I mean, we won't, but we should

After SARS, East Asian countries were scared shitless and got their shit together for the next pandemic. Now that SARS‑CoV‑2 has hit everybody, we need to get our shit together now. Not for COVID-19, but for the next one. Like East Asia, we have to build up our public immune systems. This is how.

The First Realizations

Before getting to what exactly, we need to discuss why. There are a few important realizations about our current reality.

1. The first realization is that a pandemic is not a short-term problem. You can’t just fight the pandemic in front of you, you have to prepare for pandemics in general.
2. The second realization is that pandemics are global by definition. The word literally means global disease. Without cooperation regardless of whatever conflicts you’re having, everyone is fucked.
3. The third realization is that we have two immune systems, one personal and one public. Public health has to catch new pathogens, our personal health is too weak.
4. The final and most important realization is that pandemics are environmental problems. If we keep fucking with the environment, the environment will keep fucking with us.

I’ll go over each of these points here, but if you go no further, just know this. Another pandemic is coming, public health is our only protection, and environmental degradation is the root cause.

4. Work The Root

I’ll do this backwards because the root is the most important part. Everything else is just pruning branches. The more we encroach on the natural world, the more the natural world will encroach on us. The more we push into animal habitats, more bacteria and viruses will inhabit us. This is the iron law.

Especially with climate change, we are unlocking god knows what. As temperatures rise globally, tropical diseases like dengue will suddenly become topical everywhere else. As permafrost thaws in the Artic, frozen bacteria there will reawaken. As ecosystems collapse, who knows what will come scurrying out.

Without fundamentally addressing our relationship with the outside world we cannot fix our inside relationship with bacteria. The root cause of pandemics is not actually viruses or bacteria. Your body is covered with trillions of bacteria and viruses right now, most of them harmless or helpful. The problem is balance.

We are out of balance with the world so of course our inner world is imbalanced. This is inevitable, it is all one system. When we fuck with the world we fuck with ourselves. We have to stop.

As our population growth slows and begins to decline we have to begin degrowing our economies and prioritizing health and human outcomes over money (for the few). Capitalism is, fundamentally, a cancer on the planet, and until we cut that out the symptoms will keep getting worse. Hence what is required is not just incremental environmental change. What’s required is outright revolution.

3. The Two Immune Systems

Second, just as we are not separate from the Earth, we are not separate from each other. A virus doesn’t see humans as separate things, it just sees one biological soup. We have to start thinking that way.

Your personal immune system keeps a list of problems, identifies known pathogens, and isolates and destroys them. All public health is is these principles writ large. Public health monitors known diseases, isolates them, and hopefully eliminates pandemics before they become pandemonium. This is the infrastructure we need to build.

You can see this infrastructure working in China, for example. After SARS they got shit scared and actually built this stuff out. The most crucial thing they built up was fear. People knew to take diseases seriously (it’s not ‘just the flu’) and the CPC took any outbreak as a serious threat to its own stability.

Hence when COVID-19 hit, they reacted with overwhelming force, quarantining and entire major province and sticking to the target of elimination, not living with this shit. This is the only appropriate response. Your body does not generally ‘live with’ disease, it eliminates or dies trying. Public health has to follow the same principle.

Like a human immune system, Chinese public health relentlessly tested-and-traced every single case. Testing is actually the most important thing. PCR testing is the only significant technological advance since vaccines and it can be intelligently batched to test millions of people at once, which they did. For each new outbreak they tested the entire city, often overnight. This is the level of vigilance required. If it seems like a lot, the alternative is doing a lot more over fucking years. You need to go fast and go hard.

If your public immune system is good enough at A) reacting quickly B) finding every single case and C) isolating, you can actually eliminate disease without vaccines, as China has done.

Crucially, however, this was only possible for China because they had SARS experience. Once-bitten, twice shy. Hence similarly scarred places like Taiwan, Vietnam, Mongolia and, to a lesser extent, South Korea and Japan were able to respond quickly, albeit less decisively.