I have spent my whole life preparing for COVID-19. Here is what I have learned.

Between modern virology and the history of the Black Plague, I have some thoughts to offer from a life spent preparing for “the big” pandemic.

“Nothing in our lives has prepared us for this moment,” a leader at my job said yesterday on a staff call. For most people, that’s true.

I used to get sick a lot when I was a kid, so I spent a lot of time in doctor’s offices. I guess that’s where my interest in disease started; I was always curious and there’s not much else to learn about in doctor’s offices.

I got my first job in a lab basically, doing DNA testing — when I was 16. I’ve been a biologist ever since. In undergrad, alongside my biology major, I did a thesis on public health responses to the Black Plague in 1348.

As a PhD student in biomedical sciences, my thesis — “A Paramyxovirus Strategy for Dismantling RIG-I Signaling” — was born out of my study of a key emerging pathogen, Nipah virus, which has several similarities to the SARS-CoV-2 pathogen that causes COVID-19.

Since my PhD, I have worked in the pharmaceutical industry across the entirety of the product lifecycle, from development to launch, as a communications and strategy consultant.

The point of that résumé is that I have spent essentially my entire life preparing for the moment that we are currently in. There has never been a time when I have been more able to help people who, understandably, do not feel prepared for this moment.

So that’s what I’m going to do.

Understanding Epidemics

Epidemics are not the usual crisis. I remember 9/11, 3/11, Katrina, the Indian Ocean Tsunami, and many other disasters that have happened in my time. Even the global financial crisis of 2008. None of these are similar to the epidemics that snowball into a pandemic.

Most crises are a fast burn. Things escalate quickly when the underlying conditions are just right to let something catastrophic or disruptive happen. Epidemics are not like that. There are no clouds of smoke and there is no giant storm or great wave. The bottom does not fall out of society immediately.

Instead, in an epidemic, the sun still comes out. The birds still sing. You can still make your morning coffee and you can watch from your balcony while the crisis unfolds over a period of months. The Black Plague, for example, is an extremely well-documented event compared to other medieval era occurrences, because people had a lot of time to do things like write letters to one another as events unfolded. It took years for the initial pandemic to start to stabilize into periodic, local outbreaks.

This means that while the immediate, acute fear of COVID-19 may make you feel fear and panic, there is no way that you can sustain those feelings throughout this entire crisis. Human psychology doesn’t allow it. For this reason, it’s important now to understand that this is a marathon, and you can’t let emotional responses change your behavior. Your emotions are going to change many times as this develops around the world. Your approach to dealing with it cannot change with your feelings; it needs to change with new information and patient consideration. Just because you feel less scared one day does not mean you can relax social distancing. Just because you feel more scared another day does not change how much toilet paper you reasonably need. What you need to be doing is following the requirements of public health officials — at least.

What NOT to Do

During the Black Death, people did a lot of things that didn’t help. Massive religious processions to convince God to end this time of judgment may have made people feel better, but they also put people in close enough proximity to spread the disease.

Don’t Run

Fleeing to the hills from affected areas resulted in spread of the infection to the hills. Trying untested cures was dangerous too; especially in a world before evidence-based medicine.

We can learn from all of these things. We already should know that large gatherings need to be canceled. Right now, the US federal government is recommending that any gathering of more than 10 people should not take place. Explicit restrictions have been put in place in many cities. Follow these recommendations.

Fleeing cities may seem appealing; the virus is here, so you want to go there. Please don’t do this. One of the reasons that “shelter in place” has been the order of the day is that leaving is a great way to bring the virus with you. There are of course exceptions; people who are at particularly high risk, perhaps, who are able to leave without coming into contact with anyone else. But in general: stay where you are to ride this out.

Don’t Turn to Superstition

During the Black Death, people thought that God was punishing them. They began to believe all kinds of things, like the notion that torturing themselves via hair shirts, self-flagellation, and other means would convince God to spare them.

The problem is, this not only harmed the people doing it substantially — whipping your body until you bleed is NOT recommended — it also led people to gather for public displays of self-harm. Gathering in times like this is a very bad idea, and I have already seen evidence of houses of worship calling not only for services to continue, but actively encouraging the sick to come gather with the healthy so that they can obtain “healing.”

Religion is important in my own life, and I am a believer, but I also don’t let that belief overtake what is in front of my own eyes. If you believe in God, or any benevolent deity, that deity wants you to take care of yourself and your community. You can best do that by staying home.

What TO Do

We’ve all had a crash course in social distancing in the past few weeks; you can read my article about it, too, but to be quite honest things have moved so quickly that this information is now out of date. Which is why I’m not linking to my own work, and thus breaking some sort of unwritten rule about self-promotion.

However, I do want to offer some thoughts from the other side of an epidemic, again picking on the Black Death. When the Black Death first ravaged Italy, it spread quickly, but cities eventually developed countermeasures. They figured out pretty quickly that the disease was contagious and came up with the idea of “quarantine” — the word originally comes from the Medieval Italian word for “forty,” “quaranta,” because the period of isolation was forty days.

Listen to public officials

In 1374, the plague returned to Milan. This was a Milan that had seen plague before and knew what it could do. Almost immediately, the lord of Milan, Bernabo Visconti, decreed the following:

“…that each person who displays a swelling or tumour shall immediately leave the city, castle, or town where he is and take to the open country…until he either dies or recovers.” — Bernabó Visconti, “Plague Regulations of Bernabó Visconti, Milan, 1374”, in The Black Death, trans. and ed. Rosemary Horrox, Manchester Medieval Sources Series (Manchester: Manchester University Press, 1994), 203

I recognize that this sounds like “fleeing,” but the world of 14th century Italy was a lot less densely populated, and what Bernabo here was trying to say was that people should isolate themselves. He also ordered isolation for anyone who had attended to the sick or dead, and instituted a minimum period of isolation.

This approach, by the way, worked. It worked because people listened to Bernabo; likewise, you should listen to the people in charge today. When they say to shelter in place and avoid nonessential travel — do it. They have a high-level view of matters, and they have access to information that you don’t have. You don’t know better than the experts.

Lay low

It doesn’t hurt, though, to keep the recommendations of public officials and then add additional restrictions of your own. What’s being publicly ordered is the bare minimum; you can do more on a personal level.

It pays to lay low and to keep yourself inside except for essential trips and perhaps daily exercise. I’ve personally been going to the park for between 1 and 1.5 hours each day, and that’s it. The rest of the time I am inside my apartment where I pose no threat to others. When I am out, I am also keeping myself 6 feet away from others however often I can; living in NYC, this rule gets bent a little bit, but I’m doing the best I can.

I’m doing this because I think back to the words of Petrarch, a famous medieval philosopher who lived through the plague. Keep in mind that the plague killed entire villages, and when it was all over between 1 in 3 and even 1 in 2 of all the people in Europe were dead. This is a very different scale from COVID-19, but I still find Petrarch’s words meaningful:

“While I am lamenting in vain and unburdening my spirit of these sorrows, I am accusing men who cannot reply: if only, dear friend, they had followed you in physical action as they always did in purpose, and had been willing to lie low with us in our trusty home and retreat from the plague, which was so conspicuously laying waste to Rome and Naples. I rejoice that you did so and thank you for thinking my roof worthy to shelter in while our country was suffering from these same evils…We have mourned the year one thousand three hundred and forty-eight of this age.” — Francesco Petrarch, from Selected Letters Vol. I (I Tatti Renaissance Library) p.93–99.

Petrarch had seen the other side of something like what we are going through now, and surrounded by a world emptied of living friends, he wrote to one of the last survivors that he was going through the expected grief — anger at those who did not avoid the plague, shelter in place, and wait for it to end. Clearly this anger is also mixed with sadness.

In general, I’d like to help us all avoid the sadness that Petrarch communicated to us down through the ages. We have the opportunity to keep ourselves and our families safe if we do the smart thing and let this pass.

Lie low, and take care of yourselves.

Virologist, author, damn fool. Also found at www.johnskylar.com and www.betterworlds.org. Opinions my own, impressions yours.

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