It is tough to make predictions, especially about the future. –
Yogi Berra
As I write this column (March 8, 2020), long before you will see it, we are all trying to predict what is going to happen with the COVID-19 virus epidemic and the effects of the response to it. In China, it was eventually taken very seriously, with draconian measures taken to stop its spread. Did those measures blunt the spread and limit the outbreak to the quarantined regions? Similar measures were taken in Japan and some European countries. In others, and in the United States, almost all preventive measures until now (March 8, 2020) have been voluntary despite cases being reported in most states. Although the stock market has taken a serious hit, the effects on the economies are just beginning to be felt.
When you read this, will we have seen a pandemic akin to 1918 with its enormous mortality and severe economic consequences? Or, will this virus be viewed as another threat that was overblown? We wish for the latter. However, if it is the first, we probably see it by now, but hopefully for many, the progress in managing infection over the past 100 years has reduced mortality and morbidity. On the other hand, if things have settled down, with cases declining and the confidence of the public increasing, will we return to life as usual? By now we may know. We may also be making judgments about different approaches to such threats in countries where societal benefits trump individual freedoms and those where individual freedoms rule even to the overall detriment to society at large. We, in medicine, should recognize that almost all issues are about health. Some say everything is about economics, but ultimately, it is about health. Economic prosperity is about health, and poverty is an important detriment to health. Climate change is about health. Gun control is about health. Healthcare financing is about health. As we struggle in a free society to cope with all the issues facing us and elect representatives to enact measures to deal with them, we realize that almost all of them come back to health and well-being, and the tensions between the individual and society will remain. In the United States, several issues may have made control of the epidemic more difficult. What better way to spread an epidemic than to have a large population uninsured so they are unlikely to seek medical attention, or millions without documented immigrant status fearful of reporting to public health facilities, or those without paid sick leave continuing to report to work even though they are sick?
This epidemic, whether it has turned out to be an existential threat or not, should help us reflect on how the competing interests will be dealt with when the next threat appears. Unfortunately, our attention span is short. We are easily mobilized to threats like World War II or an impending collision with an asteroid but less adapted to slow threats like climate change. Maybe this virus that has caused some of us in the high-risk demographic (old people) to travel less will give us more time for reflection on these questions. The questions may seem philosophical, but the answers must be scientific. As with any scientific question, we must build on what we have learned from history. By the time you read this, we will have learned a lot. History is everything that happened until now. At the recent Cardiovascular Research Technologies (CRT) 2020 meeting in National Harbor, Maryland, Ron Waksman brought us a fascinating history lesson in the form of his interview with former U.S. Secretary of State John Kerry as he reflected on the diplomacy around climate change and control of nuclear weapons. History is important for planning; background evidence is important for scientific investigation. For the future, plans must be made, investigations must begin, and for public health, decisions (right or wrong) must be made. There are other threats, and this experience should cause us to plan for them; even the slow ones.
Yes, Yogi, it is tough predicting the future, even if you did not say exactly that or if everybody from Nostradamus on down also said it. But since the future is all we have left, we must give some serious thought to it. What did we learn since I wrote this? I hope the lessons were not too hard, but if they were or were not, I hope we can at least begin to anticipate the future, if not predict it.
