The Pattern That Epidemics Always Follow

First comes denial. Then panic.

You are reading this because of your ancestors’ immune system. The odds of your predecessors surviving the myriad microbes that have stalked humanity every step of its march toward becoming Earth’s dominant species were incalculably long. More Homo sapiens have probably died from infectious disease than all other causes combined. Only in the past 150 years, owing to nutritional and medical advances, have we emerged from living in constant worry that a cough or fever or scrape might be a death sentence. But that fear of infectious disease remains embedded in the brain, as visceral as our sudden alarm when encountering a snake in the wild. Despite all our medical and technological breakthroughs, when confronted by the prospect of an epidemic, we are not that different from a farmer in an ancient Sumerian settlement making offerings to a local fertility deity so that he might survive the mysterious pustules killing everyone in town.

Or so it seemed to me when I was living in Hong Kong at the height of the SARS outbreak, a crisis I covered as the editor of Time AsiaTime’s sister publication. SARS, a coronavirus, emerged in Shenzhen late in 2002 before burning through humanity, eventually infecting more than 8,000 and killing 800 for a mortality rate of about 10 percent. I wrote a book about SARS, and as I read the coverage of the latest coronavirus to achieve widespread human-to-human transmission, which causes the disease called COVID-19, I have noticed a pattern in how the media, governments, and public-health systems respond to infectious-disease outbreaks. There are four stages of epidemic grief: denial, panic, fear, and if all goes well, rational response.

Whenever a new microbial killer emerges, we go through each of these stages, starting with denial as government officials insist that there is no outbreak. When smallpox appeared in the Roman Empire in a.d. 189, one local prefect attributed the upsurge in deaths to a displeased Jupiter, while another assigned blame to a poisoned barrel of wine. In China, where the state largely controls the media, denial usually takes the form of a cover-up. The first mention in the press of the disease that would come to be known as SARS was a story on January 3, 2003, in the Heyuan Daily, a Communist Party–controlled newspaper in southern China. “There is no epidemic in Heyuan,” assured the anonymous reporter on the front page. “There is no need for people to panic.” Just in case readers weren’t convinced, a nameless party official proclaimed, “People don’t need to panic and there is no need to buy preventive drugs.”

Not surprisingly, denial did little to reassure the population of Heyuan, a city of nearly 3 million, who emptied pharmacies of antibiotics and began the widespread boiling of vinegar, a traditional folk remedy for respiratory ailments. Thus denial led to panic. Denial always leads to panic.

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