Sanjay Gupta - World War C: Lessons from the Covid-19 Pandemic and How to Prepare for the Next One

New York Times bestselling author of Keep Sharp

Sanjay Gupta, M.D.

World War C

Lessons from the Covid-19 Pandemic and How to Prepare for the Next One

To the soldiers of COVID -19, from all the doctors, scientists, and health care workers, to the survivors and victims young and old.

To the children who will go bravely forward and carry these important lessons to the next generation.

And to the collective breath of the worlds inhabitants and the nature in which we coexist on this planet and persevere in our survival.

Ingenuity, knowledge, and organization alter but cannot cancel humanitys vulnerability to invasion by parasitic forms of life. Infectious disease which antedated the emergence of humankind will last as long as humanity itself, and will surely remain, as it has been hitherto, one of the fundamental parameters and determinants of human history.

William H. McNeill, Plagues and Peoples (1976)

The single biggest threat to mans continued dominance on this planet is the virus.

Nobel Prizewinning biologist Joshua Lederberg (1958)

I was drinking wine with, of all people, Francis Ford Coppola while enjoying the beautiful coast of this Central American paradise hours before wed ring in 2020. We were there as part of a climate change charity and had spent the day touring the surrounding coral reefs. It was a perfect day, and I remember feeling very much at peace. I distinctly recall Coppola asking me about a potential new virus that had been detected in the Peoples Republic of China. Earlier that day we had both read reports buried in the back of the newspaper about an outbreak of respiratory illness in the central city of Wuhan. Some were already comparing it to the 20022003 severe acute respiratory syndrome (SARS) epidemic. The local health authority there had released a concerning epidemiological alert, stating that twenty-seven people had fallen ill with a strain of viral pneumonia, and seven were in serious condition. Fifty-nine more suspected cases with fever and dry cough were transferred to a designated hospital. While details from the Chinese government were vague, scientists and others were sounding louder and more detailed alarms. Hong Kong scientist Dr. Li-Meng Yan said a scientist at Chinas Center(s) for Disease Control and Prevention, with firsthand knowledge of the cases, was very worried, confidentially telling her the illness might already be spreading human-to-human. It was hard to know what to believe.

I remember everything about the moment sitting with the legendary filmmakerthe Godfather himself. I can still see both of his hands on the glass, filled with rich red wine. I can hear the clusters of family members romping on the beach and the kids giggling in the water. If I close my eyes, I can still smell the fragrant oceanfront air, rife with the tropics and the salt. Fact is, we were happy, and we were content. And, we had no idea how quickly that was all going to change.

We had no way of predicting that within just a few months, millions of people around the world would become infected, overwhelming entire health care systems. Or that many people would die alone, isolated from their family in their last moments due to the remarkable contagiousness of the virus. I could not imagine the nightmares I would continue to have of those particular scenes more than a year later. My sleeping mind filled with patients lying prone on their bellies while brave nurses in full protective moon suits held screens in front of their faces so they could try for that final good-bye.

Borders would close. Schools and colleges would shut their doors. Students would be abruptly sent home. I would spend more time with my wife and three daughters in one year than in the previous ten. Parents would wring their hands in the sudden messy juggle of overseeing their kids distance learning and holding on to their jobsif they were lucky enough to keep them. Stadiums, theaters, museums, playhouses, and concert halls would become desolate as professional sports and arts would suddenly cease. Businesses halted, some forever, and global economies shuddered. Large gatherings would become a distant memory. Soap, wipes, hand sanitizer, and, inexplicably, toilet paper would vanish from store shelves.

Personal protective equipment (PPE) would become as precious as gold, prompting some hospital heads to use their personal credit cards to buy whatever they could, no matter the price. People would hastily write their wills, sew masks from cloth, and draw down their savings accounts. Some would tap retirement accounts.

Grandparents would soon become the loneliest members of our whole society.

Peaceful protests juxtaposed with historic civil unrest would take to the streets as the pandemic yanked the veil off deeply rooted racial injustices. Political divides would widen. Individuals whod never contemplated buying a gun now had second thoughts. Dangerous conspiracy theories would spread as fast as the virus itself, challenging the veracity of science and the integrity of scientists. Some of those scientists would receive credible death threats, and would be forced to live with around-the-clock protection.

As dark as it was, there were also stunning bursts of light. The race for a cure would destroy academic silos. Business rivals in pharma would suddenly collaborate to develop vaccines. Public health experts, too often sidelined, would be in unprecedented high demand and quickly thrust to the front lines. Health workers everywhere would leave their families every day to be the only family of the dying, often risking their lives to do so. I still get goose bumps when I reflect on their sacrifice.

No, we didnt know the pandemic of our lifetime was already forming and gaining strength a world away as Coppola and I enjoyed that pleasant, peaceful New Years Eve. We joked that the story unfolding might be something Coppola could put his own spin on, like some modern-era version of Apocalypse Now. But neither of us believed anything like that would really happen.

In the beginning, you just never know with these things, I remember telling him somewhat nonchalantly at the time.

We also talked about another movie that might have foretold the year we were about to endure. In 2011 I had a small role playing myself in the blockbuster thriller Contagion. (Thats the one where Gwyneth Paltrows character brings a new pathogen home to Minnesota from Hong Kong, has a grand mal seizure in the kitchen, and ends up dying horrifically in the hospital.) I recently revisited the script of my scene with the fictional head of the CDC, Dr. Ellis Cheever (played by the great Laurence Fishburne), and was struck at how prophetic the filmmakers really were.

Me: There are stories circulating on the Internet that in India and elsewhere the drug Ribavirin has been shown to be effective against this virus. Yet the Department of Homeland Security is telling the CDC not to make any announcements until stockpiles of the drug can be secured.

Dr. Ellis Cheever: Well, Dr. Gupta, there continue to be evaluations of several drugs. Ribavirin is among them. But right now, our best defense has been social distancing. No handshaking, staying home when youre sick, washing your hands frequently.

Sound familiar? The buzz about hydroxychloroquine early on during the pandemicand the politics swirling around its messagingeerily parallels the movies storyline. And Dr. Cheevers remarks about social distancing, handshaking, staying at home, and washing hands became a part of the worlds daily dialogue. It was as if the writers had some access to an oracle, but the truth is it was a deep-rooted knowledge of science. Dr. Cheevers character even mentioned how difficult it was to know the actual death count, as well as the trouble with having fifty different states which means there are fifty different health departments followed by fifty different protocols. The night before filming began, the screenwriter, Scott Z. Burns, and director Steven Soderbergh had dinner with me to talk about their sci-fi movie, which they said was based on existing public health models readily available all over the world.