Future Pandemics—Today (Part 3)

Part 3: Too Much Belief, Too Little

Many months ago, before the COVID-19 pandemic struck a seismic blow to the routine activities of most of humanity, I had finally felt my meandering musings on this blog had rightly tethered themselves to a theme. I would hone my focus and write about the future of medicine. I recognized that both lay and specialty periodicals that examine how technology affects societies and individual behavior were neglecting future medical breakthroughs for the furtive field of thought I believed it was. My background as a physician afforded me insight into specifics about the feasibility of these technologies, but it was my interest in spirituality that made me curious about the psychological and societal implications of the widespread adoption of technologies that would alter the human experience. This naturally lends to some techno-skepticism. After all, we live in an age where time and again, non-medical technologies that were once thought to be liberating, equalizing, and progressive have in fact been shown to be manipulating, polarizing, and hazardous (I’m talking about you again, Facebook!)

I wanted to have a forum to think about medical technologies years, sometimes decades in advance, and consider how they would change what it means to be human. What would it mean if a woman no longer had to gestate a fetus in her uterus but instead watched her child grow in a pod, an artificial womb, on her nightstand table? How would we feel if our doctor was able to calculate our day of death with such precision that it haunted our every waking moment? I set about to explore these questions because I don’t want us to be blindsided by these technologies in the way that, say, social media apps have bamboozled us. These essays aren’t meant to be a confident forecast, nor are they entirely skeptical by design. I’m a physician and so I'm certainly looking forward to advances in medicine and technology that will lead to less disease and suffering. But I’m also a realist and I know that we must wrestle with the full spectrum of implications of a new technology, the good and the bad, if we are to widely adopt it. Doing otherwise is arrogant and illusory, feeding into the zeitgeist that all technological progress is good. We are inundated with techno-optimism and it blinds us to how technology changes our realities and alters the human experience in unexpected ways. I embarked to examine these unexpected ways far before they occurred so that we could approach them critically and thoughtfully.

And then the pandemic hit. On a day in late February when America had just 15 cases and the CDC just reported their first case of community spread of coronavirus, I posted an essay about how and why the virus would spread rapidly here and infect millions. I saw that the low case fatality rate combined with an incubation period of up to two weeks meant that there would be a great deal of asymptomatic spread. What I failed to presage was how devastating the virus would be to American society, beyond just morbidity and mortality. It has indeed infected millions and likely killed close to 200,000 as of this writing, but I did not predict that it would ravage our nursing home population and decimate our economy. The social, financial, and political fallout will ripple onward so long as the virus remains out of our control.

My second post shortly thereafter spoke to how our decisions during the pandemic would frequently be motored by our emotions. Certainly, world order has not collapsed exactly in the way that I predicted, but it’s hard to escape images of anger, hatred, and authoritarianism that have blazed in the foreground of the pandemic. After that post, I hit pause on the blog for the next five months. The burdens of caring for critically ill COVID patients in my hospital’s expanded ICU proved too taxing to maintain my posts. The interval between that last post and now has been revealing in many ways I could not anticipate. In that time, cases exploded and a country that prides itself on its technological, medical, political, and economic superiority was brought to its knees.

Why did America get bested by a virus it had anticipated, through simulations and briefings, prognostication and all manners of preparedness, for nearly two decades, during which time SARS-CoV-1, MERS, H1N1 flu, Ebola, and Zika rattled us enough to take future pandemics seriously? What conditions have thus far led to the deaths of some 200,000 of my countrymen? If we’ve come so far in our technological prowess, in our capacity to more than just adapt to but in fact to manipulate our environments to our collective wills, why did we get trounced by a being of the tiniest dimensions that has no will and no intent, other than to unendingly iterate copies of itself?

I think the reason our nation failed is because we vacillated between too much belief in science and technology and too little. Let’s begin with how too much belief in science failed us.

There were many of us who thought a bevy of new drugs conventionally used to tamp down the overactive immune systems of patients with autoimmune diseases could prove useful in the sickest COVID patients suffering from cytokine storm. They didn’t. What worked instead were tried and true decades-old steroid medications. We thought very advanced modes on mechanical ventilators would somehow prevent the sort of ventilator-induced damage to lungs that would prove fatal. They didn’t. Instead, simply flipping people on their bellies, hardly a “technological” breakthrough, did more to prevent lung damage than any advanced functionality on the ventilator itself. And we were hyped to believe that all this would be over just as soon as we all got shot with a newly materialized vaccine that has never been tried before. It’s mid-August now, still no vaccine, and still no end in sight to COVID-19. Like tamiflu in influenza, the anti-viral remdesivir for COVID has proven lackluster in the sickest patients, the ones who need it the most, and we’ve yet to develop any monoclonal antibodies that might be able to soak up the virus. Our brains, which have been wired to think of new technologies as instantaneously within reach, ready to mass produce, and a panacea to all that ails us, have been marred by disbelief in the months since the virus became a threat. We now have to remind ourselves that silver bullets are rare in medicine, that future vaccines or treatments for this virus will take much longer to develop and that our expectations of them should be tempered by the slow and steady engine of good, reliable science.

Isn’t it surprising that the most effective tools in fighting the virus thus far have been non-technologies or basic technologies? We were so primed to believe that technology alone could be victorious in conquering the virus that we thought it inconceivable that our rudimentary plague hardened ancestors had been right along. When pandemics hit in the past, they closed their doors and stayed away from each other, social distancing before the term existed. Additionally, the ultra low-tech solution of simply washing your hands and wearing a mask has done more to save lives than anything conceived in a lab. But social distancing and mask wearing have been difficult to enforce and uphold in our country, which brings me to the other reason America’s response has been flatfooted. To understand that, we’ll have to journey to the other end of the spectrum, the one in which we don’t place enough belief in science and technology. There are large segments of the populace who call the virus a hoax or don’t understand how dangerous it is or think that nefarious political strategies are at play to impoverish us and make us fear the virus. The virus, though, has no care for these science deniers. It feeds on their arrogance and ignorance, filling hospital morgues with their brazen corpses.

So what would have been a better path? That brings me back to the point of this blog, an attempt to shine an honest and critical light upon our relationship to technology. We should have, instead, chosen a middle way, one in which we have respect for a virus that has no care for our sentiments, an entity that can very readily shut down one’s organs and end one’s life, and one that can set off a chain of social, economic, and political events that can upend world order. We should have a healthy skepticism about any particular new treatment or prophylaxis because new technologies must be proven to work using well-established protocols to determine efficacy. We should have looked back to our ancestors for their low-tech solutions to plagues and humbled ourselves to the precarious life we live on a spinning ball in space where our every waking moment is due to happenstance and the good fortune of our environment, a place that remains inhospitable due to nature-made and manmade processes, and where time and again we receive a terrifying reminder that our days as a species on this most serendipitous of planets are numbered. If we are at all fortunate and intelligent and thoughtful about the lives we live and the path we wish to stake out for ourselves, in the final sum, the thing that inevitably does us in hopefully won't be us.