Note: This article was originally published on Medium.com on April 16, 2020. My account has been deleted (by me) due to Medium’s unfortunate policy of banning authors they do not agree with.
As an immunologist that studies infectious disease, I’ve thought a lot about how a person responds to an infectious invader. Whether it’s a virus, bacteria, a parasite, or a fungal pathogen, our cells have to be able to detect the presence of a dangerous invading microbe, and process that information in order to signal other cells near and far that there is a threat. Usually, this happens at an external surface that is exposed to the outside world in some way. Like the skin, or a mucosal tissue like the lungs or intestines. After the cells in those tissues detect a threat, they have to change their behavior, that is, their gene expression, to respond appropriately. As a result of the danger signals produced at the site of infection, other cells will arrive, some to help out, some to kill the invader, and some to clean up the damage. At first, the response will be inefficient, messy, damaging. A bit of an overreaction. Over time, as the nature of the threat becomes clearer, the response will become more complex, more tailored to the specific invader, more adapted. The cells that show up to help will be better equipped to handle the infection. They will be specialists. As a result, the amount of collateral damage to unaffected cells and tissues will go down. Other cells will help regulate this process to ensure that it is measured and appropriate. Eventually, as the invader is beaten, other cells will stop the responding cells to ensure they do not cause any more damage than is necessary. Some cells will be activated to promote healing. Normal activity will be restored. Most importantly, the response will have a memory component. That is, if the same invader is detected again, this time, the response will be faster, less damaging, more adapted.
I’ve just given you a brief outline of an immune response to an infection, without all of that immuno-jargon that makes non-immunologists cringe. When I first observed the response to the United States to the COVID-19 pandemic in the past months, I was pretty frustrated. It seemed messy and inefficient, focusing on the wrong things, causing damage where it wasn’t needed. But, then I realized, the response of the United States was just like the immune response to a person who is infected! Then, the more I thought about it, the better I felt. People were like cells, communities were like tissues, states were like organs, and media were like signals. Things were going to get better! Here is how to explain the same response, nationwide:
A pandemic threat first enters the country through access points, places that are important centers of global commerce. Ports, airports, facilitate this entry. Places on the coast, like New York City, Seattle, get hit first. If there is forewarning, people in these places have already received external signals from the media that other countries are being hit, and what to look out for. Since ports and hubs are important areas for communication with the rest of the country, they have pretty good access to specialists trained to recognize the problem quickly. The specialists, infectious disease experts, sound the alarm, through the media. The message isn’t clear at first, because even the experts are not sure exactly what’s coming, and even if they do, it’s hard to explain nuance to non-specialists, so they keep the message simple: Danger is coming. The media send out these signals to the rest of the country. The message isn’t perfect. In fact, at first, it’s very inefficient, and messy. Filled with inaccuracies. The control mechanisms, run by state and local leaders, process the signals as best as they can. All sorts of non-specialists are activated, just to keep things under control. The levels of danger appear worse than it might actually be at this point, and there will be unintended consequences of mitigation policies that will affect people and communities far and wide, even though some of those communities will not have the same threat level as others. The initial surge of the pandemic is painful, and the sites of introduction and spread fare the worst, because the people there are least prepared, and there are a lot of them there to feel the impact. As the news spreads of cases and deaths, the people in the rest of the country alter their behavior, hoping that the fate of the coasts doesn’t befell them.
After a while, the threat becomes clearer. The spread of the pandemic slows. The specialists have had time to respond, to think about what really works. They identify the places that are most threatened, and abandon the one-size-fits all policies, opting instead for targeted policies that focus on the most vulnerable communities and populations. Some people urge caution, and some people remind others that the initial harsh policies of containment are no longer necessary, and if continued, will be more harmful than the pandemic itself. As the surge of infection passes through most areas, there are specialists who are activated to clean up the mess. To restore life as we know it. And finally, there will be people who use the knowledge gained from this crisis, their experience, their memory, to prevent it from happening again.
Just like the cells, tissues, organs, and signals involved in an immune response to an infection, everyone in the United States has had a role in the response to the COVID-19 pandemic. As we move into a period of specialists and towards clean up, we should take the time to be thankful for all the people who played the roles that were needed to get us back to normal, and those who will help us in the future ensure that we are better prepared for the next big crisis, if, or when, it comes.