Coronavirus Briefing: Pandemics future and past

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

Jonathan Wolfe, TNYT, 16 Oct 21: First, we’ll take a look at what we can expect from the virus this winter, and how the virus may evolve. Then, I’ll explore the legacy of past pandemics, and what they can tell us about our current crisis.

What the future holds

The U.S. is recording about 86,000 Covid-19 cases per day, down from 160,000 at the beginning of September. While some places like the Upper Midwest and parts of the West are not in great shape, the South is doing a lot better after a terrible summer.

Could we possibly be nearing the end of America’s last coronavirus surge?

The pattern of the pandemic is not encouraging. It has crashed over the country in waves, inundating hospitals and then receding, only to return after Americans let their guard down. Britain and Israel, which both have higher vaccination rates than the U.S., are still struggling with outbreaks.

Experts told my colleague Emily Anthes that they would not be surprised to see at least a small increase in cases later this fall or this winter as people begin spending more time indoors and traveling for the holidays. But because the vaccines remain highly effective at preventing hospitalization and death, this winter may be less catastrophic.

“It doesn’t mean Lockdown Christmas No. 2,” said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada. “But it does mean that we should all just be mindful that this is not completely over yet.”

Predicting the course of the pandemic into next year is even tougher. Scientists say we are extremely unlikely to eradicate the coronavirus in the next few years, or perhaps decades. What we do know are the rules that govern epidemics and viruses, which provide clues to where we could be headed.

The big wild card in the months and years ahead is whether the virus will mutate into a more destructive version of itself. The good news is that while all viruses evolve, coronaviruses are known to be relatively stable, changing more slowly than the common flu.

That said, our relationship with Covid has just begun, and we’ve already seen many new viral variants, including the fast-spreading Alpha and the immune system-evading Beta, along with Gamma, Delta, Lambda and, most recently, Mu.

The coronavirus can mutate in all sorts of ways, many of which are benign, but there are three concerning possibilities: It could become more transmissible, it could become better at evading our immune system or it could become more virulent, causing more serious disease.

The virus has already become more transmissible over time (Delta), but there are probably some basic biological limits on just how infectious a particular variant can become.

The virus also bumps up against constraints in its attempt to evade our immune system, which it has already accomplished (Beta). While mutations allow viruses to slip past our defenses, our immune system has also evolved to counteract the evolution of viruses. After an infection, our body generates a diverse army of antibodies — “a library of guesses,” as one expert put it — some of which might be a good match for the next variant that comes along.

The hardest evolution to predict, however, is whether the virus will become more deadly. Unlike transmissibility or immune system evasion, virulence has no inherent evolutionary advantage.

“The virus has no interest in killing us,” said Jessica Metcalf, an evolutionary biologist at Princeton University. “Virulence only matters for the virus if it works for transmission.”

Over time, scientists predict that we will reach an uneasy equilibrium with the virus. There are four other coronaviruses that have become endemic in human populations. We are exposed to them early and often, and all four mostly cause run-of-the-mill colds.

Echoes of the past

A few months before the coronavirus outbreak, Steven Taylor, a professor and clinical psychologist at the University of British Columbia, predicted much of what the world was about to experience: Widespread misinformation, toilet paper hoarding and the backlash against lockdowns, masks and vaccines.

His book, “The Psychology of Pandemics,” argues that pandemics are not just “some microbe going viral” but are rather inherently social and psychological phenomena.

“There was no crystal ball involved,” Dr. Taylor told me. “It’s all based on what’s happened in the past.”

I spoke to Dr. Taylor about what previous pandemics could tell us about our current state of mind. Our conversation has been condensed and lightly edited.

With history as our guide, what are some of the psychological phenomena of pandemics?

There are obvious ones, many of which we’ve seen during Covid: The rise in racism, panic buying, the proliferation of conspiracy theories and rumors, the progressive non-adherence to social distancing as lockdowns and other restrictions drag out.

Fleeing is another characteristic psychological reaction you see during pandemics, with people in urban settings fleeing to perceived places of safety, like the countryside, or to stay with friends or family. There are also things like quack cures, sporadic looting and rioting, but also commonly a rise of altruism as communities come together to assist one another.

Why do human beings act so strangely during pandemics?

One reason we’re having the sorts of reactions we’re having right now — including the negative impacts on mental health — is lockdown. Unfortunately, lockdown is a necessary evil, but it impairs people’s mental health. And that’s because people are inherently social creatures and lockdown requires us to inhibit that ability to socialize and draw social support from one another.

Have you noticed any societal phenomena unique to this pandemic?

Pretty much all the phenomena observed during Covid have happened before, but Covid is different in that everything is bigger and faster. And that’s partly because of social media and the 24/7 news cycle.

In past pandemics, politicians have tended to downplay the seriousness of the pandemic, but there hasn’t been the political involvement that we saw in 2020 with Boris Johnson, Jair Bolsonaro and Donald Trump getting out there with all their antics, like the spreading of false information and touting of quack cures.

In 1919, for example, the health authority of New York City endorsed the conspiracy theory that the flu was being brought to Manhattan by German U-Boats. But that was an isolated incident, not like today when there is far greater public awareness of conspiracy theories, and political leaders who refer to them.

What are lingering psychological issues we should be worried about with this pandemic?

The obvious ones are the so-called long Covid and post-traumatic stress disorder. But there’s another issue and that’s prolonged grief disorder, which is like grief on steroids. For about 10 percent of bereaved people, like those who’ve lost a close relative, they develop this disorder where they’re continually pining for the deceased. They have no joy in life. It’s a serious chronic disorder, and while it’s treatable, there are probably not enough practitioners who are trained in treating it.

The other concern is suicide. We know from research on past pandemics that they have been associated with an increase in suicide, particularly when they are followed by economic recessions.

Based on history, what should we be worried about in the coming months?

My big concern has to do with vaccinations and something called the nocebo effect — the evil twin of the placebo effect. It’s going into an experience expecting to have negative side effects and then experiencing side effects.

With vaccinations, we’re seeing a very small number of people develop functional neurological disorders that seem to be real. But they have nothing to do with the components of the vaccine — they’re caused by psychological factors. What this can lead to is something called mass psychogenic illness, which is just a fancy way of saying mass hysteria.

In past pandemics, there were numerous reports of mass psychogenic illness around vaccinations, and they usually happened in schools. So one kid goes to get the shot and passes out, and the other children become alarmed, and suddenly you get dozens or hundreds of very frightened children who are rushed off to hospital. And at the end of the day, it’s decided that it was just a stress reaction. But it does great harm to vaccination uptake. It spikes vaccination hesitancy and gives fodder for the anti-vaxxers. I am a little surprised we haven’t seen any of that yet. I think it’s mainly because vaccines haven’t rolled out to the younger people in the population.

I heard an editor didn’t think your book was a good idea.

Yes, I sent it to the editor who published my previous books. He did a quick turnaround and said, “Yeah, it’s an interesting idea, but nobody’s going to want to read this.”

More on past pandemics:

My colleague Gina Kolata writes that history reminds us that Covid will be an era, not a discrete crisis.

What else we’re following

• September had the most new Covid cases and deaths among U.S. children since the pandemic began, NBC News reports.
• Chicago’s mayor and the city’s largest police union are clashig over vaccinations.
• Italy’s stringent “vaccine or test” requirement for workers took effect today, more or less smoothly.
• A lab in England issued about 43,000 false negatives on virus tests, the U.K. Health Security Agency said.
• Around six million New Yorkers, or around 85 percent, have received at least one shot of a vaccine, WNBC-TV reports.
• Who are the unvaccinated now? Zeynep Tufekci, a contributing opinion writer for The Times, looks at the group and their motivations for avoiding a shot.

What you’re doing

My entire family is vaccinated and healthy — except one. We begged and pleaded to no avail. We asked why, and we were told that we had been suckered in to the biggest hoax in history. We had a birthday party and he refused to get vaccinated and come. His godmother called him out of the blue and begged, he said no and then sadly she passed away. So what do we do now? How do we agree to disagree? How do we move forward as a family?

— Elizabeth Cunningham, Falls Church, Va.