One of the most common questions asked of health experts about the new coronavirus is some variation of the same thing: How worried should I be?
It’s a complicated question for two reasons.
Why it’s so complicated
First, while global knowledge of Covid-19, the disease caused by the new coronavirus, is growing every day, much remains unknown. Many cases are thought to be mild or asymptomatic, for example, making it hard to gauge how wide the virus has spread or how deadly it is.
Second, much of the risk comes not from the virus itself but from how it affects the societies it hits.
For most people, the disease is probably not particularly deadly; health officials tend to put it somewhere within range of an unusually severe seasonal flu. Even in a global pandemic, it’s expected to kill fewer people than the flu virus. Data so far suggests that if you catch the coronavirus, you may be likelier to have no symptoms at all than to require hospitalization.
The coronavirus is thought to be much more dangerous for people over age 70 or with existing health conditions such as diabetes. This is also true of the flu.
But because the coronavirus spreads widely and quickly, it can overwhelm local health systems in a way that the flu does not.
This is thought to have driven the unusually high mortality rate in Hubei, the region of China where the coronavirus first spread. Officials, unprepared for the outbreak, were caught without sufficient hospital beds or health care workers, meaning that many people who might have survived with better care did not. In South Korea, where officials were better prepared, the mortality rate has been a fraction of that in Hubei — so far, about that of the flu.
But the disease’s spread, along with measures to contain it, is also bringing disruptions that even the worst flu does not. Economic slowdowns, supply chain disruptions, school closures, public transit restrictions and mandatory work-from-home policies all exact tolls, whether you get sick or not.
Individual risk versus systemic risk
So how worried should you be?
Let me answer with a personal anecdote. In early December, I fell ill with symptoms that just happened to mirror those of a serious Covid-19 infection. I was bedridden for weeks with pneumonia and, for some stretches, had trouble breathing.
It was unpleasant and disruptive. But I was basically fine. A couple of doctor visits and timely prescriptions ensured that the symptoms posed no serious risk.
Family and friends helped pick up the slack on my personal obligations. My colleagues did the same at work.
All told, the net societal, economic and public health impact of my illness was negligible.
But my symptoms were bearable because I’m relatively young and don’t have existing health conditions. Otherwise, they could have required hospitalization or posed a risk of death.
And my illness’s societal toll was negligible because I am just one person. As we’ve seen from the coronavirus’s spread, when a community is hit by thousands or tens of thousands of cases at once, this brings systemic risks that a one-off illness like mine does not.
Consider a scenario in which my relatively mild illness had affected not just me but much of my community.
My local health office might not have been able to see me as quickly or as often. I would have still been fine, if more uncomfortable and more worried.
But my neighbors who are older or who have existing health conditions might have required hospitalization. They would have been at greater risk of dying — particularly if overrun hospitals had to turn some away.
China’s experience also suggests that, in an outbreak, you could have a harder time getting care for health ailments of any sort.
Then there is the social burden. Friends and family who helped pick up the slack for me would have been less able to do so if they were dealing with lots of sick friends at once, or were sick themselves.
Imagine if much of your family and social circle became ill simultaneously. Who would assume your child care or elder care responsibilities? How much would you have to pick up for others? In countries with major outbreaks, the burdens have fallen on nearly everyone, sick or not.
Government measures to limit the coronaviruses’s spread can increase those burdens.
In Italy and Japan, school closures have required parents to stay home from work for weeks at a time. That brings a financial cost for families that need to miss work or hire help, as well as an educational cost for children out of class.
Transit restrictions and other measures bring more hardship, particularly for part-time workers who can’t rely on paid time off. It all adds up.
Economic disruptions can be severe as well. One of my neighbors works for a company that manufactures consumer technology. Another works for a global marketing firm. A couple are doctors.
If our employers were all hit with big staffing shortfalls at the same time, even if that lasted only a month or so, the economic consequences could quickly grow.
If supply chain breakdowns worsen, it could become harder to find products that rely on parts or materials from affected countries — which, in today’s globalized world, could be almost anything.
Maybe the manufacturer has trouble buying parts from its suppliers in Asia. Maybe the marketing firm loses a couple of corporate clients in Italy, as companies there tighten their belts. That can take on a domino effect all its own as global economic supply and demand feed each other’s decline.
A global slowdown, even a brief one, means layoffs at a time when governments will also have less tax revenue to fund social safety nets. At the same time, a pandemic means that virtually everyone could face unusually high health care, child care and elder care burdens.
The inequality problem
Much as the virus’s direct impact on your health depends on your personal details, such as your age, any systemic risk from an outbreak also varies based on your personal context.
If you live someplace with good governance, along with plentiful health care and economic resources, the risk to you is likely to be lower. The state will be better able to absorb any societal and economic burden and, if you fall ill, to ensure you the appropriate care.
As in Italy or Japan, people in wealthier countries may also be able to rely on government-funded assistance.
But if you live someplace where state and society function less effectively, the consequences are likely to be greater — and the burden pushed onto individual families. An economic slowdown might also be more painful and longer lasting.
Part-time workers like restaurant servers or Uber drivers will feel more consequences. Any time off is likely to be unpaid and the financial toll harder to absorb. Many may feel greater pressure to keep working, even if they have an existing condition that makes Covid-19 more dangerous.
People in poorer countries may also be more vulnerable, as Iran’s example shows, if health services are more easily overwhelmed and families are less able to absorb any financial hit.
As is so often the case, people who live in wealthy countries, who are wealthy themselves or who have good protections at work will be much better positioned to ride things out.
For many of them, the systemic risk of a coronavirus outbreak is probably about on par with the health risk I faced with my own illness: unpleasant and disruptive, but probably far from catastrophic.
Maybe it’s easiest, then, to think of this as less of a seismic shift in global circumstances than a deepening of one of our era’s most consequential trends, in which the well-off are cushioned and protected, while the burdens are pushed onto the poorer and the working class.
In other words, a story of inequality older than the novel coronavirus.