SALT LAKE CITY — Rebecca Sunenshine is a medical doctor, a specialist in infectious disease and a captain in the U.S. Public Health Service.
Yet she believes that the governor of Arizona was wrong when he recently ordered the closure of schools, businesses and other public spaces because of the threat of COVID-19.
“I would try to minimize spread, maximize distance, but keep facilities open because I think this is going to be a long haul,” Sunenshine said, speaking to Phoenix City Council, the Arizona Republic reported.
Although she has been vilified for taking this position — some people have said she should be fired — Sunenshine is among well-credentialed voices who are calling for a more measured response to the novel coronavirus that is spreading across the U.S.
Others include a Stanford biophysicist and Nobel laureate who has said that it’s panic, not data, that is fueling dire predictions of long-term closures and millions of American deaths. And some experts say that widespread catastrophizing — focusing on the worst possible outcomes — is inappropriate because there’s simply not enough information to make these predictions, particularly in the U.S. where we still don’t know how many people have contracted the virus, due to an insufficient number of tests.
Even renowned epidemiologist Larry Brilliant urges calm when talking about what he believes is the most dangerous pandemic in our lifetime. “Everybody needs to remember: This is not a zombie apocalypse. It’s not a mass extinction event,” Brilliant said in Wired magazine.
These, however, are lonely voices in a roiling sea of worry, as the U.S. on Thursday surpassed China and Italy to become the country with the most confirmed cases in the world, and a new report suggested that 80,000 Americans could die during the next four months.
President Donald Trump has said that he hopes the nation can begin to return to normalcy by Easter, April 12. This goal has been widely castigated on social media even though there are smart people who are saying much the same thing, while acknowledging that for the next year or more — until a vaccine is available — the nation will have to continue to protect its most vulnerable citizens and require isolation of people who contract the virus.
Here are some of the arguments that support Trump’s initial call for Americans to relax, and why our brains find it so much easier to accept a shrill invitation to panic than a reassuring voice saying everything’s going to be all right.
‘Slowed growth’ ahead?
The rapid spread of the novel coronavirus in states such as New York, California and Louisiana has residents of those states justifiably worried — but fear is rampant also in states that have documented fewer than 100 cases, such as West Virginia and North Dakota.
Fear about worst-case scenarios, to include millions of Americans dying and a long-lasting economic depression, has been stoked by predictions of a 30% unemployment rate and a dramatic reduction in the nation’s gross domestic product. Anxiety is also magnified on social media such as Twitter, where the president’s hope for widespread recovery by Easter was met with an #Eastermassacre hashtag.
But Michael Levitt, the Stanford University biophysicist recently quoted in the Los Angeles Times, believes that the U.S., like China, will get through the worst of coronavirus infections quicker than some experts believe. In an article by Joe Mozingo, Levitt said that people need to work on controlling their panic and, in a phrase reminiscent of Trump’s early assurances, said “we’re going to be fine.”
Levitt, who shared the 2013 Nobel Prize for chemistry with Martin Karplus and Arieh Warshel, began examining the rates of infection and death in China late in January and emailing friends his observations.
Based on a slowing rate of infection, even while deaths were still rising, Levitt concluded that the outbreak would soon begin to diminish and predicted total cases in China to be about 80,000, with 3,250 people dying.
“This forecast turned out to be remarkably accurate: As of March 16, China had counted a total of 80,298 cases and 3,245 deaths — in a nation of nearly 1.4 billion people where roughly 10 million die every year,” Mozingo wrote.
Now Levitt is analyzing infections in countries around the world and says he sees “clear signs of slowed growth” in countries such as South Korea. Meanwhile, the London professor behind the Imperial College London report that spurred the U.K. and the U.S. to enact stricter measures recently adjusted his earlier predictions of 500,000 or more deaths in the U.K.
Infectious disease expert Neil Ferguson, who himself has contracted COVID-19, told British lawmakers Wednesday that the National Health Service now appears to have sufficient resources to care for patients when the virus hits its peak in April, and that it’s unlikely that U.K. deaths will exceed 20,000 and could be substantially fewer, New Scientist reported.
And Dr. Deborah Birx, coronavirus response coordinator for the White House, said this week that widely reported predictions of infections and deaths rely on three phases of the virus moving unchecked through the population for more than a year. “You can get to those numbers if you have zero controls and you do nothing. And we know that every American is doing something,” Birx said in a White House briefing.
Cure versus disease
Levitt, at Stanford, supports social distancing as a means of controlling the spread, but he also has said that governments must be cognizant of unintended consequences of extreme measures, such as depression and suicide resulting from financial difficulties.
The economic costs of containment measures were also cited by Sunenshine, medical director of the Disease Control Division of Maricopa County in Arizona, when she disagreed with the Arizona governor’s decision to close many places of business there indefinitely.
“I think that it’s important to be realistic about what the true cost and harms to society are from closing things and I think that if enough people lose their jobs, and lose access to food and learning, and their livelihoods, that you’re doing more harm than you are by having a minor illness,” Sunenshine said at a Phoenix City Council meeting, Fox10 Phoenix reported.
“I do public health for a living, and health is not just the absence of disease. It’s being able to maintain food and nutrition and sometimes exercise and some socialization,” Sunenshine said.
Other experts have come forward this week, sharing concerns that some predictions of COVID-19’s impact amount to catastrophizing, a term used in psychology to describe thinking in worst-case scenarios. Writing in The Wall Street Journal March 24, Stanford professors Eran Bendavid and Jay Bhattacharya said there is “little evidence” that the novel coronavirus will kill millions of Americans without extreme distancing orders and quarantines, and that calculations that warn of 2 million to 4 million Americans dying are deeply flawed.
“This does not make Covid-19 a nonissue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don’t know the true infection rate in the U.S.,” Bendavid and Bhattacharya wrote.
Indeed, it’s the dearth of data that makes many medical professionals and public health experts measured in how they speak of the novel coronavirus and its ultimate toll. Dr. Marc Siegel, a professor in the Department of Medicine at NYU Langone Health and medical director for “Doctor Radio” on SiriusXM, said three months into the pandemic, there’s too much that remains unknown.
“How dangerous is it? Well, it’s evolving. We’re figuring that out. How deadly is it? Well, that’s hard to tell because we don’t know how many mild cases we’re missing and how many asymptomatic cases we’re missing. How long is it going to spread at this rate, and to where? Well, we don’t know that either,” Siegel said in an interview with the Deseret News.
Siegel believes there’s a sense of hysteria surrounding COVID-19 that is, in part, because of disparate sources of information, including elected officials with no background in health and people sharing information on the internet. He’s also skeptical of mathematical modeling “because we don’t have numbers to do it.”
“Another problem with this situation is, if it hits New York and LA, well, that’s the nerve center. … It might be very quiet in the middle of Montana, for all I know, but the news outlets emanate from New York, and New York is hit very bad, so people in New York unconsciously spread the sense that it’s everywhere,” he said.
To help provide a medically based perspective on COVID-19, on March 6 the satellite radio provider SiriusXM and NYU Langone Health launched a 24-hour channel with content exclusively about the pandemic. Some of the broadcasts have addressed anxiety about COVID-19, which is rampant in America right now because of uncertainty about how the coronavirus will affect us personally, and when (or even if) we can return to familiar routines of a few weeks ago.
Snowstorm, not apocalypse?
Julie Pike, a psychologist in Chapel Hill, North Carolina, who specializes in anxiety, said that anxiety flourishes amid uncertainty as a mechanism to help us solve problems.
“An old mentor of mine broke it down and said that anxiety is just an overestimation of threat and an underestimation of our ability to cope,” Pike said.
“By and large, there is so much uncertainty right now and information is constantly changing so I can’t say that people are necessarily overestimating the threat,” she said.
But if you’re in an area with relatively few cases of coronavirus and are taking precautions like washing your hands and practicing social distancing, it makes sense to listen to people telling you to calm down, or, as Pike put it, to pay attention “to where your feet are right now.”
“When I’m listening to other people panic, I’m treating this thing like it’s a death sentence. My limbic brain is saying, ‘I heard that scary thing your neighbor said, and if I get it, I’m going to die.’
“But right now, I’m not in Italy. I’m in my house, and I’ve disinfected everything. Right now, it is spring in North Carolina, and it is gorgeous,” she said.
Pike recommends people limit their exposure to incendiary media; she gets news from a trusted local, national and international source once a day — and to pay attention to how consumption of news makes you feel. Does it make you feel better about the situation, or worse?
“I would like my life to be run by values rather than my old reptilian brain,” she said.
That doesn’t mean that COVID-19 isn’t worth our attention.
In an interview in Wired magazine, epidemiologist Larry Brilliant, chairman of the board of Ending Pandemics, said that he’s not scared, despite being in the age group that has a 1 in 7 mortality rate from COVID-19.
“I firmly believe that the steps that we’re taking will extend the time that it takes for the virus to make the rounds. I think that, in turn, will increase the likelihood that we will have a vaccine or we will have a prophylactic antiviral in time to cut off, reduce, or truncate the spread,” Brilliant said.
And former Federal Reserve Chairman Ben Bernanke is also reassuring, talking about the economic fallout from the pandemic on CNBC on Wednesday, calling it “much closer to a major snowstorm or a natural disaster than it is to a classic 1930s-style depression.” Bernanke said he expects the nation to have a recession, but a “fairly quick” recovery.
The president, of course, is even more hopeful. “I would love to have the country opened up and just raring to go by Easter,” he has said.