vrais dangers et fausses alertes
by didier raoult
michel lafon, 160 pages, €8.99
The Rules of Contagion:
Why Things Spread—and Why They Stop
by adam kucharski
basic, 352 pages, $30
A wise man knows that he must put things into perspective, but a still wiser man knows what perspective to put them into. A doctor who tells the widow of a patient who has just died that, after all, her husband’s was only one of 2,800,000 deaths a year in the United States alone (56,000,000 worldwide) is a monster of insensitivity. But an epidemiologist who tries to express his compassion for every death that he enumerates will never progress beyond his first statistical table. The proper perspective changes with context.
What is the correct perspective into which the average citizen should put the current pandemic of the coronavirus, assuming that there is a single correct perspective for him to put it into? Most people, I surmise, veer between complacency and panic. They are like home investors who follow the fluctuations of the stock market with febrile attention. A graph showing exponential growth in the number of cases induces a state of anxiety; a histogram showing a decline in the number of deaths the day before causes a burst of relief that the worst is over.
Follow the scientists, you might think; that is the way to become a fully rational human being. On this view of the matter, science speaks with one voice, ex cathedra. It lays down doctrine that humanity, most of which is not scientifically minded, must humbly accept. But of course neither the world nor science is like this.
Confined in my flat in Paris (like a true prisoner, I am allowed out for one hour’s exercise a day), I have just read two books of the most obvious relevance to the current situation: The Rules of Contagion by Adam Kucharski, a mathematical epidemiologist at the London School of Hygiene & Tropical Medicine, and Épidémies: vrais dangers et fausses alertes (Epidemics: Real Dangers and False Alarms) by Didier Raoult, one of the most eminent infectious disease physicians in the world, who is based in Marseille. The scientific status of neither author is in doubt, yet they are no more in agreement in their outlook than is a militant secularist with a theocrat. The layman who is trying his best to be rational is often at the mercy of the last expert he read or heard. Raoult may yet ruin his reputation by his noisy and completely unscientific advocacy of hydroxychloroquine treatment, while Kucharski does not acknowledge the limits of epidemiology, which is not only often an inexact science but, at its worst, can be a powerful tool for the regulative bullying of the population by bureaucracies.
Raoult pours scorn on epidemiological models whose record of prediction is spotty, to put it kindly. He gives a list of recent epidemics, including two bird flus, mad cow disease, Ebola, chikungunya, Zika, SARS, and MERS, upon which epidemiologists have provided dire models of progression, and then says:
Predictions and mathematical models for all these illnesses were made which announced the deaths of millions of people. None of this happened, other than an epidemic of flu that was as fatal as flu normally is.
Errors of the kind that he describes are not of merely intellectual import; they have grave practical consequences in what we are apt to call the real world. They skew medical effort, diverting it from far greater problems. Raoult calculates that for one of the illnesses above, there were sixty-one scientific articles in the best medical journals per death caused by it. Panic is often more dangerous than that which occasions it.
Among the illnesses that Raoult dismisses as of small medical impact, statistically speaking, is COVID-19. (His book was published in March.) Is he right, or is he being cavalier? How is our poor layman supposed to decide? I confess to a state of cognitive dissonance—surely I cannot be alone in this?—when I read that overall mortality in populations as a whole has been hardly affected if at all by the epidemic, and yet everywhere there are reliable reports of apocalyptic scenes in hospitals of a quite unprecedented nature. Of course, the worst scenes are heavily localized: No epidemic strikes everywhere with equal force. But this is clearly not the Black Death, which killed between a third and a half of the population of Europe, and which no one at the time could have mistaken for not being the existential threat that it so obviously was.
Does the worldwide panic about COVID-19 tell us anything about ourselves and the modern world? In 1957, the Asian flu was said to have killed up to 2,000,000 people, and the Hong Kong flu of 1968 was said to have been responsible for more than 1,000,000 deaths, and yet they have passed entirely from collective memory, perhaps without ever having entered it in the first place. According to Raoult, moreover, panics about possible epidemics are ever more frequent. Why should this be so, when the average world life expectancy exceeds the biblical span by three years, the highest in human history? Are such panics a symptom of our increasing unfamiliarity with death as the natural end of life?
One of the problems is that one cannot fear in strict proportion to the risk, even when one knows it. No matter how many times we are told that air travel is by far the safest form of travel, is there anyone who does not experience a momentary frisson of fear as the frail metal tube in which he is sitting hurtles toward the solid ground at more than a hundred miles an hour? The statistics of death by air crash do not entirely calm him.
Surely the panic over COVID-19, assuming that it remains an epidemic of relatively minor consequence for the overall mortality of the world population, must be in part because of the apocalyptic nature of death from the disease. If instead of such horrible suffering, the fatally ill simply went to sleep one night and failed to wake up, the epidemic would hardly have been noticed, certainly not by our media, and all the more so because the deaths occur predominantly among the old. Attached as I am to life, I cannot disguise from myself the fact that death at my age would not be as tragic as the death of a twenty-year-old.
COVID-19 will no doubt be mastered in time; there will be a vaccine, perhaps a treatment. But it will have dented mankind’s belief, or illusion, that it has everything under control, give or take a blip on the upward ascent to a life without suffering, the unpleasantly untoward or the unforeseen. For us after the epidemic, science will have strengthened its grasp but shortened its reach.
I am reminded of the time before the collapse of Lehman Brothers (the epidemiologist Adam Kucharski mentions it) when mathematicians claimed to have developed a model that eliminated the risk of epidemic default on mortgage obligations. This, of course, proved illusory, and was always foolish; but if the analogy holds, it also suggests that the illusion of control will return soon enough, once the epidemic is over. Illusion springs eternal.
Catastrophism is the verso to total control’s recto. We can switch from one to the other without passing through realism, just as we are capable of gestalt switches when we see a drawing that can be interpreted either as a duck or rabbit, but not as both at the same time. Today’s utopian is tomorrow’s dystopian.
Worst-case scenarios have, in any event, a natural attraction for the human mind, all the greater in times of fundamental security. (I have reached the age of seventy without having suffered war, oppression, or any serious outside threat to my health, something probably unprecedented in human history.) Literature and film prove our love of imagined catastrophe. Realism, by contrast, is dull and uninteresting. The comfortable like danger as long as it does not immediately threaten them. I cannot prove it, of course, but I even sense a certain delectation in the reports of the rising death tolls from COVID-19. Professional Cassandras (of whom I suppose, in a different context, I am one) can take pleasure in saying, “I told you so.” There is more pleasure in being right about forthcoming disaster than in being right about incremental improvement. There will possibly be a slight unacknowledgeable disappointment in some quarters when everything returns to normal. How will we occupy our minds then?
Theodore Dalrymple is the author, most recently, of False Positive: A Year of Error, Omission and Political Correctness in the New England Journal of Medicine.