Listening to SARS
Some thoughts on what the SARS in Beijing might mean for the rest of the world, with a focus on the United States.
- Information can’t be controlled. During the period before the amazing press conference on April 20 (somewhat sanitized transcript at: http://www.chinaembassy.se/eng/47200.html), rumors abounded, some of which were even more extreme than the reality (which was extreme enough). The lack of reliable news about the real situation didn’t equate to a lack of news or a lack of worry, but rather to a real flurry of stories, some of which turned out to be true and others not. Information leaks; I’m not sure that it leaks any more or less in China than in the United States. If something like SARS came along and were classified as “terrorism” or “biological warfare,” I wonder whether the U.S. government wouldn’t make the same mistakes that the Chinese government did in trying to control what people knew about it.
- At the same time, official announcements do make a difference. Although everyone knew there were far more cases of SARS than the official announcements, it was still shocking to hear that there were something like 20 times the number announced. Perhaps an analogy can be found in the United States’ economic situation. Despite creative accounting, “everyone knows” that the government is piling up debt at a phenomenal rate, and that we will shortly face the need to pay for the retirement of an enormous demographic bulge (see, e.g., Scott Burns:
http://www.dallasnews.com/business/scottburns/columns/2003/stories/0504dnbusburns.70724.html ). Yet I suspect that many people will still feel at least some surprise when that day of reckoning finally comes and they learn that they won’t be retiring quite as soon as they expected.
Times of stress are not times of change. I’ve read several predictions that the coverup of SARS will lead to demands for a new governmental and social system in China. I’m skeptical, because under the stress of dealing with an immediate epidemic, people are more likely to become more cautious and conservative. At the same time, there’s a Chinese expression: “qiu hou suan zhang—sorry I can’t get Chinese to work in this software— ”We’ll settle accounts after the autumn harvest”) that suggests that the political consequences of this experience are likely to come down the road.
The problem of central authority. China has problems that stem from too much central authority (no checks and balances) and too little central authority (local authorities don’t necessarily pass information to the center or accept directives from the center). Outsiders typically push the government to decentralize and devolve power, but I suspect that the current pressure to bring SARS under control will, if anything, work to increase the power of the central government. Mark Twain observed that Americans have freedom thought and freedom of speech and the good sense not to use either of them. Contagious diseases bring issues about the real limits of freedom into a far sharper focus than otherwise.
How long can you hold your breath? Over the past few days it’s been interesting to watch Beijing slowly come back to life. Quite a few people fled as soon as the true situation on SARS was revealed and others, like students, are restricted to their campuses. The increase in traffic has been striking, given that there has only been a modest improvement in the number of SARS cases reported every day. I would guess that a week is about as long as people are willing to give up their accustomed lives without any kind of continuing direct evidence that they need to do so.
People are not good at estimating risk. It has long been known that humans are not very good at estimating the risk of different kinds of activities, dramatically over-estimating the risks of some dramatic events (e.g., airplane crashes) and underestimating the risks involved in more mundane activities (e.g., taking a shower or driving). It’s clear that something like this is going on with SARS. A diminishingly small number of people have come down with this illness, and it probably ranks low compared with other risks of living here. I thought I saw more traffic accidents in the first few days after people started wearing face masks, and saw the aftermath of one very sad incident, where a bicycle was left by the road where it had been struck by a taxicab. On the back of the bike was a small bag containing the packets of Chinese medicine that schooles and factories were handing out. A poignant reminder that it’s easy to overlook one risk in trying to adjust to another.
Viruses evolve, too, and that may be good news for the United States. One of the best articles on disease I’ve ever read concerned the work of Paul Ewald at the University of Louisville
(http://www.theatlantic.com/issues/99feb/germs.htm ). The relevant part of his argument is that natural selection works on diseases as well as on organisms, so that they will tend to be less virulent in settings with better sanitation (because otherwise they will kill their hosts before they can be transmitted). I hope so!
The U.S. is not prepared to deal with something like SARS. Stopping the spread of a disease requires interfering with the free movement of potentially infected people. This is very unpleasant. For example, I live on a campus in Beijing with about 10,000 students. One of the smartest things they’ve done (although students really hate it) is to divide the students up into smaller groups and limit where they can eat, bathe etc. This turns a potentially infected pool of 10,000 people into smaller units that need not infect each other. In the U.S., I work on a campus with about 40,000 students. I wonder if we would be prepared to take steps like this? Hopefully we won’t need to, but there’s no reason to think that something even more contagious than SARS isn’t coming down the road.
Excess capacity is the key to adaptation. One of the late Stephen Jay Gould’s arguments (I think in The Flamingo’s Smile, although I don’t have access to that now: http://www.powells.com/subsection/BiologyStephenJayGould.html) is that redundancy is one of the keys to evolution. For example, it is because we don’t need to walk on them that our hands could evolve into the complex structures with which I’m typing these words. The U.S. medical system has systematically tried to weed out excess capacity over the last decade or so. The theory has been that the more doctors you have, the more medical tests they’ll order, etc. The more hospital beds you have, the more sick people will be in them. To some extent it’s worked, but if we’re confronted with a disease that requires hospitalization and isolation of many people, I worry that the system will quickly come crashing down.
There are important ”network efforts” in health care. The term “network effect” refers to the fact that some artifacts become more valuable the more other people who have them, in contrast to most goods. For example, my telephone becomes more valuable as more other people have them, because I can call them if I choose to do so. In a world of contagious untreatable diseases, your health status becomes urgently important to me, because of the possibilty that your disease will turn into mine.
Overcoming the distance. A Chinese student sent me an email message recently that included the evocative phrase that “distance is respect” in these strange times, because one needed to think carefully about the possibility that they might carry a disease that would make others sick. Internet technology can provide a way to overcome this distance. The possibility that this kind of physical isolation might become part of the life experience of American students is a good reason to build up the networking infrastructure that would allow education to go on in cases like this.
I hope that the hopeful evolutionary argument based on Paul Ewald’s ideas (I don’t know if he would agree with this conclusion) will carry the day, and that the United States will not be faced with the kind of rampant contagious illness that Beijing is experiencing. Even better would be the discovery of the viral equivalent of penicillin, a panacea that would give us 50 years or so of respite from such disease. But I don’t think we can count on either of these happy outcomes, and this suggests a real need for considering how our own communities would be prepared to respond to an event like the SARS epidemic.