The biggest pandemic in decades serves as a reminder of just how big a role infectious disease has played in human history — and will continue to play in the future.
The big picture: Without a victory over an infection, humanity wouldn't have developed the globalized and populous civilization of today. Yet that civilization is vulnerable to COVID-19, which can only be fought by decoupling the connections that underpin the modern world.
COVID-19 is, ironically, a function of the richer, more connected and more populous world created by the defeat of disease.
Background: For most of humanity's history, disease and infection kept a check on human development. Population growth, economic growth, even the spread of people across the planet — all were curbed by the threat of contagion.
As late as 1800, the average global life expectancy was just 29 years. This wasn't because human beings couldn't live to old age but because almost half of all people born died before their 50th birthday, mainly from contagion.
Death from disease in urban areas was so rampant that up until the 19th century, cities were only able to maintain their population through a constant influx of migrants to replace the dead.
All that began to change in the 19th century, with the sanitary revolution and later the widespread development of vaccines and antibiotics.
Untold numbers of lives were saved. Global life expectancy rose — to 71 years on average today — and with it, global population. Freed from the constant reaping of their citizens from infection, cities exploded, their larger populations becoming engines of rapid innovation. Global travel became safer and with it, the global trade that has helped drive startling levels of economic growth over the past century.
"Our defeat of infection overcame the barriers to human development," says Kenny.
Yes, but: That defeat has been so total that we often take it for granted, especially in the developed world, where we are far more likely to die from heart attacks or strokes — conditions human beings rarely lived long enough to suffer from — than infectious disease. As a result, we've let our guard down.
Global vaccination rates have stagnated and declined for diseases like measles in recent years, partially driven by anti-vaxxers who have no memory of a world threatened by childhood diseases.
As antibiotic resistance grows because of overuse, we desperately need new drugs. Yet in January the World Health Organization warned the pipeline for new antibiotics was essentially dry.
And of course, the explosive spread of COVID-19 has shown just how unprepared the world was for a contagious, new infectious disease.
The bottom line: The reason COVID-19 feels so disruptive is that our world was built on the idea that events like this no longer happen. We won't get that world back until we beat this disease. And we can't safeguard that world unless we ensure it won't happen again.
What a coronavirus exit ramp looks like
Americans are looking for an exit ramp away from the extreme social distancing brought on by the coronavirus, but that will require steps we're not yet prepared for, I write with my Axios colleague Caitlin Owens.
The big picture: Responsibly easing off of social distancing will only be possible as the number of new cases levels off, and will depend on extensive testing to avoid another surge in infections.
"The problem is that the next phase of containment is contingent on resources we don't have,” said Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security.
Where it stands: If we're going to back off of aggressive measures like school and business closures, the next phase of the response would involve doing a lot of the things we should have done from the beginning.
That includes quickly identifying and isolating newly infected patients and identifying others they may have infected.
Places that house vulnerable people, like nursing homes, would still need strong oversight.
Yes, but: All of that requires fast, widespread testing, which the U.S. still can't do.
What's next: Syndromic surveillance — testing a random portion of the community — might help the U.S. get a better handle on the true prevalence of COVID-19.
Seattle has launched an effort to do just that, adapting an existing program that checks for influenza prevalence.
Life won’t go back to normal for a long time. Normalcy will return in doses, and at different paces in different parts of the country.
“It’s not like a switch that’s going to be flipped. It’s going to be much more gradual. And people that are high risk are probably going to be the last ones” to see relaxed restrictions, John Hopkins’ Joshua Sharfstein said.
The bottom line: “The worst possible outcome would be a second epidemic, a second wave…. We can’t afford to have this happen again,” said former FDA commissioner Scott Gottlieb.
Axios Future
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