The Doctor who Helped Defeat Smallpox Explains What’s Coming by Steven Levy

An interesting and useful article on the Vius and its ramifications
Larry Brilliant says he doesn’t have a crystal ball. But 14 years ago, Brilliant, the epidemiologist who helped eradicate smallpox, spoke to a TED audience and described what the next pandemic would look like. At the time, it sounded almost too horrible to take seriously. “A billion people would get sick,” he said. “As many as 165 million people would die. There would be a global recession and depression, and the cost to our economy of $1 to $3 trillion would be far worse for everyone than merely 100 million people dying, because so many more people would lose their jobs and their health care benefits, that the consequences are almost unthinkable.”

 

Now the unthinkable is here, and Brilliant, the Chairman of the board of Ending Pandemics, is sharing expertise with those on the front lines. We are a long way from 100 million deaths due to the novel coronavirus, but it has turned our world upside down. Brilliant is trying not to say “I told you so” too often. But he did tell us so, not only in talks and writings, but as the senior technical advisor for the pandemic horror film Contagion, now a top streaming selection for the homebound. Besides working with the World Health Organization in the effort to end smallpox, Brilliant, who is now 75, has fought flu, polio, and blindness; once led Google’s nonprofit wing, Google.org; co-founded the conferencing system the Well; and has traveled with the Grateful Dead.

We talked by phone on Tuesday. At the time, President Donald Trump’s response to the crisis had started to change from “no worries at all” to finally taking more significant steps to stem the pandemic. Brilliant lives in one of the six Bay Area counties where residents were ordered to shelter in place. When we began the conversation, he’d just gotten off the phone with someone he described as high government official, who asked Brilliant “How the fuck did we get here?” I wanted to hear how we’ll get out of here. The conversation has been edited and condensed.

Steven Levy: I was in the room in 2006 when you gave that TED talk. Your wish was “Help Me Stop Pandemics.” You didn’t get your wish, did you?

Larry Brilliant: No, I didn’t get that wish at all, although the systems that I asked for have certainly been created and are being used. It’s very funny because we did a movie, Contagion—

We’re all watching that movie now.

People say Contagion is prescient. We just saw the science. The whole epidemiological community has been warning everybody for the past 10 or 15 years that it wasn’t a question of whether we were going to have a pandemic like this. It was simply when. It’s really hard to get people to listen. I mean, Trump pushed out the admiral on the National Security Council, who was the only person at that level who’s responsible for pandemic defense. With him went his entire downline of employees and staff and relationships. And then Trump removed the [early warning] funding for countries around the world.

I’ve heard you talk about the significance that this is a “novel” virus.

It doesn’t mean a fictitious virus. It’s not like a novel or a novella.

Too bad.

It means it’s new. That there is no human being in the world that has immunity as a result of having had it before. That means it’s capable of infecting 7.8 billion of our brothers and sisters.

Since it’s novel, we’re still learning about it. Do you believe that if someone gets it and recovers, that person thereafter has immunity?

So I don’t see anything in this virus, even though it’s novel, [that contradicts that]. There are cases where people think that they’ve gotten it again, [but] that’s more likely to be a test failure than it is an actual reinfection. But there’s going to be tens of millions of us or hundreds of millions of us or more who will get this virus before it’s all over, and with large numbers like that, almost anything where you ask “Does this happen?” can happen. That doesn’t mean that it is of public health or epidemiological importance.

Is this the worst outbreak you’ve ever seen?

It’s the most dangerous pandemic in our lifetime.

We are being asked to do things, certainly, that never happened in my lifetime—stay in the house, stay six feet away from other people, don’t go to group gatherings. Are we getting the right advice?

Well, as you reach me, I’m pretending that I’m in a meditation retreat, but I’m actually being semi-quarantined in Marin County. Yes, this is very good advice. But did we get good advice from the president of the United States for the first 12 weeks? No. All we got were lies. Saying it’s fake, by saying this is a Democratic hoax. There are still people today who believe that, to their detriment. Speaking as a public health person, this is the most irresponsible act of an elected official that I’ve ever witnessed in my lifetime. But what you’re hearing now [to self-isolate, close schools, cancel events] is right. Is it going to protect us completely? Is it going to make the world safe forever? No. It’s a great thing because we want to spread out the disease over time.

Flatten the curve.

By slowing it down or flattening it, we’re not going to decrease the total number of cases, we’re going to postpone many cases, until we get a vaccine—which we will, because there’s nothing in the virology that makes me frightened that we won’t get a vaccine in 12 to 18 months. Eventually, we will get to the epidemiologist gold ring.

What’s that?

That means, A, a large enough quantity of us have caught the disease and become immune. And B, we have a vaccine. The combination of A plus B is enough to create herd immunity, which is around 70 or 80 percent.

I hold out hope that we get an antiviral for Covid-19 that is curative, but in addition is prophylactic. It’s certainly unproven and it’s certainly controversial, and certainly a lot of people are not going to agree with me. But I offer as evidence two papers in 2005, one in Nature and one in Science. They both did mathematical modeling with influenza, to see whether saturation with just Tamiflu of an area around a case of influenza could stop the outbreak. And in both cases, it worked. I also offer as evidence the fact that at one point we thought HIV/AIDS was incurable and a death sentence. Then, some wonderful scientists discovered antiviral drugs, and we’ve learned that some of those drugs can be given prior to exposure and prevent the disease. Because of the intense interest in getting [Covid-19] conquered, we will put the scientific clout and money and resources behind finding antivirals that have prophylactic or preventive characteristics that can be used in addition to [vaccines].

When will we be able to leave the house and go back to work?

I have a very good retrospect-oscope, but what’s needed right now as a prospecto-scope. If this were a tennis match, I would say advantage virus right now. But there’s really good news from South Korea—they had less than 100 cases today. China had more cases imported than it had from continuous transmission from Wuhan today. The Chinese model will be very hard for us to follow. We’re not going to be locking people up in their apartments, boarding them up. But the South Korea model is one that we could follow. Unfortunately, it requires doing the proportionate number of tests that they did—they did well over a quarter of a million tests. In fact, by the time South Korea had done 200,000 tests, we had probably done less than 1,000.

Now that we’ve missed the opportunity for early testing, is it too late for testing to make a difference?

Absolutely not. Tests would make a measurable difference. We should be doing a stochastic process random probability sample of the country to find out where the hell the virus really is. Because we don’t know. Maybe Mississippi is reporting no cases because it’s not looking. How would they know? Zimbabwe reports zero cases because they don’t have testing capability, not because they don’t have the virus. We need something that looks like a home pregnancy test, that you can do at home.

If you were the president for one day, what would you say in the daily briefing?

I would begin the press conference by saying “Ladies and gentlemen, let me introduce you to Ron Klain—he was the Ebola czar [under President Barack Obama], and now I’ve called him back and made him COVID czar. Everything will be centralized under one person who has the respect of both the public health community and the political community.” We’re a divided country right now. Right now, Tony Fauci [head of the National Institute of Allergy and Infectious Diseases] is the closest that we come to that.

Are you scared?

I’m in the age group that has a one in seven mortality rate if I get it. If you’re not worried, you’re not paying attention. But I’m not scared. I firmly believe that the steps that we’re taking will extend the time that it takes for the virus to make the rounds. I think that, in turn, will increase the likelihood that we will have a vaccine or we will have a prophylactic antiviral in time to cut off, reduce, or truncate the spread. Everybody needs to remember: This is not a zombie apocalypse. It’s not a mass extinction event.

Should we be wearing masks?

The N95 mask itself is extremely wonderful. The pores in the mask are three microns wide. The virus is one micron wide. So you get people who say, well, it’s not going to work. But you try having three big, huge football players who are rushing for lunch through a door at lunchtime—they’re not going to get through. In the latest data I saw, the mask provided 5x protection. That’s really good. But we have to keep the hospitals going and we have to keep the health professionals able to come to work and be safe. So masks should go where they’re needed the most: in taking care of patients.

How will we know when we’re through this?

The world is not going to begin to look normal until three things have happened. One, we figure out whether the distribution of this virus looks like an iceberg, which is one-seventh above the water, or a pyramid, where we see everything. If we’re only seeing right now one-seventh of the actual disease because we’re not testing enough, and we’re just blind to it, then we’re in a world of hurt. Two, we have a treatment that works, a vaccine or antiviral. And three, maybe most important, we begin to see large numbers of people—in particular nurses, home health care providers, doctors, policemen, firemen, and teachers who have had the disease—are immune, and we have tested them to know that they are not infectious any longer. And we have a system that identifies them, either a concert wristband or a card with their photograph and some kind of a stamp on it. Then we can be comfortable sending our children back to school, because we know the teacher is not infectious.

And instead of saying “No, you can’t visit anybody in nursing home,” we have a group of people who are certified that they work with elderly and vulnerable people, and nurses who can go back into the hospitals and dentists who can open your mouth and look in your mouth and not be giving you the virus. When those three things happen, that’s when normalcy will return.

 

Waste Not Want Not

Glittering Glass 2The phrase “waste not want not,” sounds as though it might have come from the Bible, however it did not. It also sounds like old fashioned New England thrift. My mother being German, definitely learned the concept from her experience. I have found it useful in trying to utilize whatever food I might have left over from any meal. In my book, wasting food is not to be done.

It helps to be prepared. I usually cook enough rice to have plenty for extra meals. This saves me cooking time later.  I am always happy to see some leftovers in my refrigerator. One reason is that they help me to fix meals quickly, another is that they help make it less work to do so. I love to cook, and I also love to write poetry and do many other things. Cooking is fun, but not if I have to neglect the rest of my various duties and activities. I usually make enough food for a meal to create another or part of one from what is left over.

It is also true that by utilizing my leftovers, I save not only time but money. My mother, who grew up in war torn Germany, felt food was very precious. I was made aware of this very early on and it stuck. I often use small amounts of vegetables, for instance, or cheese, bread, rice or pasta and so on to incorporate into what I call a “Never Again,” because I will most likely never have just that combination of ingredients to use.

It is important to make sure to blend flavors appropriately. For instance, I’d never combine a curry with an Italian flavored dish. I would blend anything plain into something spicy or tangy. I don’t generally combine a cheese and pasta dish with something involving a strong fish, however you might. One of my favorite tricks is to add shrimp I’ve baked at 425 for 10 minutes to any leftover rice or pasta, then put in herbs to taste, some sautéed onions and any leftover vegetables I might have.

Try spreading leftover chicken or seafood salad on bread, cover it with cheese, and bake in a toaster or regular oven at 425 degrees for 10 minutes. Add a salad to make a fast, tasty supper meal. There are several rules I follow in my thrifty ways with leftovers: I never combine pasta and rice leftovers; I usually incorporate some chopped, sautéed onions to freshen the flavor; I try to use most leftovers within a week. Have fun, Leftovers present great opportunities to be creative.

What is there to Fear?

As above so below, pink flowers

The acronym for fear is False Evidence Appearing Real. I learned this a few years ago and I think of it sometimes when I am tempted to be afraid of or afraid for what appears dire. Life presents plenty of scenarios that could give us the shivers if we let it. Right now, the bogeyman is the Coronavirus. Please understand, I am not downplaying the importance of avoiding this virus, what I am concerned about is the climate of fear that surrounds something we are told is not more dangerous than a bad cold to most, though it can kill vulnerable people. Unfortunately, so can many germs, easy to encounter at all times. It is also said that using sanitizers is not helpful and might even make you more vulnerable. Soap and water are always effective.

However, in order to maintain your good health you need to take all the measures you have been told to take ever since you were old enough to care for yourself. Number one, of course is to get enough sleep. I can’t emphasize this enough. Do what it takes for you to get to bed for a restful eight or nine hours of slumber. If you have problems sleeping, check out the effective homeopathic non-addictive, no-side-effects aids to sleep. Your local health food store has them, and they are not expensive. Some mild stretching before bed sends me gently off to slumber, as does alternate nostril breathing. Google this for more information. It works well for me. I learned it, then taught it in my yoga classes some years ago. And of course, wash your hands frequently, especially when out in public.

I wish I had known about this breathing technique when I was between eight and ten, or perhaps even earlier when I suffered what might be called Night Terrors. I would lie in my bed quaking with fear about an imagined tragedy I believed would take my parents from me. One of these waking nightmares stemmed from a radio program I heard when I was in the second grade and home from school with a cold. I still remember the room I was in and the radio that told what was probably a tale of some kind, about the building of a tunnel that collapsed and drowned people. If I had called out to my parents, I would have been scolded, so I just coped as best I could. Perhaps this is how I learned to be courageous later in life.

When my children were small there was plenty that I might have feared, however, I had confidence in their behavior and their choices. I continue to do so. As I grow older, much could cause me to be afraid. Any ache or twinge could turn into a crisis if I let it, but I don’t allow myself to tie into that negative thinking. It’s also true that when I face what seems fearful, it dwindles and becomes much less threatening. When I say to myself, “I am safe now in this moment,” I can realize the truth of that and do whatever is necessary to stay that way. Taking sensible precautions is one thing, hiding under the bed is another. Keeping your immune system strong works best to help you avoid catching any germs. Negative thinking is counter-intuitive to that. I refuse to take fear into my heart or into my thoughts.

 

Polishing the Pots

Pots and pans 1In the fifties, when I was a young mother with two small daughters, my friends and I often gathered in one another’s kitchens for visits and chitchat. One day one of my friends looked at me, shook her head and said, “You are so brave, hanging your copper-bottomed pots for all to see without polishing them. Most women wouldn’t dare.” I smiled at her. “It doesn’t seem important to polish them,” I told her. “I’d rather play with my children or read to them.”

Today many mothers do not have that opportunity. Most families these days require two incomes for survival. This has not always been true, and it is also true that some mothers sacrifice the income and make do in order to be with their children while they are young. However, at that time, many young mothers did not work outside of the home, and instead put their diligence into their housekeeping and their children. Their pride was put into their homes and its appearance.

I was happy to be home with my children. My mother was an artist. I had not been raised to work outside the home, or to have a career in the wider world. My ambition was to be a writer, and I pursued my craft any way I could, writing publicity for the various organizations I belonged to, and sending my poetry off to magazines. Housework was not my first concern. I even wrote and sang a humorous song about how the housework could wait until my children grew up. I recall one husband of our acquaintance remarking to the children’s father that he felt I was out of line with my sentiments. Truth be told, I was happy to avoid housework any way I could.

One of the main reasons I disliked it so much was that once I began cleaning, it was difficult for me to stop until I was completely finished. Yet finishing was a goal that often eluded me because I kept thinking of more, I could do to make whatever I was cleaning perfect. One day I ran across a magazine article that suggested limiting a task to twenty minutes at a time. This helped somewhat, and I began to attempt to put this regimen into practice. I still suffer from this condition to a degree. I’m not sure why, and I look upon it as one of my opportunities to be mindful rather than go on automatic and be carried on the tide of my forward motion.

I haven’t polished the bottoms of my pots for many a year. My housekeeping duties have changed considerably, nor do I any longer have little children to mind. I can usually sit down to write whenever I like. I truly cherish this freedom, once so rare. Remembering those happy days I spent with my little ones, I do feel for mothers who  have to work outside the home, and who don’t have the time to spend with their young children that I and many of my generation had. Rather than spend my free moments polishing, I do my best to find the time for fun that brings me joy, whether it’s watching movies with Stephen, taking a walk in the good weather, or simply sitting and allowing myself to relax and listen to music. Polishing the pots for show is the least of my concerns, and I most likely will never hear anyone comment on them again.

 

Something from the Oven

Cooking with heartThere was an advertising phrase that went, “Nothing says loving like something from the oven…” however, I think the advertising agency had it backward. It’s the love in the preparation that does this. The oven only helps, as do the ingredients, preferably as clean and fresh as possible. Love helps us to choose them, as well as to guide the utensils used in the preparation. Furthermore, the focus of the mind is an important ingredient as well. If I am angry or upset when I am preparing food, it could affect the way it tastes as well as the way it is digested. Though I can’t prove it, it’s my belief that thoughts and feelings can be powerful in their effect on food.

A study of this potential would make an interesting experiment for a science project, though it could be difficult to set up. I do really enjoy cooking. Though I’ve never had any courses or training for it and am completely self-taught, I get great praise from those who taste my cooking. I remember one person saying, “This must be Tasha’s kitchen because it smells so good.” Another time, I had prepared a tropical entrée made with bananas with other ingredients, baked inside their skins. When I stopped one guest from cutting into his, he said, “Oh, I thought if you had cooked it, I could eat it.” I laughed and thanked him.

One of the most cherished comfort food desserts is bread pudding. According to the internet, sometime in the 11th or 12th centuries, a frugal cook somewhere in Europe needed to use up their stale bread and began thinking up ways to do it. Perhaps instead the cook needed a dessert and had only stale bread, eggs and milk to go with it. Be that as it may, bread pudding has become a staple food. Once called “Poor Man’s Pudding,” it is said to be served in upscale restaurants as well as homes all over the world. Many of the recipes for it call for some form of fat. My recipe omits this ingredient and I don’t think the calories or the taste of it will be missed. Feel free to experiment, I still do. You can butter the bread first if you wish to include it.

The recipe I have evolved from making it often is simple, and we eat it all the time. You do not have to wait until the bread is stale, though of course that is a good use for any you might have. Preheat the oven to 350. Grease a 1 ½ or 2-quart covered casserole. Put a pan of water the casserole will fit in into in the oven. Begin with 2 cups torn up bread—around 4 to 6 slices. I use a raisin bread and it’s on the small side. Sprinkle on ½ cup sugar and ½ to 1 cup raisins if not using raisin bread. Beat up 2 eggs and 2 cups any kind of milk. Add 1 plus teaspoon vanilla and 1 plus teaspoon cinnamon and beat again. Pour over bread and stir to combine well. Place covered casserole in the oven in the pan prepared with water. Bake 1 hour, remove cover and bake to brown for 15 or so minutes. If you can resist diving into it, the pudding tastes best the next day when flavors have developed.

I have no recollection of having been served bread pudding in my childhood; I have evolved this recipe from following one in a cookbook of recipes based on the Cat Who mystery series by Lillian Jackson Braun, both of which which I highly recommend.

 

Be Your Own Valentine

Heart and BellsWhen I was growing up it was the custom for valentine cards and gifts to be sent unsigned. I believe this was a tradition that dated back many years. The custom of celebrating Valentine’s Day goes back even further, to ancient Rome. It originated in a festival of the time called Lupercalia, after Lupercus, a nature god of the Romans who resembled the Greek god Pan. It also has roots relating to Juno Februata, honoring Goddess Juno. Then, young boys and girls drew lots to see who they would be partnered with for the year which began in March. The Christian church opted to keep the holiday and rename it, calling it after a saint who may or may not have existed.

I remember that one year when I was around the age of twelve, I received a lovely red, heart shaped compact. No one in my household would admit to giving it to me, although I suspected it had been given me by my father. He swore up and down that he hadn’t done it, and at the time I believed him. He had a very convincing way about him and made an excellent actor.  I remember seeing him in at least one locally produced play when I was growing up. He had an affinity for the theater.

When I was in the early grades, paper valentines were placed in a red and white crepe paper decorated box.  Someone was chosen to be postman and distributed the cards to the room full or classmates. There was no talk of partnering, nor of love, per se. Rather it was all about who got the most cards. Later on, I had fun making my own valentines and sending or giving them, and I have done this for many years. Many purchase them. Commercial valentines have been in use since 1800, and Worcester claims to be the originator of early ones, though others have made that claim as well.

My first husband and I met on a day early in February long ago. I wanted to send him a valentine, however, I could nothing but find only a humorous one. Although it was not very nice, it was all I could find so I sent it anyway. Fortunately for the five children we later produced, it didn’t ruin the relationship. Perhaps it was meant to be. The arrows of Cupid, a god of love also known by Greeks as Eros, sometimes do hit the mark. The Greeks have six words that express love: Eros: or sexual passion, Philia: family love or deep friendship, Ludus: or playful love like for children, Agape: or spiritual love/love for everyone, Pragma: or longstanding or enduring love, and Philautia: or love of the self.

The average Westerner saying, “I love…” may be expressing affection, or a preference—I love ice cream, or aptitude–I love to exercise. All these fit our definition of it. And they are all conditional upon our personal choices. Yet spiritual or unconditional love, the most difficult form of love is also the most beneficial for both giver and recipient. This is the love that endures. When I give myself the valentine of unconditional love, I can be much more loving to everyone else. In addition, I do not take issue with any faults, but instead regard with compassion the struggles of the one who is loved and express patience without expectation.

 

Competition Versus Cooperation

chickens.jpgI’ve never been a competitive person. Usually a sense of competition kicks in around the age of four, when a child gains a clear understanding of “me” and “mine.” Even then there is often a desire to share unless the child is surrounded by competitors. When I was growing up competition was the rule and the idea of a game that required cooperation instead was unknown. I did not enjoy the competitive world I grew up in.

Even as a child I disliked competition in sports. One reason was that I wasn’t very agile or well-coordinated and thus most often chosen last for any team. Another was that it made me sad that someone had to lose in order for someone to win. I played board games yet not with a keen desire to win. For instance, Parcheesi which was a popular game when I was young was best won by blocking opponents and rendering them helpless. I never enjoyed doing that. For me, that was like punishing someone or hurting them.

My mother was a fierce competitor. She loved games and was good at them. She played Bridge and Mahjong with her friends. With me she played card games and Chinese checkers, which she played without mercy, making no allowances for youth or inexperience. She played to win, regardless. As a result, I did learn to play a good game of Chinese checkers. Fast forward to my adulthood. I still resisted competition when I could. Unfortunately, my children invariably made me enter the tired Mothers Race at the fourth of July games. in the town where they grew up. I came in last no matter how hard I tried.

My children’s father was very competitive. He encouraged the children while they were still quite young to play on teams and to compete. He even started a girls’ softball league in the town where we lived.  My daughters and then my sons all strove to do well in order to make him happy. He cherished their ribbons and trophies and often coached their various teams to victory. As a loyal mom I used to attend their tennis matches and their and baseball and ice hockey games, cheering along with the other parents and trembling for fear they would lose and be sad.

Regardless whether or not they won, I was glad whenever the games or matches were over. Certainly, my children learned much from their years playing tennis, hockey, and baseball. They had fun and met other children they would not have met otherwise. I am not regretful for them, though I do feel there are other ways to have fun that they might have enjoyed as well. I was too busy keeping up with household and child caring duties to do much about that.

Competition is said to be a good learning experience for children. Today even little ones barely out of toddler years are put on teams to play at various sports. For competitive people that’s good. For those like me, not so much. On the other hand, it is possible to play games in the spirit of cooperation. Team efforts in sports are only one way. There is also a cooperative way to play many games, and that is to play to see how high the score can rise. Scrabble can be played that way, and I know that’s how I would prefer to play it.