A patient is wheeled from the Wyckoff Heights Medical Center to an ambulance during the coronavirus outbreak in Brooklyn, N.Y., April 7, 2020. (Stefan Jeremiah/Reuters)

The more I study how countries have responded to contagious disease outbreaks, the more I suspect that the way countries responded to the threat of the coronavirus was driven by their preexisting culture and previous experiences with contagious diseases.

Heading into this SARS-CoV-2 epidemic, the United States had been lucky with disease outbreaks. This century has seen a variety of outbreaks that generated news headlines around the world, but most of these diseases did not hit the U.S. that badly at all.


In the first SARS virus outbreak in 2002-2004, the United States had 29 cases and no deaths. The peak of the outbreak in Asia occurred around the same time as the lead-up and launching of the invasion of Iraq, so most Americans may not have heard much or even noticed coverage of the outbreak.

Of our recent contagious disease outbreaks, the 2009 H1N1, a.k.a. “swine flu,” outbreak hit this country the hardest. The CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8,868-18,306) from 2009 to 2010. (Note that the death toll from SARS-CoV-2, at 27,600 as of this writing, is now well beyond the upper estimate for the swine flu’s toll.) Probably the most memorable aspect of that viral outbreak in the United States was Vice President Joe Biden recommending Americans “don’t go anywhere in confined spaces now,” a recommendation he walked back within a few hours.

The Middle East Respiratory Syndrome — another kind of coronavirus — in 2012 barely touched the United States, with just two cases and no deaths.



The Western African Ebola virus outbreak that started in 2013 did garner considerable public attention; perhaps we sit up and take notice for any disease that can make you cough up blood and bleed from your eyes and that kills 90 percent of those infected. But for all of the public fear, the U.S. had only four cases and one death.

In the Zika virus outbreak in 2015-2017, about 5,500 cases in the states and about 37,000 cases in U.S. territories, mostly in Puerto Rico. The risk of death from Zika was much lower than these other diseases, but infection increased the risk of microcephaly and other birth defects.

In a country of 300 million people, outbreaks on this scale won’t seem all that severe, or maybe even all that noticeable. Even under the worst estimate, the swine flu put about one-tenth of one percent of Americans in the hospital. About one in five Americans caught it and probably thought it was just the regular flu.

Hong Kong, South Korea, Japan, Taiwan, Singapore — all of those countries populations have endured much more severe outbreaks of contagious diseases in recent years. All of those countries’ populations have been conditioned to take any reports, or even rumors, about contagious diseases seriously.



It should not surprise us that when the first reports of the “Wuhan flu” or coronavirus grew in the first months of 2020, most Americans thought it was yet another overseas viral outbreak that sounded scary, but that would not affect their daily lives. This isn’t really a “boy who cried wolf” effect; any of these previous outbreaks could have had a much worse impact on Americans, if not for luck and some effective quarantine measures. Those viruses turned out to be less easily contagious than SARS-CoV-2.

We can be irritated with the people who lined up outside bars on Saint Patrick’s Day or the college students enjoying spring break on the beach — but there was something distinctively American about that belief that this contagious disease couldn’t be that bad. After all, the last four or five hadn’t seemed to amount to much.

But now we know better, in a truly painful lesson.