Its an author discussion on the potential longterm effects covid19 will have on society. Hello, im brian tate and i am pleased to welcome you to to the 2020 brooklyn book festival. We are here today with authors paola giordano, Mark Honigsbaum and sonia shah. Im gonna read very brief bios. Mark honigsbaum is a medical historian, journalist, author of five books including the pandemic century 100 years of panic, hysteria, and who works. And the fever trail in search for the cure for malaria. His current elector at City University london. Paola giordano is a physicist and author of four internationally bestselling novels including the solitude of prime numbers, which are sold over a million copies worldwide. His essay how contagion works published in italy at the beginning of the coronavirus emergency as the mathematics of contagion was shared more than 4 million times and help shift Public Opinion in the early stages of the pandemic. Sonia shah is prizewinning author of pandemic tracking contagions from cholera, ebola and beyond. A finalist for the Los Angeles Times book prize and New York Public Library award for act dumb excellence in journalism. She has written for the new york times, wall street journal, and many others. Her ted talks, three reasons why we still havent gotten rid of malaria, has been viewed by more than 1 Million People around the world. The most recent book is the next great migration, the beauty and terror of life on the move, she lives in baltimore. Welcome to you all. Thank you brian. Thank you. To get us started, i have some questions to ask you all. Im hoping for a very lively conversation around this topic. I want to invite anyone who would like to read something of to read to get started please do. We can dive and from there or we can dive in whatever feels right. I should justay that, so i wrote the pandemic century, i began writing it in 2017 and i actually finished it at the end of 28 but it didnt come out until april 2019. Within a matter of weeks my published n my publisher approached me and said is there anyway you can upstage it with a new chapter on covid . As you can imagine, im se paolo can appreciate awell, rather challenging writing about a topic like this when youren the midst of it and so many knowns. I just want to share a brief passage that describes my frame of mind when i was going through i was writing this in late march in london when london was on lockdown. I will just read it. Im writing these words for my sickbed in london, in march 26 and im nursing a temperature and an intermittent cost. Because of the lack of National HealthService Testing kits i have no way of knowing whether i have covid19 or a cold. Much less one it will be safe to hug my 88yearold moth again. Several friends have reported works including unsettling loss of sense and smell and diminished sense of taste. Just as china was too slow responding to warning signs in early january, the British Government being too slow to follow chinas example and impose this sort of draconian measures that mightve halt the action chain. Instead the British Public like americans have been asked to practice social distancing in order to flatten the curve. Until last week terms that few people had heard of and even fewer could define. It continues, 100 years ago en the planet was swept by a similarly devastating plague the world was at war in the spanish influenza ma curiously little impact on the collective consciousness of society. Americans took litt notice of the pandemic, remarked the environmental historian crosby, and quickly forgot whatever they did notice. The times of london was pummeled by the pemex favor to move to more emotional residue. So alas is the catastrophe and if the cordis is its presence that online ncurrent with the hardware refuse realize ab the quote continues it came and sweeping away our youth and hundreds of thousandand leaving behind a total of sickness and infirmity whic would not be recommended in this neration. Even now just three months to the pandemic of covid19, it seems little danger the conavirus being similarly forgotten. Indeed newspaper columnist already referring to the pandemic as our New Historical divide. Looking forward to the firsa aone that will be, no one can say. That was written obviouslin april but i think that ware still right in the midst of it d they dont know really what its goi to end and a thank y mark. Sonia , uld you care to share something . Sure. I can share a little extract from the new forward i wrote for my book pandemic came out in 2016. We just put a new forward in, i guess i wrote it in the spring of 2020. For me the most striking aspect of this pandemics how eerily familiar it feels. According to taxonomists, not only from the same family of ours is that the fellow pandemic causing pathogens sars coonebut from the same specie the virus had emerge from bodies of bats to the intermediary host of cats thanks to the peculiar opportunity available in a rapidly expanding chinese economy is increase the probability of intimate contact between people, bats, and other wild creatures. The first sars has dected in 2003, the balancit has struck between coagiousness and deadlinessead to burnout after infecting more than 8000 and lling ndreds. But the desire bruising factory that led to e first sars virus had ner been shut down. It was only a matter of time between another virus of potentially more successful combination would reemerge. Indeed its younger sibling just a little more contagious than a little lesdeadly was vested cestor by far. Theast globalization, leaders around the world at war with the infection this president said. China wou wage a peoples war thisresident said. U. S. President would be a war president. But a war implies invasive outsiders single out, repel and destroy and acts of force to quell into submission. It pitted one opponent against the other. The widely distributed virus, already is well iorporated into bodies and society has cotton thread wont fit in fabric, were not clottrategy as one observer pointed out. It was incapable of malice or fear. Just w or what standin was open to interpretation and outrht manufacture. Some took theicroscopic approach targeting every residue for chemica annihilation. In jamaica it was a Bus Passenger who bean up and thrown out on the road by his fellow passengers. In australia it was a m who suffered cardiac arrest on the street outside of a chinese restaunt, convinced the microbial enemy inside and the crowd gathed around, watching him die rather than providing lifesaving cpr. During the 19th ctury cholera pandemic, doctors were sted in the street, hospitals burned to the ground by angry mobs. During the covid 19 pandemic docts in upstate new york were sat onurses immersion late night shifts find their tires in the cars . An indiana help coburg in light blue scrubs market during narrow alley was csed by a mob. Overwhelmed president bme the world health organizati. With fingers pointed at the chinese and animals in a lab somewher political shadow day ten shadowy International Authority the virus spreads undeterred. Thank you sonja. Follow yes we areovering different ments in the epidem. Semi brief forward brings us back. It sounds today as i. Reporter it with some sort of historic book already. Im writing this on a rare february 29, a saturday of this leap year. The global cases of infection have surpaed the 85000 threshold. Almost 80000 in china alone, yesterday we passed 1 mlion deaths. The event toll is around 3000. Those numbers have been my lent companion for the past month. Much to everyones surprise hasound itself leading the race in this competition. This has happened entirely by chance. In a few days, suddenly, unexpeedly other countries are finding tmselves in even worse conditions. At thi moment of crisis, the expression it italy has no meaning. There are no borders, regns, neighborhoods. The naturef what we are going thrgh us about identities andulture. Epidemic is the ultimate proof how our world has become globalized interconnected. I decided to make use of this void by writing. Writing can sometimes a anchor that helps ustay grounded and holdback fear. But there is also another reason. I dont want to lose what the epidemic is reviewing about ourselves. Once the Emergency Air is over any temporary awareness but also disappear. As you read this pages the situation will have changed. The numbers will be different. The epidemic love spread further. It will have either reached every corner of the globe or will have been stopped. Me of the reflections emerging from the contagion will still apply. Because what has happened is not random accident or a scorch. Its nothing new either. It has happened and it will happen again. You may thank you all. Well i guess im going to pick up on something y mentioned in your reading, paulo. Noticed the headline this morning, probably the sam when you also breaking news the coronavirus is killed at least 1 Million People around the globe. There is no end in sight. So this makes me, sort of brings them back to the pandemic that you all have itten about that preceded the coronavirus. I guess, you know the fir question is from your research, how dependent mix ten to resolve . Subpoena by n. Do the end . I dont know ifhey do end. That is a question. Its aery short answer they tend to enter but the winter that a bang. The bigst reason pandemic is istill with this is it did not end. When i think theres every prospect tt coburg could go the same way. ,till have cholera. Color w the most successful pandemic. Whats going on right now just a few hundred miles up the coast of florida. The mainhink this is the big accomplishment of microbes over humans. We dont change enough. They can continue effectiveness. You think about the billis of years they were here before even our earlies ancestors were here. It is their world not ours. Spain back what scares me a lot about this is i agree with mark and sonja. Everyone is acting a if there is an eing to this. And its very soon and its a vaccine that surely going to come because weanted to be there very soon. Especially news that comes from the u. S. That says are a little frightening for me. Beuse on one side they show some certainty that i simply cann find. You mentioned hiv, he mentioned calais area, he mentioned so many illnesses. That are still there as you are saying. But somehow we want to be so sure that we are going to have a vaccine and it is going to be soon. This is causing, i would say this is a threat within the threatnd my idea. I think theres a useful stinction between the biological phenomenon of the pandemic and the social and political phenomena of the pandemic. We still have hiv but we are not living in the panic that was much ofhe 80s when it first came out. I think the difference is really when privileged people can find some kind of way to protect themselves. That happed with hiv with new drug cocktails and therapeutics over very expensive a the beginning. But it seems that it came online the pdemic dissipated. People who were powerful enough to access those could protect themselves. Color was not scary for mos people in the world because we have clean Water Systems now. We are not at risk of it. I think the same thing could happen with covid when we have a therapeutic, or weave Greater Knowledge of who is at risk. In aherapeutic that would help for those people. In the socl and political panic of it will srt to subside. Does not mean the pandecs going to go away. There evil still exped in that risk. We live with people arod the world who are still at risk of malaria, tuberculosis and all of those others tt we know how to prevent and treat. But homes of thousands of people get those a die every year. Life goes on, the economy goes on. I think its really about who is going to be exposed to the risk or time and who is not. Just say right here, i dont think i equallyhare your thought of medicine to solve this pandec. Its not becse i dont think well have a vaccine at some point in a year to 1 months. Think we are no longer living in the kind of moment we were in the 19th century. My population, trust and confidence anymore. We mention the pandemic with people refusing vaccinations. But even here recently in london and publix where there are mass demonstrations about ople dont believe covid is actually real. They think the whole thing is a hoax. In our movements in america are driven by hysteria. So my worry more is this phenomena that is today. Ththat populations no longer trust in medicine. And theyeject medicalization which is why the conspiracy theory, i almost see consertory of thinking of rejection is almost a bigger threat. Exactly a good point. I think thas absolutely true. I think the populism around the world is a big part of the puzzle of whats happening right now. We have these mtiple crises out the same time interacting. And each one making the other one harder to respond to. So we have the biological crisis of the pandemic we also have the Climate Crisis going on. And then we have this governance crisis going on at the same time. All of those three thingsake each one harder to get the response for the other one. I see the rise of right wing populism around the world. I think mark may be would agree with me. We are wting about thi in the earlier part of the decade, it was just not foreen at all thathe united stes would have such an absolutely chaotic response. That the cdc would be this organist propaganda the people without trust. That was never themed outcome is absolute unexpected, right . The cdc is the lead organization to go around the world. But yeah i think we have a lesson in his policy somehow, European Health systems, we have seen how asia and africa. What i noticed about what you are saying, with the attitude of people for instance the attitude that changed aot during this month. So nowhat we are starting a second to we, we dont really understand where we are right now. But there is some tension growing and people are starting to talk abo possible new lockdowns and all that stu. The attitude is completely changed. Most o the people probably wod not accept that situation again. Because the denial has thickene in the meantime. But what i see, and you were mentioning also other countries. We had that comg from above, coming fromhe leaders of the governments was a big part of the problem in this pandemic. But to me, it all goes back to, how can i call it a sort ofontradiction that was within science and the very beginning. It is very clear by think ao elsewhere. Thecientific community was dided between those who are saying this is dangerous, where we need to act very fast. And another part of the scntific community was saying this is just like a seasonal fl flu. This idea of the seasonal flu has beenhere since the very beginning. Somew its not the results. And to me its the cause of many behaviors also that we are seeg and growing within the populatn. I would agree withhat. Its fast thi here your take on this. It all comes dow to helping people understand. I wanted to follow up on that. To me, the influenza, it is really serious. Use the metaphor like its nothing its just the flu. Flu kills wondered if thou people year even thoug we have heard immunity. Even though we have vacnes. And we spend tens of millions of dollars every or creating all that. We still lose another tensf billion dollars a year because peop cant go to work. Its a huge burden on our society. The applicants just another fl flu. Theres a strange misunderstanding. Would agree with that i think the samen the benning it was divided between this is the big one weve all been expecting. And other scientists who were wary of sing that. The prediction can be mad in 2009 likely to emerge. They did not turn out to be severe global pandemics. They were pandec just severe. [iudible] i think iluenza hasisled because the point aut influenza as even when there is a pandemic strain theres always immunity because of t protein we shared the previous virus. Particularly 1918 the pandemic ended when a third of the population has immunity. Therefore continues and they did not get very ill. This is one of the problems with covid19. We really dont know. People tal about heard immunity the term that has been borrowed tre is assigned forommunity and life given the pulation. You know, the rule of thumb is lead we reach 60 or 70 of people whove had covidr how recovered. We dont know there certainly an unown. Plus we dont know if there is some preexisting, right . Which means we may not actually hear the second or third period or it could be the other way. We dont get the assistance of protection. So we really are, you know, the time cant give us the answer. That also drives distrust and everything expert might tell a straight i want to ask each of you to expand on a coue of things that you have said. That youve said elsewhere. I just want to read you a couple of things. Paolo i would like to start with you to pick upn the previous conversation. He sai that and, forgive me if im difficult to hear. This pandemic was a health crisisreceded by a mathematical emergency. Could you elaborate on that . I really startedooking into this in writing at t end of february which the pandemic was not yet a pandemic i think first of all. Beuse it took some time to call it that. But especially in europe. In all of the western world, the Health Emergency hadnt started jet. And so ten days after that, the intensive cares and italy would be deep into the health crisis. But at tt moment is still invisible. Yo could only see what w about to happen. In the growth ofumbers. It was another world comred to this one. Its even hard to go back to that moment. Because we had no testing. We had no tracing. We h nothing basically. So we were just counting people. They were getting to the hospital who were already severe. And they numbers that were given to us were growing very, very fast in those days. But there was nothing to show to people. There is no Health Emergency. So myoint was, i knew that we could change the course of the pandemic and italy in those days still. At lst a little bit. The peopl needed to understand why and how they needed to behave in a way that wouldearn social distancing and all of tt. So, my only way to show that was to try and explain the numbers. What is the different for instance between a linear growth of a phenomenon and a known linear growth. Which is something to most of us is pretty car. But not to most of the people. So explaining why and ask the dam it can grow not fast but much faste than fast. And what does that mean in all of tha why we need to behave in such a way. Thatshy i called it a mathematical emergen. And then we saw the images of the coffins taken out. From that point on, everying becamelear to everybody. Fed by then it was alreadyoo late. Do you feel that the mathematical framework help to shift peoples thinking about the epidemic . I think it helped people to have clearer vision. And so not to panic. Or panic little less. We were having very contradictory messages in those early days. That happens more or less in every count. And every country after that. People we scared. Mostly becauseith everybody was saying was not clear at all. So people were confused. Just by giving a couple of very simple epidemiological tools, which is the basis of every mathematical model of epidemiology, but i realize fr the feedback of readers that it helped to them to be a little more calm at least. Increaseheir understanding. Guess i could big part of the problem during an epidemic. I would say even the biggest part of the problem. Io want to ask all of you about pan and fear. Been there to build my way up to that one. At something that certainly thres through so much of each of your writing. Sonja, you have said that, and i tnk you said this simply covid19 pandemic, but generally around pandemics and epidemics. So one from the beginning is a passive population. Suddenly attackedy a foreign being and i want to ask, wl the narrative around this. Even going back to what you shared earlier about that militaristic war and so forth. Can you elaborate a bit on how thatlays into where we are now in terms of o response, our understanding of this moment . Yes. I think its been a conceptual framework we can used to understand contagion. At least in the germ theor times. Which is external quicken attack fromutside of us. You see that inner rhetoric and narrative the way we name pathogens if from far off place places. Sit in the scapegoating that often occurs, you try to say its not us its of them. Shld the uncontaminated from the foreign contamination. And i think is a policy solutio solution. So i one vaccine in the drugs make a different biomedical commodity. Its not tha its thats not true. Its partially true, course that is happeni on some level. Part of the fabric of all of this. Just become you have the german side does not mean youre going to get sick. We kno on some level theres some interaction there. Its not just that were passive things that we have been victims of this external alien or creature. Our immunity matters or social lations matter and of course what this whole paradigm im ajar own activities are what has broug these micros into our population. And you know, this i why experts who predict for over n years that a pandemic like this would occur. We have a steady drip of new pathogens like this. The 19 we had hundreds of them. Not just the last sars virus. But a bullet in west africa never been seen before, cholera had never been seen in a hdred years. The kind of antibody resistant pathogens. All this is building up. Its becse of how we are creati opportunities for microbes that exist in the world elsewhere. And here in different parts of the environment. We are buildingridges for this microbes t cross over into human bodies. Whether its because were cutting down the forest or we are hunting them andring them into our marke. Any number of way in which we are buildinghe highways that bring these microbes into our bodies and turns them into pandemic causing pathogens. I think that is an important part of the story because of course isnt the last pandemic. We already had one sars virus. And we knew another was coming. And this one has come. And as horrible as this one is , as how deadly as it is, theyre so anywa you can imagine a pathogen that could be worse i could s primarily young people for example ratr than elderly people. That can be mor deadly or symptoms more scary than this one. This is some we are familiar with in a l of ways. So i thi it so important for us to get t those causes i think that means telling a different story of where this pandemic came from. Mark, you have said the scientif knowledge of viruses and other infectious pathogens can blind medical researchers. An immunological inshts as well as the epidemic just around the corner as you read in your peace. And also the tendency of medical researchers to become prisoners of caution, winding them to these threats what is known and unknown. Is there anything you like to collaborate on tha elaborate i would like to aborate its one of the main themes of the book. What would covid19 b if nothing else a worldwide lesson. With complacency of every kind. Complacency of western government that thing that is happening thousands of miles awayt wuhan its never going to come her several pointed happen here. But i supposedo ask you a question more directly, if we look at the modern era, which i mean from 1950s what is the areas it epidemiology both the statiical understanding, and the end of the 19th century through bacteriology and germ theory. What we have seen, force the Scientific Understanding of the disease has been a he boom to humankind. Control disses its flowed by vaccines work cholera and typhoid and other disease spad. But as we move progressively forward toward the prese day we have actually seen that scientistsre continually being taken by surprise. By familiar pathogens happening in new ways thatre unexpected. That would be the ebola west africa 2014. The been Something Like 12 large outbreaks acrs central africa. But the main part of t outbreaks began in remote region never reached a major area. They got quite close, but they neverctually got to major cities, right . That all changed in 2014. Partly because the outbreak occurred in the tribal water region and liberia. More importantly is a new chinese road t the border, likewise impved communication. To nairobi and europeanamerican system. With his eco in brazil, we had known about is eco since 1947 when it was identified and isolated by an epidemiologist. But we were not interested in is eco. Until 2016 it was a disse that can cause a rash and flulike illness. Nobody did seen these disorders in young children. There never been as eco outbreak i brazil and sth america. And it happened of course everyone was taken by surpse. But what we are really seein is what i talk about in my book the philosophy of knowledge. The idea of things we know that are littleknown,ts the disease and World Health Organization that cam up with. Recognizing we keeping caught unare. We need to actually have a placeholder and Health Regulations for disease we dont ev know about yet. But weve also seenheres others that are almost as important. And that is the unknown known. The coronavirus is a perfect example. Lets not the first coronarus. Sars one and 200 or the coronavis. I think the third of them are caused by conavirus. Weve knownbout for a long time. But theres still so much we dont know. It true up to the present moment. We dont rlly know why this particular virus is so much more transssible than sars one. And why it causes in some people and notn other people. Use weow have a category of patients is having persistt longhaul symptoms, we call them long haulers. They are the people who got ill in february march and are still ill. Right . Maybe something they haveo live with for the rest of their life stuart i cant think ill enough for participatingn this conversation. Everyone whosatching this i encourageou not have picked up the books by these authors. There is just so much there. We really scratch barely the surface. Thank you paulo, sonja, mark. Everyone pase member you can order books and the link low. Please also consider making a donation to theook festival which is celebrating its 15th year of presenting free literary programming