Continued — Part Three of “Coronavirus: Facts We Need to Know and What We Can Do” If we look at the history of dangerous viruses globally, one of the deadliest viruses of the twenty-first century has been the H5N1 influenza virus, known as avian influenza or bird flu. Since the suspicious death of a three-year-old boy in 2003 led to investigation and identification of the virus, and through the subsequent cases that have occurred, the virus has killed only 445 people, despite a reported fatality rate of 60 per cent. In other words, the likelihood of dying after contracting this virus is greater than the likelihood of surviving it. Yet we see that it has been contained effectively, because the severity of its symptoms, rapid identification of new cases, and international preparedness have prevented widespread transmission. Even two very dangerous close relatives of coronavirus, SARS and MERS, have each so far caused fewer than one thousand reported deaths, while even at this moment coronavirus has produced roughly three times the death toll of either one. What makes coronavirus particularly dangerous is not an exceptionally high fatality rate, but its distinctive characteristics. The virus is potentially fatal, but its fatality rate is not as high as that of some previous viruses and is estimated here at only around 1–3 per cent. Many infections produce only mild symptoms, making them difficult to identify even though those people may still transmit the virus to others. For this reason, over a wide population the virus could produce a much higher total number of deaths. In this respect the virus can be compared with influenza. The fatality rate of influenza is only around 0.1 per cent, but hundreds of millions of people contract it each year and in the United States alone roughly forty thousand people a year die from the disease. Even if we assumed that Iran’s medical facilities were equal to those of the United States, given that Iran’s population is approximately one quarter of America’s, in the most optimistic scenario more than ten thousand people—and realistically many more than ten thousand—would die from influenza in a year, even though a vaccine exists. Influenza is not a virus that can be completely controlled anywhere in the world, because complete control is impossible. At present, even in the most favourable estimate, coronavirus appears around ten times more lethal than influenza. In Iran, at this moment, the observed proportion is unfortunately far higher, and in China it has also been much higher. This situation will probably improve after vaccines become available in the coming years, but it is conceivable that the virus may remain endemic with seasonal outbreaks similar to influenza. This would mean that, in the first year, if complete elimination is not achieved, the number of deaths across Iran could be tens of times higher than deaths from influenza, a situation that, if it occurred in an unprepared society without an accurate understanding of what lay ahead, could bring that society toward social and psychological collapse. Another major problem is how much remains unknown about the behaviour of this virus. With influenza we know that its pattern is largely seasonal and that after the cold season it usually becomes less visible. Although something similar may happen with coronavirus, it is also possible that the virus could continue taking lives throughout all twelve months of the year. Continuation — Part Four of “Coronavirus: Facts We Need to Know and What We Can Do” The effect of coronavirus on the world economy is another issue, one that acquires an additional impact in Iran. For example, the value of the Australian currency, solely because of the effect of coronavirus on China and trade between the two countries, had fallen to what the source describes as its lowest level since 1930. With the spread of coronavirus in Iran, Iran’s remaining window for national revenue—non-oil exports—would also, in the event of the country being placed under quarantine, be substantially closed, creating another challenge. The large question in any major epidemic is always: how many hospital beds are available to help patients? And how much specialized protective clothing can be provided for healthcare teams? Even at the global level these are major challenges for advanced countries. In previous outbreaks of deadly viruses since 2003, the world responded very rapidly by drawing on earlier experience. In the present case too, China’s rapid action allowed the coronavirus genome to be identified quickly and its findings to be made available to countries around the world for research. Countries acted rapidly to impose restrictions, and yet the virus continued to spread. If the trajectory then underway continued, it was even possible that in less than twelve months half the world might be infected. It was also possible that, in future years, even after a vaccine was discovered, the world might have to prepare for coronavirus to remain endemic alongside colds and influenza during the colder seasons. Everything I have written to this point has been a painful attempt to offer a realistic view of the conditions ahead. But the purpose of the piece is not to stop amid all the fears and dark points before us. We human beings have always assessed risk not through logical analysis alone but through our instincts and emotions. An aeroplane crash, for example, is always a catastrophe that receives extensive news coverage and provokes strong emotions in many of us because of the absolute number of deaths, yet the probability of its occurring is extremely small. Tens of thousands of flights take place every day across the world, producing only a handful of aviation accidents each year. Even so, our evaluation of flying is shaped not by probabilities but by the emotions created in us by news reports and images of previous crashes. The present condition of coronavirus reporting around the world is as if every day we were hearing reports of dozens of fatal aeroplane crashes while also facing the possibility of being sent on a flight every day. Part of our profound fear of coronavirus is shared by people everywhere in the world, and this unconscious evaluation of risk forms part of that collective fear. Continued — Part Five of “Coronavirus: Facts We Need to Know and What We Can Do” The truth is that, wherever we are in the world, there is still much we do not know about coronavirus. Its precise long-term fatality rate, the possibility of reinfection, possible mutation of the virus, and the degree of progress toward developing a vaccine remain unclear. With influenza, for example, we have either had it ourselves and recovered—sometimes repeatedly during our lives—or we have watched other people contract it and survive. In general, human beings cope far better with familiar and controlled risks. Uncontrolled risks throw us into absolute chaos, whereas controlled risks allow us to stand at the boundary between order and chaos. Another point is that part of our mind naturally fears the unknown more than the known. We therefore focus more intensely upon unknown risks and magnify their dangers. At present the entire world’s attention is focused on coronavirus because it has suddenly emerged from the unknown as a new threat. Over time, as knowledge increases, this focus will diminish and we will learn how to live with the dangers and risks of the disease, as human beings have done for millennia. Accepting danger and suffering has always been the first great step toward overcoming them, and this new danger is not exempt from that general rule. Even if everything described above comes to pass, it would mean that we must prepare ourselves to live alongside a virus that has arrived and may remain among us, like influenza. The difference, at the individual level, is that where previously our chance of being overcome by influenza may have been around one tenth of one per cent, this time the chance may be one to three per cent for the new virus. Yet each individual’s chance of surviving remains above 97 per cent, although it decreases with advancing age and chronic illness; even under the figures being discussed at present, the chance of recovery in people over eighty remains above eighty-five per cent. What defeats us psychologically is our focus upon the small individual probability that, at the social and global level, is reported every day under the name of death—and we may soon see these numbers become far larger and more frightening. This does not mean that the possibility of hundreds of thousands of deaths ahead is unimportant or unrelated to you and me. It means that, at the individual level, the person whose chance of overcoming the disease is greater than 97 per cent can rise with hope and determination so that at the social level we can also overcome what threatens social life. Moments such as these are a great test for all of us. Sometimes our attention is focused only on winning one game, but in the games of life the wiser strategy is to focus upon the way of acting that allows us to win more games over the longer term. Nothing places a society on the path to long-term victory more securely than standing beside truth and integrity. Truth allows us to understand our circumstances accurately and mobilise our resources effectively. Social administrators may imagine that there is such a thing as a beneficial lie, or truths that should be concealed, but history has repeatedly shown that this approach ends only in disaster. To speak truth in the language of honesty means standing before one’s people, telling them the depth of the crisis ahead, and at the same time assuring them that together we can overcome it. Falsehood and lack of responsibility at the threshold of new crises carry within themselves the seeds of the greatest disasters. Such conduct brings Noah’s flood, because it carries chaos beyond the limits of social control and tears apart the fabric of social solidarity. Continued — Part Six of “Coronavirus: Facts We Need to Know and What We Can Do” The truth is that most of us will probably contract this virus in the coming months, and most of us will survive. Bitter events lie ahead, events that may be difficult even to imagine before they occur, but we must enter this storm prepared and beside one another. In recent days social media have been filled with attacks upon one another: attacks on doctors and nurses, on people who are ill, and even on those who have died from the disease. Several hospitals have been attacked, and improvised instructions for preventing infection can be found everywhere. There may be many faults across different parts of our society, but at such a moment the way to confront these deficiencies and weaknesses is not to destroy the few social structures that remain. The strength we give one another in this struggle will give us the capacity to overcome the threat before us. A large part of the country’s administrative structure is made up of people like you and me. Like many of you, I have wished that greater wisdom and foresight governed the administration of our Iran, but I see no alternative to beginning the creation of that wisdom and foresight with each one of us. Spreading social anxiety through false information, whatever the motive, seeing ourselves as separate from other people and their fate in such circumstances, and attacking one another are neither wise nor far-sighted. These behaviours begin with us, and at a larger level in the administration of society they manifest themselves as a complete crisis of management. At this moment none of us knows a way out of this crisis. A terrible social event is approaching us step by step. No piece of writing anywhere can provide an operational instruction manual for escaping the complexity of the present circumstances. Yet there is a general principle: “When circumstances are complex and filled with chaos and danger, asking ‘What should we do right now?’ is the wrong question. The right question is: what are we doing right now that we know in our hearts is wrong, and yet continue to do? We must find it and stop it, because in complex circumstances every step we refrain from taking toward greater complexity and chaos is itself a step toward a solution.” At the individual level, the question each of us must answer is this: what are we doing in these circumstances that we know in our hearts is wrong, and that does nothing to loosen the knots of the social crisis? We must stop doing it. If all of us do so, truth itself will show us the way out. Dr Aydin Areta February 2020