Could We Be Living Under Coronavirus Forever?

Global health expert and TED Talk speaker Alanna Shaikh thinks there’s light at the end of the tunnel

A testing tent at St. Barnabas Hospital on March 20, 2020 in New York City. Photo: Misha Friedman/Getty Images

As humanity steps into the reality of life with Covid-19, we’re all searching for calm, expert voices to guide us in making sensible decisions for ourselves, our families, and our society. Global health expert Alanna Shaikh — who studies what happens to health systems when diseases move at scale — is one such voice.

On March 6, Shaikh flew from her home in Sri Lanka to Dallas to speak at TEDxSMU about Covid-19. She offered a realistic yet somehow reassuring big-picture perspective that has already garnered more than 5 million views. I’m well acquainted with Shaikh’s comforting pragmatism and thoughtful intelligence because she also happens to be a colleague, friend, and fellow mother.

On March 11, the day her talk posted, my 14-year-old daughter came down with symptoms here in the U.K., a couple of hours ahead of the WHO announcement of pandemic. I canceled everything, packed up my office in Cambridge, isolated ourselves in our home, and wondered what to do next.

I’d stocked up on staples in case of some theoretical future lockdown, but I was not equipped to immediately go into quarantine, much less isolate my daughter from me while nursing her illness at home. Could I go out and get supplies? Should I stay in and protect my neighbors? How could I keep from getting sick myself? I reached out to Shaikh for her take on the situation, hoping for global context as well as personal guidance.

ZORA: As a mother who happens to have knowledge of how diseases spread and their impact on global health systems, what are you doing to prepare for Covid-19?

Alanna Shaikh: I’m worried as a mother, but I’m actually more worried as a daughter. We’re a multigenerational household. My mom, who is going to be 77 in July, is smack in many risk groups for Covid-19. It will be very dangerous for her if she’s infected. It seems to be less dangerous for children. I am worried about them, too — they’re my kids! But I’m less worried.

How are you handling this personally, for yourself and your family? For example, you were just on the plane to Dallas and back to give the TEDxSMU talk.

Going to give that talk was probably a mistake. I looked at the numbers and data, and I made the decision that it seemed like an acceptable risk. By the time I was on the plane, though, I’d realized the situation was changing so fast, I probably shouldn’t be on it. It was too late at that point. So, you know, that’s how it goes. I hope that the talk is worth whatever mistake was made.

I have stayed in my house for eleven days now and I’ll stay in for 14 to make sure I am not spreading anything. I’m constantly washing up after myself because if I am viral shedding I don’t want to shed it onto my family.

“This is a crisis, but it’s also an enormous chance to learn and build better for next time.”

Should we be social distancing even if nobody in your family is sick, or showing any symptoms?

I’m going to go out on a limb here and say yes, even if you’re healthy and no one in your family is first showing symptoms, we should keep a distance. The reasoning behind this is that there is a long asymptomatic period where you could be sick and shedding the virus and not knowing. And if we do it by choice now, maybe we won’t be forced to do it later.

Quarantines and lockdowns do have a useful function. But for them to work, we have to get them in place fast.

Can you compare the situation we’re now in with what you learned from the Ebola epidemic?

During the Ebola epidemic, I led an evaluation of Ebola treatment centers in Sierra Leone and their impact on the disease, and how they provided care. There was an overwhelming sense that they knew that it was bad and that they were in trouble, but they just didn’t have enough money or doctors to respond.

The problem is, we didn’t learn anything from that. We acted like the outbreak was an earthquake — a freakish sudden shock we couldn’t predict. When in fact, it was a situation that’s likely to keep recurring.

What can the world do to prepare better for a pandemic outbreak in the future, once this crisis is past?

On a functional level, each community needs a facility or health care provider that people can go to when they’re sick. At that facility there has to be a doctor or some sort of medical personnel capable of diagnosing their illness, reporting that information upwards to a national laboratory — the equivalent of a CDC. They’d also need to be able to treat the person. Ideally cure them, but at the very least treat them because if you can’t treat people, they have no incentive to come in.

We need to be able to do that everywhere in the world. We are very far from that goal right now.

“Covid-19 outbreaks won’t occur again and again. We’ll find a vaccine eventually. That being said, the world is going to change.”

It feels like we’re having a sea change in mindset now that is unprecedented, yet besides Ebola, we’ve also had SARS and swine flu before this. How is this more of a wake-up call than those were?

With SARS, we got lucky because they stopped it fast enough. SARS was actually more fatal. And because it was more fatal, it didn’t have as much time to spread. Ebola, too, killed people fast enough that it didn’t spread as quickly as it could. Swine flu turned out to be really mild. It spread like crazy, but it wasn’t a serious illness. The theoretical “big one” — the virus infectious disease experts really worry about — is the one that spreads fast, takes a while to kill you, and is highly infectious.

So is Covid-19 the big one?

We don’t know what the fatality rates will be from this yet, so we don’t know yet, but it sure looks a lot like the big one. If it’s not, it’s the canary in the coal mine. This is our signal to fix our systems and be ready for next time, if we do it right. Or it could just weaken our systems a little more.

Covid-19 will teach us a lot about how to take care of ourselves in a situation like this. Right now, in my house, my daughter and I are following isolation protocols we could have never imagined a week ago, for example. Life already feels drastically different. But I imagine it will all become standard practice for many households around the world as the disease continues to spread.

This situation could help build logistical and social resilience against pandemics. If you look at the way California responds to earthquakes, they have been through it so many times it’s a given of life and they’re pretty good at it at this point. It’s possible that as communities and societies, we’re going to learn good pro-social habits from this and be more ready to take care of each other next time, like starting to isolate faster. The best thing we can do is for communities to try to look after each other. And in a weird way, in this case, communities looking after each other involves communities avoiding each other.

Another human behavior we could change is to leave our remaining wild spaces alone. We could put much stricter restrictions around rainforests, crack down on the wildlife trade. Slowing climate change would help protect us, too. As the climate changes, there are pathogens (diseases) that like this new climate better.

Those are the big, high-impact changes we can make to stop new diseases at their source.

If, as we have been hearing, Covid-19 outbreaks could occur again and again, and new pandemics are inevitable in our future, how might this outbreak represent a paradigm shift in how the whole world socializes, works, and so on on a day-to-day basis?

Covid-19 outbreaks won’t occur again and again. We’ll find a vaccine eventually. We might spend the next two years social distancing, but there will eventually be a vaccine. That being said, the world is going to change. If we’re going to accept a world where these outbreaks just happen, then you start thinking about outbreak responses and minimizing impact. Maybe more people work from home, and we get better at holding digital conferences. Maybe we go back to individual offices with doors instead of cube farms.

We are all going to be far more deliberate about our interactions with other people. I think we’ll value them more: If there is one thing we’ve learned from quarantine it’s that people hate being alone. At the same time, we will be much more careful. None of us is ever going to venture into a dense crowd ever again without thinking very seriously about that choice.

Maybe we also live in a more precarious world now, and we’ll be less sanguine about thinking the future will look like the past.

“Covid-19 is our signal to fix our systems and be ready for next time, if we do it right.”

Can you give us some authentic and reliable resources to turn to where citizens can stay informed and make the best decisions for their families?

I’m pretty much always going to suggest the World Health Organization. When you’re thinking about health information, actual research beats anecdotes or case studies — and a team of experts beats just one individual. The WHO is very good at convening teams of experts to review data and provide advice people can act on.

If there’s one thing you want to say to the public right now, what would it be?

We ignored our public health systems for a long time because it takes a black swan event to show us the problem. Well, the black swan is coming in for a landing. This is a crisis, but it’s also an enormous chance to learn and build better for next time. It could be the emergency that makes us understand the importance of good health systems.

Answers were edited for length and clarity.

organic unidirectional time machine // writer + artist // aka oculardelusion //

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