You Won’t Enjoy Survival

Trust me. I’ve outlived my own mortality on three separate occasions, and I’m now almost five months out from my maximal “due date.”

So, in the latest Covid 19 news, A. Fauci is saying that hundreds of thousands of Americans might die (https://www.huffpost.com/entry/anthony-fauci-predicts-hundreds-of-thousands-american-coronavirus-deaths_n_5e80c707c5b6256a7a2c7df7), the disease might be airborne (https://www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak), and, according to the Coronavirus dashboard (https://ncov2019.live/); the death rate on Covid ranges from 0.03% (In China)(boy, those numbers don’t seem suspiciously low at all), to Turkey, with a death rate at 18.24%, with an overall death global rate of 4.02%. Which means, if you’re reading this, and a normal, healthy, adult, you have about a 96% chance of survival! Great, right?

Nope. First of all, survival statistics can only give you an idea of the risks involved, but rarely the story behind those statistics and risks — the risk of being struck by lightning is very low, but I imagine you probably stay indoors during thunderstorms. You have a better chance of being killed by a donkey than a shark; you probably avoid both, even if that’s not a conscious decision on your part (which undoubtedly contributes to the mortality rate of both — if coral reef diving and mules were a regular part of life, those numbers would be larger). But I’m not writing all of this to discuss what statistics or probability mean (most of us weren’t paying attention in Statistics 101; I can only imagine the general public is organizing a Mad Max-style raid to get toilet paper). I’m here to discuss what losing 4% of your friends, family, and social circle looks like, and what it will do to you. TLDR version: it sucks, and you’re going to be deeply traumatized.

Let’s talk about Dunbar’s Number for a moment. This is the concept of how many stable relationships a human can comfortably maintain, based on human brain size, and comparable (accurate) projections correlating primate brain size and social circles. Dunbar informally described it as, “the number of people you would not feel embarrassed about joining uninvited for a drink if you happened to bump into them in a bar.” That number, BTW? Estimates range from 100–250, with the most-commonly-used one being 150. To make the math easier, we’ll stick with 150, and a 4% death rate (even though the US death rate is about 1.5% at the moment). That means that the average person will know six people who die. This is where personal experience on Planet Cancer is instructive; the thing about diseases and survival is, it’s far more random than you’d think. Yeah, it could be your grandparents and your aunt with lupus. It could also be your spouse and children. In which case, you’ll be be completely fine and ready to go back to shore up the faltering economy, and not require months of intensive therapy and antidepressants just to leave the house, right? I know from Planet Cancer that Pyrrhic Victories are a thing, and I’ve met any number of survivors who’ve quietly voiced that terrible admission, “I’m not sure I should have lived.” What they’re quietly saying is, of course, “The costs of my survival have so outweighed the benefits, stolen any remaining joy from me, that simply getting out of bed each morning is an exercise in agony.”

Flipping this back to my own situation and perspective; let’s invert the numbers. I have a terminal disease that has a two-year survival rate of 22%. I hit the 24 month mark back in November. I should be ecstatic, right? I’m in the upper 22%. Well, yes, and no. I’ll admit that I’m still pleased to be daisy-side of the dirt, but, the costs- both one-time and ongoing — are enormous, and it’s not like I was magically handed a, “You survived!” golden ticket that grants me serenity. No. When I wake up, I’m terrified that today I’ll get a call from the Warlocks, or I’ll hear from another one of my cancer friends’ family members that they didn’t make it. It’s an inescapable sense of existential terror that I can’t begin to describe. Before this epidemic is over, though I won’t have to; a large percentage of the populace will get a day-pass to the existential hell I’m in. Especially since there are at least two different, documented strains of Covid (and probably more on the way); if you duck this one (or survive it), you don’t get a free pass on infectious disease — you just survived this one. And, when you survive, with just 3–6 people permanently cut from your life, do you really think you’ll be ready to continue at the altar of market worship and continue on? Or will you quietly avoid your favorite coffee place forever, because that friendly barista you used to chat with is no longer there? Will our nation’s overworked medical professionals go about with a renewed sense of purpose and drive? Or will they quietly dread and resent being forced back into the place where policy rules forced them to kill Mrs. Smith by giving her ventilator to Mr. Johnson, because he was, statistically, more likely to survive? The pandemic is terrifying and on-going, but, trust me, the aftershocks of physician burn-out, the diminishing faith in government as a problem-solving tool, the vulnerabilities in our manufacturing and supply chains, are going to completely dwarf our current predicament.

And I’m not writing this to needlessly scare anyone, I’m writing it to prepare us for a long, dark, inevitable fight for survival that we haven’t seen the likes of since the second world war (yeah, be prepared for several really bad years). And I’m doing this because I saw an inkling of the worst Planet Cancer survival coping mechanism ever, the other day: rationalization. This was in regard to a teen in California who died, but whom, the article noted, “had an underlying condition.” Great. He totally deserved to die because of that poor choice of genetics and medical history. Trust me, I know what survivor’s guilt looks like — I’ve lived with it for 18 years — and it starts with that, “Why did they die when I didn’t?” question/rationalization. I went to grad school to figure that one out. There is no answer to that question that will make you less shattered by trauma; so, let me just cut to the chase. Yes, in a survival situation, there are certain factors at play that you can use to your advantage and/or to minimize risk. But, at the end of the day, it’s like who survives the D-Day landings, or who survived 9/11 — it’s simply an enormous, incomprehensible amount of luck. The reason why we have governments and markets and civilization isn’t so that the chief doesn’t have to scrap it out with saber-toothed tigers; it’s so that, collectively, fewer of us suffer from misfortunes. There are only two long-term outcomes I see happening on an individual level: First, after surviving a devastating global catastrophe that experts have been warning about for years (Contagion came out ten years ago, folks), we brush ourselves off, and continue with life as normal, pretending that disaster and death are not constantly looming. Or, we bush ourselves off, look at which disasters are largest and most-imminent (global warming, anyone?), and get to the hard work of mitigating or removing them.

I’d be tempted to quote Churchill’s infamous statement:

Except the stakes are so much higher, now. It’s not just Western civilization being threatened by warfare and aggression; our species’ existence is about to undergo an intense, lengthy battering from both a disease, and a century of really bad industrial decisions, and the buy-in starts at 3–6 people you know; the stakes are about to be dramatically raised. Under those circumstances, a far more humane voice and quotation is indicated:

Batten down the hatches. Don’t leave the house unless it’s a life-and-death situation. Don’t socialize. This month, it’s coronavirus. Look upon it as practice, because next month, it’s an economic crisis. Next year, it’s global warming.

And, a bit of positive news from Planet Cancer, when you’re fighting for your existence, and you must do it perfectly or die; you would be amazed at the depths within yourself you never expected, let alone can call upon.

Written by

Science journalist, cancer survivor, biomedical consultant, the “Wednesday Addams of travel writers.”

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