that time?

Of course, most people -- I do not include myself here -- are creative. My son, for example, tells me he is now trying to master the art of making baguettes. But since he is not French, good luck, Dave!  At least it keeps him occupied. And apparently many people have found this a propitious time to reorganize their kitchens (even I did that) or their closets (forget it). More creative types have been busy sending out sheets of surplus toilet paper full of humor, anecdotes, poetry and feel good stories. And then our inboxes are now groaning under the weight of podcasts, videos, essays, blogs (guilty!) in sufficient daily quantities to result, if we are not careful, with our eyes becoming permanently yoked to our screens. A writer friend of mine, who also works with clients on their own books, informs me her business is now booming because the pandemic has freed up so much time that everyone is writing a book or threatening to (not guilty!). The pandemic may be bad for our health, but it is apparently doing wonders for our creativity.

On the other hand, it is, as I have claimed, also narrowing our horizon. What I mean is that, once you stop watching TV (which I recommend), you wind up watching yourself, as it were. The outside world, from which we have been cut off, reduces to our own little world, to ourselves, to our petty concerns and trials. As if we weren’t already self-involved as it was, but now narcissism is having a field day. L'etat, c'est moi.

I certainly notice this in my own case, which is why I referenced "the age of Ken" in the title to this blog. But since I am also "of an age," that phrase has a double meaning. As I have already mentioned, surely to the point of tedium to some of my readers, I am not only old but decrepit and infirm. Virtually every morning when I awaken, I realize I have made an error. Why should I continue to live in a body that is clearly long past its expiration date? I am apparently doomed because I have a high bilirubin count, which seems to be associated with longevity. My dad died at 41, and I have always regretted his early death and have mourned and missed him for most of my long life. Now I think he was one of the lucky ones since he was spared the torments of old age. I joke with my girlfriend, Lauren, who is currently spending time taking care of me and without whom I am convinced I would soon perish, that I am fighting my own pandemic, old age, against which there is no cure. But the pandemic that the world is facing is just causing me to become preoccupied with my own troubles.

Who cares, Ken? They are trivial in the scheme of things. You think billions of people who have already lived and died or who are still living, haven’t experienced what you are, and far worse? What you are going through is simply par for the course if the course happens to extend far beyond the 19th hole.

But that, you see, is the point I have been driving toward, despite these jocular asides. Because of the pandemic, it's easy, even if you are not old but in the spring of your life and not its winter, to turn to your own pursuits and problems -- and to forget the world in which you are living now. And what is that world? Well, a good part of it is that a lot of people -- many hundreds of thousands, if not millions -- have become sick, and many of these have already died. And although the eventual totals may prove to be fewer than the alarming figures that were originally forecast, many more will become ill or die. Not just their lives but the lives of their families will be upended and in some cases ruined beyond restoration. Death leaves a hole in families that can never be filled.

And what about all the health care workers who have been forced both by duty and compassion to attend the sick and dying, risking and in many cases losing their own lives in order to help to save others, or even if not succumbing themselves, becoming infected and sick? How many such people throughout the world have had to deal with these energy-draining duties, day after day, sacrificing themselves, if necessary, for the sake of others?

And what about all the people -- millions, just in our own country -- who now find themselves out of work? They don’t have time to organize their closets. Many of them are wondering where to get their next meal or how they are ever going to manage without financial ruin. Not to get too political -- but at my age, what do I care what people think? -- but this country in my opinion already had been in deep decay, with so much poverty, so many homeless people, so much suicide, so many addicted to and dying from opioids, and so on -- long before the pandemic struck. And now this on top of everything else? It is almost unbearable to think about the sheer quantity of suffering that people have had to endure in recent years, now compounded manifold because of the pandemic. How do such people cope with this?

Added to this are just the more ordinary burdens that many people, especially families with children or elderly loved ones at home (or worrying about their elderly relatives in nursing homes or old age residences), have been forced to shoulder -- how hard their lives must be. Parents going nuts with their kids underfoot all day, trying to keep them entertained or getting them to do their online learning from school, trying to figure out meals, desperate to find time to rest, wondering how long this will go on?

But I don't need to go on, do I? I trust I've made my point.

In our understandable concern for ourselves, let us not forget the wider world of which we are an inseparable part. Truly, we are all connected, we are indeed one, we are part of the whole, and our collective identity as humanity itself and what it is going through now must never be allowed, not just to be forgotten, but felt! Let us remember who we really are beyond the porous boundaries of our own egos and physical bodies. We are all those who are suffering and dying as well as those who are striving to make this a better world when at last the COVID cloud will lift, the sun will shine again on our lives, and we can finally wipe away our tears.

April 7, 2020

Plagues, Pandemics, Poxes and the Electric Toothbrush

By Kenneth Ring, Ph.D.

Elizabeth Kolbert is a longtime staff writer for The New Yorker, an expert on environment issues, particularly those pertaining to the climate crisis, and the author of one of the most terrifying books of our time, The Sixth Extinction. In that book, she describes in horrifying detail what human beings have done in the newly named epoch of our time, the anthropocene, to destroy nature. We have done a very good job.

But none of that, fortunately, is our concern here. What is, is an article of Kolbert's I recently read that had to do with the history of pandemics. That stimulated me to do a little research of my own into this matter, and that is what I would like to share with you here. At the outset, however, I need to acknowledge my indebtedness to Kolbert for some of the information I will be presenting in this blog.

Those of you who are older, or perhaps as old as hills as I am, may be familiar with some of this history, but for younger readers, this may be new territory. Let’s begin to explore it.

Almost all of us who have grown up during the past hundred years or so have not had any personal experience with pandemics until now. We have of course grown used to the seasonal flu, which causes many people to die every year. But the flu doesn’t stop the world; it goes on just minus thousands of people. A pandemic, however, not only stops the world but changes it in unpredictable and often decisive ways. History, as one author has recently suggested, is not just made by men, but by microbes. Of course, in our lifetime and relatively recently there have been outbreaks of serious respiratory diseases, also caused by coronaviruses, such as SARS and MERS, and the Ebola virus, the H1NI flu, and so on, but these were, fortunately, mostly regional illnesses and were relatively quickly quelled. Malaria, though a very serious disease (it kills about a half million people every year) is familiar to most of us only from reading about it. It is rare in the United States. So, by and large, we have been very lucky to live during these times. Most of us have emerged unscathed by serious widespread disease and life has gone on in its wayward way, as have we.

Needless to say, however (a phrase that always goes on to contradict itself), this has not invariably been the case. There is hardly anyone left on earth who survived the Spanish flu that began as World War I was ending in 1918 and didn’t burn itself out until 1920. During that time it killed an estimated 50 million people throughout the world, maybe more. By comparison,"only" about 20 million people perished in the war. That flu was a lot more deadly in scarcely more than a year than in the four years of "The Great War."

But pandemics like the Spanish flu go back a long way and it is sobering to become familiar with their history. These days almost everyone knows something about "The Black Death," the plague that after it started in Europe in 1347 was eventually to wipe out about one-third of the population of that continent. But plagues and other pandemics of world-changing consequence began to afflict vast populations of humanity long before that.

According to Kolbert and other sources, the first pandemic of which we have knowledge broke out in 541 near what is now Port Saïd in Egypt. It then spread to the west toward Alexandria as well as toward the east where it reached Palestine. And then it just kept going, and going. In early 542, it had reached Constantinople, which was then the capital of the Eastern Roman Empire under the rule of Justinian (who also caught the fever, but managed to survive it). The plague hit Rome the next year, Britain in 544, Constantinople several more times over the next forty years and didn’t burn itself out until the year 750, more than two centuries after it started. Can you imagine?

And what was it like for people who found themselves caught in the vicious vise of this devastating plague? Here is Kolbert's account of it:
The earliest symptom of the pestilence was fever. Often, [according to one contemporary historian] this was so mild that it did not "afford any suspicion of danger." But, within a few days, victims developed the classic symptoms of bubonic plague -- lumps, or buboes, in their groin and under their arms. The suffering at that point was terrible; some people went into a coma, others into violent delirium. Many vomited blood. Those who attended to the sick "were in a state of constant exhaustion. For this reason everybody pitied them no less than the sufferers." No one could predict who was going to perish and who would pull through.
When the plague came the first time to devastate Constantinople, Justinian had his hands full. Again, Kolbert:
The Emperor paid for the bodies of the abandoned and the destitute to be buried. Even so, it was impossible to keep up; the death toll was too high. [One historian thought it reached more than ten thousand a day, though no one is sure if this is accurate.] John of Ephesus, another contemporary of Justinian's, wrote that "nobody would go out of doors without a tag upon which his name was written," in case he was suddenly stricken. Eventually, bodies were just tossed into fortifications at the edge of the city.
That's what plagues were like for those who lived in those times. And of course they were far worse when the Black Plague broke out. It not only blasted many millions of lives and changed course of history in Europe but it never stopped. It just kept going year and after year, century after century. In those times, people had to learn to live and die not with the flu, but with the plague.

The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries. According to one historian, the plague was present somewhere in Europe in every year between 1346 and 1671.

If you were unfortunate enough to live in London in 1665 when the plague broke out there, you had a one in five chance of dying. That plague itself killed perhaps as many as 100,000 people.

And the plague is still with us. There were two outbreaks of it in San Francisco around the time of that city’s famous earthquake, and even in this century, there were two eruptions of it in Madagascar.

Plagues are not only horrible and horrifying to those who catch the virus; they can be just as deadly for those who are innocent of doing any harm. This is because during such times, it is easy and tempting to find scapegoats for the spread of the disease. Jews, of course, have always been a handy scapegoat in the history of Christendom. Here’s just one example provided by Kolbert concerning what happened to the Jews of Strasbourg during the during the Black Death in 1349:
Local officials decided that they were responsible for the pestilence -- they had, it was said, poisoned the wells -- and offered them a choice: convert or die. Half opted for the former. On February 14, 1349, the rest "were rounded up, taken to the Jewish cemetery, and burned alive." Pope Clement VI issued papal bulls pointing out that Jews, too, were dying from the plague, and that it wouldn’t make sense for them to poison themselves, but this doesn’t seem to have made much difference. In 1349, Jewish communities in Frankfurt, Mainz, and Cologne were wiped out. To escape the violence, Jews migrated en masse to Poland and Russia, permanently altering the demography of Europe.
Now although we now longer kill scapegoats, some people have begun to blame the Chinese for what President Trump, our leading xenophobe -- and germophobe -- likes to call "the foreign virus."

Returning to history, we move now from pandemics and plagues to poxes, specifically smallpox. Many people today associate smallpox with the kind of pustules (actually called macules) that afflicted the faces of 18th century European aristocrats or even some of our own "royal personages," such as George Washington. Far from it. Smallpox is one of the deadliest and most dreaded scourges ever to torment the lives of human beings, and it is still with us. During the 20th century alone, it is estimated to have killed anywhere between 300 and 500 million people. Kolbert says it may have resulted in the deaths of a billion people during the course of its history, which goes back thousands of years to the time of the Egyptian pharaohs. It kills about one-third of those it infects.

Smallpox, too, has played a leading role in shaping the course of history, particularly in what used to be called "the new world."

Each race and many peoples have contributed their share of horrors to our world, but certainly the Europeans have done more than their share of heinous depredations in literally decimating (a word that is often misused since it means to reduce to one-tenth) the native populations of the Americas and Australia by bringing, and in cases deliberately inflicting, deadly diseases against which the indigenous people had no immunity.

For example, the Spanish inadvertently owed much of their success in conquering the Aztecs and Incas in Mexico in the 16th century to smallpox. Unlike the Spanish, the native Indians had no immunity to the disease, having never encountered it. It was far more fatal to them than the Spanish themselves as many native peoples succumbed to the disease. A century later, the North American Indians suffered a similar fate from a smallpox epidemic. True, the Europeans had the guns and brought the horses, but did you know that it is estimated that perhaps 90% of American Indians died of germs that the European invaders brought with them, most of all, it seems, from smallpox?

According to one historian:
"The discovery of America was followed by possibly the greatest demographic disaster in the history of the world."
Without question it changed the course history in permanent ways, as we have all now long realized, and native people, while they survived, realized most of all to their enduring sorrow. 

And this same shocking story played out elsewhere as well, for in the 18th century, smallpox also took many of the lives and destroyed the culture of the aborigines when it reached Australia, the last corner of the world to have escaped its ravages.

Perhaps that is enough about pandemics, plagues and poxes, though I could of course numb you into insensibility by discussing still other deadly and persisting diseases, such as cholera, likewise still very much with us, as we all will remember from its outbreak in Haiti in 2010 following the horrendous earthquake there. Eventually, some 800,000 people contracted the disease and 10,000 died. But I don’t need to belabor the point that, as John Irving made clear in his novel of a few years back, The World According to Garp, the world is not safe. And it certainly has been and will continue to be plagued by disease (no pun intended). There is no immunity from life on this planet.

So, finally, what are we to make of all this and what does this history, brief and selective as it had to be (a blog after all is not a book), have to teach us as we navigate our way through COVID-19, the pandemic of our own lifetime? Well, here are just some of my own personal reflections on the matter.

First, these diseases began with the domestication of animals and with people living in cities. I didn’t have to read Yuval Harari's Sapiens to learn that our hominid ancestors made a big mistake when they climbed down from their trees to the savannas of Africa and became biped primates (our back problems stem from that decision) and then, to compound their folly, as humans to invent agriculture ten thousand years ago from which all the subsequent calamities and misfortunes of civilization derive. But of course there is no going back. History does not follow a progressive track, but it does not go in reverse. We are stuck with it, and stuck with disease. And to be fair, civilization has brought us some wonderful things, such as the invention of the electric toothbrush. It’s not all been bad.

As for our current virus, one good thing about it is that has temporarily slowed the climate crisis express train before it hurdles over the cliff. It’s done wonders to stymie the production of carbon dioxide and methane into the atmosphere. But can we learn from this experience before it is too late? Time will tell.

But what I have mainly endeavored to show in this little essay is that as disruptive to our daily lives as COVID-19 has been -- and granting it could end up killing hundreds of thousands of people and sickening millions more -- in light of what our forbearers throughout history have had to endured, it hardly compares with the horrors of the plagues, pandemics and poxes of the past. For most of us, fortunately, we are chiefly being inconvenienced and forced to undergo isolation for a few months. I don't mean to discount all the suffering that our health professionals and others have had to undergo to deal with this virus. Many will have given their lives to protect the rest of us, and we will always have cause to give enduring thanks to them. They have been the frontline soldiers on this war. But in the end the great preponderance of humanity will emerge sobered by the experience but intact. We will survive. The world will start again. The economy will take a while to recover, but we will make it.

But apart from the lessons from history, the question is, what will you have made of it? What will you have learned from having gone through this? And for those of you who survive this temporary ordeal, how will you choose to live once this is over and you can finally rejoin the world? What kind of world would you want to see blossom then?