Nurse Theresa Malijan administers a test for coronavirus to a patient at a drive-through testing site at the University of Washington’s Northwest Outpatient Medical Center in Seattle, Wash., March 18, 2020. (David Ryder/Reuters)

There are a lot of known unknowns and paradoxes in these times of uncertainty. Here are a few.

1) Trump is criticized as both “racist” and “xenophobic” in his condemnations of the “Chinese” virus, while he’s also criticized for “appeasing” President Xi when he makes friendly references to their coronavirus chats. How can Trump be both?


Is he merely erratic? Perhaps any smart president at this moment would prefer both to galvanize Americans about the threat of Chinese near monopolies of industries key to the U.S. in extremis (such as medical supplies, pharmaceuticals, and rare earths) and yet to not to so offend our only importer that it cuts off a vulnerable U.S. in the middle of a crisis.

2) The media hype the increased number of cases (the denominator) without much attention to the number of deaths (the numerator) caused by, or perhaps mostly by, the virus. The numerator, however, is not increasing daily at a rate that’s commensurate with the denominator, despite a number of important other extenuating criteria:

a) Those seeking tests are mostly those with some sort of malaise or exposure, and yet they test overwhelmingly (so far) negative, perhaps at rates, depending on locale, of 80 percent to 90 percent negative (an increasingly not widely reported fact), and thus they may underrepresent percentages of the infected in the general population.

b) The real case number could be perhaps two or three times higher than tested positives, also given that many who are or were ill either did not get tested, or did not know they were ill, or did not know they were ill from the coronavirus.

c) If current daily small percentage declines in the fatality rate were to continue as the case numbers increase, we could approach flu-like levels as is almost true of Germany. This poses the dilemma: Did this encouraging trend occur because of our proper reaction to the virus, or were we mistaken about the lethality of the virus in the landscape of the U.S., or both, or neither?

We then are left with a paradox: Testing shows that many more Americans have had or have the virus than we now assume from prior tests, and many more Americans are recovering from it than we once expected.

3) The highest case numbers and deaths, as one would imagine, so far are in bicoastal, highly populated states, marked by either media and entertainment centers, numerous Chinese visitors and residents, or high-tech and financial nexuses — such as California, New York, New Jersey, and Washington State.

In some sense, our coverage and information of the virus reflect the greater influence of areas experiencing perceived greater viral ubiquity (though not always on a per capita basis) than say the experiences of Americans in a Kentucky, Utah, New Mexico, or Oklahoma.



Broadcasting from a studio or writing a column in New York, or living in Malibu or Beverly Hills, or working as a blogger-coder in Menlo Park, or working for Amazon in Seattle must affect a person’s perceptions and provide him greater exposure, compared with others who are in between such places — at least so far. ,

Even in California the natural reaction to the virus is quite different in Palo Alto than in rural Fresno County, a mere 200 miles away. These regional differences in reactions to the virus may soon be overwhelmed by a true national pandemic that finds its way into deserts, mountains, and great plains. But so far how we perceive the virus is in part influenced by how those in harder-hit states perceive it —especially in terms of relative fears of a deadly, second-phase viral explosion versus the all too human consequences of a great depression.

4) We should be somewhat suspect of data outside the U.S.



China, of course, for domestic and foreign-policy reason, has an interest in declaring victory and posing as the model of public-health policy — the new savior to those threatened by its own perfidy (which it now fobs off on the U.S.).

Italy is probably sui genesis in the Western context, for a variety of now often noted perfect-storm reasons — e.g., it has a more elderly population, a larger than average Chinese expatriate population, laxity in stopping travel from China and closing its borders, a greater percentage of elderly male smokers, suspect emergency health care, perhaps greater frequency of younger people living at home with their elders, lower per capita income ($38,000 versus $60,000 in the U.S.); pre-virus, it also had much higher unemployment (10 percent versus 3.5 percent in the U.S.).

Germany so far seems to have both lots more per capita infections (0.02 percent versus 0.001 percent) than we do in the U.S., and yet it has far fewer fatalities per positive cases (0.3–0.4 percent) than does the U.S (1.1–1.2 percent). Yet in terms of per capita fatalities, the two countries are doing about the same (0.0001 percent of the general population dying from the disease).


One might wonder how Germany is both doing an average job of preventing infections and a superb job in preventing coronavirus deaths. Or one might suspect that Germany may be better in finding and testing more of the infected, while using a different standard of ascertaining actual coronavirus deaths.


In general, however, political, cultural, economic, and climatic disparities make it hard to rely on comparisons, other than in a general fashion, between countries.

5) So far, the lethality rate is the key datum, given that, from what we tentatively know, the vast majority of people who recover have had no greater percentages of permanent lung or other organ damage than did those with the flu (this could change, of course, with further study).

The morbidity of the infected may be as severe or more severe than with a severe flu, but we do not know this other than from media-generated frightening anecdotes.

So the point is that we wish to concentrate on getting the lethality rate down, both to save the most vulnerable and to reassure a terrified public that we might get to a point where their fears should be commensurate with those typical of a characteristically bad flu year.


A caveat here: Under the present set of radically changed circumstances of the past eleven years — the current role of China, a different media and domestic politics, an election year, etc. — the mindset of 2020 transferred back to 2009 would most likely have radically changed what was then public response to the H1N1 influenza A virus. Under today’s perceptions, an eventual 60 million (?) infected Americans, and 15,000 (?) deaths at some point would have prompted similar shutdowns and lockdowns.

6) We do not know where it is yet, but there exists a golden mean between proper mobilization against the COVID-19 and proper circumspection needed to avoid a recession or great depression. We all agree that what this means is a nearly normal economy as tens of millions are tested and those who test positive and their contacts are quarantined, isolated, or restricted in their activities in the manner of tuberculosis, early AIDS, or measles, freeing up resources to concentrate on the elderly and chronically ill. But no one knows when this golden mean should be enacted.

The psychology of erring on either side is important to note: Those calling far more severe precautions that will further harm the economy do so in the admirable agenda to lower the deaths (in the sense that one dead American is a tragedy), and they can quantify their efforts in the known number of dead.


In contrast, those who advise caution out of fears of an economic meltdown will never be able to quantify the greater number of fatalities from a depression than from an infection. It is more difficult to tie likely spikes in suicides, postponed or canceled medical procedures, increased substance abuse, crime, ruined lives, etc. directly to the virus, even though the link is highly likely.

Those who urge caution, regarding the economic impacts, are also more likely to be damned as putting money over lives, even if they are more worried about lives than money in the event that a severe recession follows. And, of course, exaggeration is a two-way street — those favoring a relaxation of the shutdown may also embellish the economic costs of the present stagnation.

Still, in general, the historical psychology of plagues and panics is instructive: Pessimists who call for Draconian measures are credited with saving lives, not endangering far more lives through the severe countermeasures they take.

In a crisis, pessimism is usually more likely than optimism or realism to galvanize needed responses — at least up to a point of avoiding widespread defeatism and nihilism.

Psychologically, the expert statistician is more likely to err of the side of predicting catastrophe than amelioration, given that one is a win-win proposition, and the other a lose-lose surety. In retrospect, the pessimist’s incorrect warnings nevertheless are to be credited for inducing the needed panic to enact necessary remedies, while he appears a savior if he is correct in his prognosis. So, in a crisis, it seems wiser to overestimate the dangers than to underestimate them.

In contrast, the realist or optimist, if proven wrong, appears reckless, insensitive, even murderous. Even when right, he is deemed either lucky despite his recklessness, or proven prescient only thanks to those less cheery who ignored his unrealistic prognostications and took extreme measures to achieve what he predicted on surely false and unreliable data. That may be why early spikes in the death rate caused panic, and later declines comparative inattention.


FDR perhaps found the right formula after Pearl Harbor. He warned Americans that full mobilization would be necessary to achieve what he assured them would be the sure defeat of Japan, at a time when U.S. Pacific forces were already doomed to suffer substantial losses for the next six months without let-up — and yet the U.S. Navy was also already prepped to build and launch an entirely new fleet by 1943–44, larger eventually than the world’s combined navies of the time.

7) Finally, reliable information is so scarce, and erroneous news is so volatile, politicized, and often sensational that any analysis is either outdated by the time it is read, or it’s based on conventional wisdom that almost hourly is revealed as fake news.

Despite the prior Ebola, MERS, SARS, and H1NI scares, the COVID-19 is the first truly worldwide meltdown, in the 21st-century globalized age of social media and the Internet. Instant unfiltered opinion adds to the panic and yet in some cases can aid rapid responses in finding cures and vaccinations. We are reacting much as did past plague sufferers (though with far more volatility), whose pandemics in terms of relative lethality were far more devastating.

Even in the preindustrial age, the sense of hysteria that accompanies a pandemic explains why both Thucydides and Procopius are more famous for their descriptions of the reactions to a plague than even their astute and empirical descriptions of its symptoms.