"A Guide to Worrying About the Coronavirus", The Interpreter

Welcome to The Interpreter newsletter, by Max Fisher and Amanda Taub, who write a column by the same name.

On our minds: The question we keep getting about the coronavirus.

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A Guide to Worrying About the Coronavirus

For weeks, nearly all the U.S. coronavirus cases could be directly connected to overseas travel. In recent days, that has started to change.Allison Zaucha for The New York Times

Nearly every question we get on the coronavirus is some variation of the same thing: How worried should I be?

It’s a complicated question for two reasons.

The two reasons it’s complicated

First, while global knowledge of Covid-19, the disease caused by the new coronavirus, is growing every day, our understanding of it remains imperfect. Many cases are thought to be mild or asymptomatic, for example, making it hard to gauge how wide the virus has spread and how deadly it is.

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Second, the nature of the coronavirus means that much of the risk does not come from the virus but from how it affects the societies where it hits.

The disease is probably not particularly deadly; health officials tend to put it somewhere within range of a severe seasonal flu. The World Health Organization said that the coronavirus is thought to be a bit deadlier than the flu, but to spread less easily. Even in a global pandemic, it’s expected to kill fewer people than the flu virus. The flu goes globally pandemic every year and the world continues spinning.

But because the coronavirus spreads widely and quickly, it can overwhelm local health systems in a way that the flu does not. This is believed to be a driver of the high mortality rate in Wuhan, the region of China where it first spread. In other words, many of the people there who died after becoming infected might have survived if there had been sufficient health care workers and hospital beds to treat them. In South Korea, where government officials were more prepared (after all, they knew what was coming) and health care was more effectively administered, the mortality rate has been about 0.5 percent so far, a fraction of that in China — and it might even be lower.

Aside from any deaths, the disease’s rapid spread, along with measures to contain it, can be incredibly disruptive. School closures, public transit restrictions and mandatory work-from-home policies all exact tolls. The economic toll of supply chain shutdowns, tourism declines and a reduction in consumer demand are also expected to be severe.

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Personal risk versus systemic risk

So what does that all mean for how worried you should be?

Let me (Max) answer with a personal anecdote. In December, I got pneumonia. (Ironically, it may have been from one of the four coronavirus strains that are globally pandemic and circulate every year, just like the flu, but that you’ve probably never heard of because they’ve been around for decades.) It was super unpleasant! I was confined to my couch for weeks and, for some stretches, had trouble breathing.

But I was basically fine. A couple of doctor visits and timely prescriptions ensured that the symptoms, while uncomfortable, posed no serious risk. Even with Britain’s National Health Service already straining under budgetary problems, I posed little real burden to it. Family and friends helped pick up the slack on my personal obligations. My colleagues did the same at work; somehow, The New York Times continued publishing uninterrupted.

All told, the net societal, economic and public health toll of my illness — whose symptoms and severity happened to bear close resemblance to Covid-19 — was negligible.

But! That toll was negligible because I’m just one person. Society was prepared to absorb the consequences of my illness in a way that ensured I got plenty of care and caused no broader disruptions. As we’ve seen from the coronavirus’s spread so far, when a community is hit by thousands or tens of thousands of cases at once, the impact changes substantially.

If a big fraction of my neighborhood in West London had all fallen sick at once, it would’ve been a different story. And that’s what we’re looking at with a potential coronavirus pandemic. For most people, it’s more about the systemic risk posed by many mild-to-moderate illnesses than about the individual illnesses.

Pandemics are a big deal, even if the disease is relatively mild

For the sake of thinking about the risk of a big coronavirus pandemic, let’s consider that scenario in which my relatively mild illness had affected not just me but much of my community.

My local health office might not have been able to see me as quickly or as often. I would have still been fine, if more uncomfortable and maybe a little more worried. But some of my neighbors who are older or who have pre-existing health conditions might have required a couple of nights in a hospital bed and some dedicated care. If they had to get by without the full level of care, they would have been at greater risk.

Friends and family who helped me pick up the slack in my personal life would have been less able to do so if they were dealing with lots of sick friends at once, or were sick themselves. Imagine if, say, one third of your extended family and social circle all became ill at the same time. Think about how much spot child care and grocery shopping the remaining people who avoided Covid-19 would have to do. It would be a major disruption to everyone, sick or not.

And those disruptions are likely to be exacerbated by any government measures to limit the coronaviruses’s spread. China’s experience shows that those measures, like mandatory quarantines or mass transit restrictions, can be effective. But they come at the cost of imposing short-term hardship on affected communities.

My job does not make me a good representative of the economic risk of a pandemic. Editors and journalists can work from home easily. Other forms of economic activity do not rely on my day-to-day output. Neither do global supply chains. But one of my neighbors works for a company that manufactures consumer technology. Another works for a global marketing firm. A couple are doctors.

If our employers were all hit with big staffing shortfalls at the same time, even if that lasted only a month or so, the economic consequences become more severe. And it wouldn’t be limited to those companies. Maybe the technology manufacturer has trouble buying parts from its suppliers in Asia. Maybe the marketing firm loses a couple of corporate clients in Italy, as companies there tighten their belts because of the outbreak. That can take on a domino effect all its own as global economic supply and demand feed into each other’s declines.

The people in the upper echelons of those companies will be fine, but, as always, those at the lower levels are more economically vulnerable. A global slowdown, even brief, means layoffs at a time when governments will also have less tax revenue to fund social safety nets. At the same time, a pandemic means that virtually everyone will be facing unusually high health care, child care and elder care costs.

The inequality of the coronavirus

The risk from the virus’s impact on you individually is probably low.

As for the systemic risk, it depends, as with virtually all kinds of systemic risk, on your personal context.

If you live someplace with good governance, as well as plentiful health care and economic resources, the systemic risk to you is likely to be lower. That means that you have less chance of dying from Covid-19, yes, but it also means that any impact on you is likely to be less severe. The state will be better able to absorb any societal and economic burden.

But if you live someplace where state and society function less effectively, the consequences are likely to be greater, and more severely felt by individuals. Your elderly aunt with diabetes might have a harder time getting care, putting her at greater risk if she catches the coronavirus. An economic slowdown might be more painful and longer lasting.

Your personal circumstances may end up being just as important. As is so often the case in this world, people who are wealthy and who have good protections at work will be much better positioned to ride this out relatively unscathed.

It’s not that the ultrawealthy will all retreat to their underground bunkers in New Zealand; things appear unlikely to get anywhere near that bad. Rather, it’s that people with middle-class incomes, or with guaranteed sick leave, will be better able to take off a couple of weeks to recuperate or to help out sick family. But part-time workers or people with lower salaries will find themselves more vulnerable. A restaurant server or an Uber driver will feel more consequences from any societal turbulence. Those individuals will also feel greater pressure to keep showing up at work, even if they have a pre-existing health condition that makes Covid-19 more dangerous.

Maybe it’s easiest, then, to think of this as less of a seismic shift in global circumstances than a deepening of one of our era’s most consequential trends, in which the well-off are cushioned and protected, while the burdens are pushed onto the poorer and the working class. In other words, it is, as with so many situations today, a story of inequality.

What We’re Reading

  • Gender inequities can worsen outbreaks like the coronavirus, according to an article by Julia Smith, who researches health and development issues at Simon Fraser University. For example, family care is disproportionately handled by women, a disparity that is likely to grow as families take on more care related to the outbreak.
  • How would the remaining Democratic presidential candidates handle the Israeli-Palestinian conflict? With foreign policy issues, the best metric is often not the candidates’ statements, but their staffing — the people they hire to implement policy, and who may bring years of experience (and baggage) to their issue. Alex Kane writes for +971 Magazine about what the candidates’ advisers have done and said on the Israeli-Palestinian conflict, producing what is probably a pretty good guide to how those candidates would act in office.
  • Steven Levy has a fascinating and page-turn-inducing, if quite long, book on Facebook’s often-turbulent rise to de facto global information superpower, “Facebook: The Inside Story.” Casey Newton of The Verge interviewed Mr. Levy on some of the book’s juicier details and more interesting conclusions.

How are we doing?

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