In 1947, Albert Camus published The Plague—La Peste in the original French—a novel about a year-long outbreak of plague in the city of Oran on Algeria’s Mediterranean coast. Born in 1913 to parents of French descent in Algeria, Camus completed extensive studies in philosophy, and was involved in theater, journalism and activism on the anti-colonialist left. Eventually, he moved to France where he wrote The Plague while living in the Alps for his health (he suffered from tuberculosis) and in Paris where he contributed to the underground journalism of the French resistance during the Second World War. Activist, journalist, author, playwright and philosopher, Camus developed critical dialogues with Marxism and existentialism, and produced a body of work that resonates with pacifism, moral dignity and anarchism. He became a prominent intellectual, and in 1957 was awarded the Nobel Prize for literature. Sadly, three years later he died in a car accident at the age of 46. He was a sensitive and controversial writer who knew disease, suffering, oppression and resistance first hand. He knew Oran well, having lived there for a while, and he studied historical outbreaks of infectious disease.
The disease, quarantine and hardship in Camus’ fictional plague are only broadly similar to what we face in the COVID-19 pandemic. For example, Camus confined the outbreak to Oran, which officials isolated so completely that the city closed in around its inhabitants to become a circumscribed world of pestilence and public health measures. However, although no two outbreaks of contagion are exactly alike—not even fictional ones—every major outbreak threatens a way of life, portending a new normal.
Disease is not the only destructive force that constitutes such a threat. In fact, The Plague has been read as an allegorical account of life in Paris under German occupation. In our own time, 9/11 and the global war on terror (beginning in 2001), the worldwide economic meltdown and recession (beginning in 2007-08), and now the COVID-19 pandemic and its effects have been shocks sufficiently destructive to threaten familiar ways of life for many millions of people. Fundamentally, The Plague explores philosophical issues that arise from the confrontation with widespread and unrelenting forces of destruction which Camus believes are manifestations of an ineradicable indifference lurking at the heart of the world.
Human history is scarred with hundreds of millions of deaths from pestilence. Although the twenty-first century has formidable weapons with which to fight infectious disease, there remain serious scientific challenges, evident, for example, in the fight against the virus that causes acquired immunodeficiency syndrome (AIDS). Although there are effective treatments for AIDS, after decades of research and more than 30 million deaths, we have been unable to defeat the human immunodeficiency virus (HIV) that causes AIDS. HIV infects nearly 40 million people worldwide.
In addition to the continuing and stubborn resistance of viruses to science, there are also new risks. Worldwide development continues to encroach on the natural environment, where there are an estimated 1.67 million unknown viruses in animals, many with the potential to spread from the natural world to humans, often via the rapidly increasing global livestock population. Dr. Anthony Fauci, the leading U.S. government infectious disease expert, who is reluctantly given COVID-19 podium time by the Trump administration, said in a CBS News interview nearly 2 years ago: “I always say … nature is potentially the worst bioterrorist.” Additionally, modern transportation connects billions of people across oceans and continents, leaving each of us mere days from a distant threat to which an effective response might take months or years. Indeed, contact with birds, possibly in the US, and unprecedented mass transportation during the First World War account for the origin and transmission of the 1918 influenza virus which infected a third of the world’s population and killed perhaps fifty-million people in three waves of attack.
Currently, we are plagued by a corona (CO) virus (V). Such viruses are commonly identified by their “corona,” or crown-like surfaces as seen under the microscope, and are the causes of illnesses that range from the common cold to severe acute respiratory syndrome (SARS). In 2003, the first SARS-CoV outbreak began in China and infected 8,098 people worldwide, killing 774. Now there is a “novel”—that is a new or successor—SARS-CoV, appropriately named SARS-CoV-2. The disease caused by SARS-CoV-2 is COVID-19 which gets its name from the corona (CO) virus (VI) disease (D) discovered in late 2019 (-19) in China. Like the 1918 influenza virus, HIV, SARS-CoV, and other viruses, SARS-CoV-2 began in animals, jumped to humans, and spread around the world. It spreads from respiratory system to respiratory system, via surfaces or in the air, through minute droplets from coughs, sneezes, etc., causing the COVID-19 pandemic.
A little like HIV, SARS-CoV-2 exhibits asymptomatic spread, which means people can spread the virus without remarkable symptoms, or spread it well before symptoms appear. In contrast, the variola virus, which causes smallpox, generates notable symptoms very quickly, which means carriers may be readily identified and isolated, mitigating spread. However, with asymptomatic spread, the best defense is to isolate everyone. To deal with HIV, which is largely transmitted through sexual intercourse, everyone who engages in intercourse is encouraged to use a condom, which is a kind of physical distancing accomplished by a rubber membrane. To deal with SARS-CoV-2, which is largely transmitted by respiratory droplets, everyone is encouraged to keep outside of everyone else’s coughing, sneezing, etc., range (estimated to be two meters), and both to wipe down all surfaces where droplets might lurk, and to break pathways to our respiratory systems by washing our hands and not touching our faces. For those who must get within two meters of others, personal protective equipment (PPE) functions a bit like a body-condom to inhibit spread.
Because we are a long way off from widely available, fast and reliable testing being established in tandem with ramped up contact tracing capacity, physical distancing and hygiene remain our best weapons in the fight against the virus. Tests would help identify carriers, and tracing would identify those with whom carriers had been in recent contact, catching and isolating carriers and potential carriers at outbreak points before they became outbreaks, allowing us to relax distancing somewhat.
Because of asymptomatic spread, it is difficult to estimate the number of people with COVID-19. It is even difficult to know with precision the number of deaths, in part because the surges in hospitalisations and deaths in COVID-19 hotspots stretch healthcare systems too thin to be able to confirm all fatalities due to COVID-19. Recent studies in New York City generated good numbers regarding both the number of people with the virus, and the number of deaths, suggesting a death rate of 1.4 percent.
A death rate of 1.4 percent of those infected is relatively low, but, paradoxically, a low rate can increase the overall death toll. Because viruses need hosts to reproduce, a very deadly virus can mitigate its own spread by killing many of its hosts before they can be vehicles of reproduction and widespread transmission. A low death rate combined with asymptomatic spread generates a high transmission rate, which amplifies the total number of deaths in the end. By comparison, the 2014-16 Ebola virus disease outbreak in western Africa had death rates between 28 percent and 67 percent, killing about 11,000 people in 2 years, whereas COVID-19, with a death rate of about 1.4 percent, has killed more than 30 times that number in its first 5 months.
SARS-CoV-2 might spread to a third or more of the world’s population, as did the 1918 influenza virus. With a 2020 global population of 7.78 billion, that could mean about 36 million killed, about 176,000 in Canada alone, and for a variety of reasons these numbers might be conservative. Various epidemiologists see the spread reaching up to 70 percent of the world’s population, which could nearly double the number of dead. Because surges in hospitalisations could overwhelm healthcare, consistent COVID-19 treatment could become difficult in many cases, and hospital access for those with other healthcare needs could be further reduced. Furthermore, other impacts, such as the economic impact of the mitigation measures, are sure to have adverse effects and increase the death toll—for example, global hunger may double as a result of COVID-19.
Leaders regularly assure us “we’re going to get through this together”—words Canadian Prime Minister Justin Trudeau, for one, often repeats. Such encouragement has motivational value, for there is nothing to do but soldier on, and working together is essential if we are to lower the death toll. But encouragement is for the living. Already, nearly 400,000 people have been killed around the world. They are not going “to get through this together.”
Camus certainly has inhabitants of Oran work together in his novel, but well before the end is in sight many lose interest in encouragement. Earlier expectations and hopes that the outbreak would be brief are undermined and replaced by a dismal realism. Eventually, people come to face the truth that the machine of death and hardship in their midst exceeds their control and is not going away anytime soon.
Our own plague has been slow to instil a similar realism. Because of asymptomatic spread and a relatively low death rate, except for front-line health-care workers, COVID-19 can seem quite remote, which generates frustration around the restrictive mitigation measures. After months of lockdown there are pent up personal, social, political and economic pressures to relax measures and return to business-as-usual ahead of the science-based advice of public health officials. Apparently as untutored in pandemics as the rest of us, and subject to the same longings to return to normal, some media outlets amplify the pressures. Trying to reopen parts of their jurisdictions without flinging open the gates of hell, many politicians seem willing to play a grim game of chicken with death tolls. In the resulting confusion, many of us may slip into believing what we hope for. However, because vaccines are very difficult to get right, for another year at least, more likely about three years, and perhaps indefinitely, anywhere in our interconnected world where measures are relaxed, the reality of SARS-CoV-2 will be waiting to undermine hope with its silent, deadly attack.
Smallpox is the only infectious disease in humans that has ever been eradicated. It is not a stealthy (asymptomatic) disease, it kills up to 35 percent of its victims, those who survive smallpox get life-long immunity, it does not exist in animal populations (ready to strike humans again), and the first effective vaccine was identified 158 years before the World Health Organisation (WHO) began the 21-year long journey to eradicate it, which culminated with success in 1980. SARS-CoV-2 is very stealthy and it kills only about 1.4 percent of its victims, contributing to much greater spread, we do not know yet if those who survive infection get life-long immunity, it exists in animal populations and so may strike humans again (perhaps in mutated, that is, newly resistant forms), and there is no vaccine yet, let alone a well-tested, effective and safe vaccine that can be administered to billions of interconnected people, a significant percentage of whom are anti-vaxers (as evidenced by recent surveys both in France where 26 percent of respondents would not vaccinate, and in the US where 20 percent would not, and another 31 percent might not vaccinate against SARS-CoV-2).
When times are very tough we hope for better times. However, hope should not be our main response, because it orients us to a past remembered or a future imagined, and in so doing shifts attention away from what is real. Our plague is real, fighting it is real, and, tragically, losing many battles to it is real. Camus would advise us not to concern ourselves with hope, but rather to steadfastly face COVID-19, not only to combat it as effectively as possible, but also to acknowledge human vulnerability in our confrontation with the world.
These are not esoteric concerns. Some prominent experts are warning that we are letting our hopes be built up around a vaccine that may never be discovered. Supporting major investments in glimmers of a silver bullet, we are relaxing our critical realism and scientific standards, and very possibly wasting resources and time. “Hope … can create false expectations which lead to disaster,” warns veteran expert Dr. William Haseltine, and there are similar concerns regarding treatments such as remdesivir. Eventually, we must come to face the truth that the stealth machine of death and hardship in our midst is not going away anytime soon.
COVID-19 reconnects us with our vulnerability in the face of a world that exceeds us. We have not given ourselves conscious life or the world, so that with respect to life alone, at our best we are keepers of it, but in the end even our own lives are not ours. It is by natural processes that originated millions of years ago that forces of nature generate and maintain life, on the one hand, and reclaim it, on the other hand. Nevertheless, we soldier on for our proverbial fourscore years, often convinced by illusions that the world is what we want it to be. But the world does not heed our desires. In many respects, it is fundamentally indifferent to us, as are so many aspects of war, economic collapse, and infectious disease. From time to time, we must suffer the merciless truth of reality’s indifference, as we did beginning in both 2001 and 2007-08, and as we are doing today. To undergo the indifference of the world is to suffer it. Suffering is something we experience often enough in our personal lives, for instance on the downside of cycles of pleasure and pain, love and loss, success and failure, and life and death.
Like Camus’ plague, the COVID-19 pandemic must be undergone. Nearly 400,000 lives have already been ground into oblivion by it, not to mention the swaths of mourning, illness, hardship and frustration. Furthermore, not only does COVID-19 have at least another year to go, there will be other catastrophes down the road. Though we believe the world suits our aspirations, or that we may so order it, the truth is that it will ever exceed such conceit. The sun will not set on the real possibility of widespread and unrelenting forces of destruction.
But, Camus was no melancholic.
Acknowledging the deep indifference lurking in the world is not cause for despair. If we steadfastly face and acknowledge it even as we battle against its manifestations, we realize that it is precisely our confrontation with reality that grounds our existence, something we must embrace if our life-journeys are to be deep and real rather than superficial and illusory.
Day after day, The Plague’s main character, Dr. Rieux, diagnoses plague victims, isolates them from the population, ministers to them with ineffective treatments, and watches them suffer and die. Facing the reality of the plague, he struggles on, even though he must fail what seems to be an uncountable number of times, like the mythical Sisyphus who had to roll a boulder up a hill every day only to have it roll back down each evening. In his influential 1942 essay The Myth of Sisyphus, Camus argued that we must both see ourselves as Sisyphus, and “imagine Sisyphus happy.”
Dr. Rieux advises us not to focus on the hope of overcoming the plague, but rather to steadfastly face its reality. For him, the plague is a “never ending defeat,” but one he embraces. When asked “Who taught you all this, doctor,” he replies: “Suffering.” Having undergone a great deal, Dr. Rieux knows that the world exceeds us—it is indifferent to our aspirations. To hope it will be otherwise is to fail to understand reality. Understanding that the threats are endless, one accepts endless struggle, embraces the human condition, and lives fully.
There will always be threats. Looking a little ahead, the urgently needed international response to the ever-growing climate crisis is being kicked down the road, even mainstream institutions have recognised that decades of rising inequality—exacerbated by the pandemic—are bad for everyone, “world leaders have allowed the international political infrastructure for managing [crises] to erode,” threatening international security, not to mention the needed global pandemic response… and on it goes.
Let us put our shoulders to the boulders, and smile.
John Duncan is director of the Ethics, Society and Law program at Trinity College, and academic director of the Ideas for the World program at Victoria College, in the University of Toronto. Follow him on Twitter @John__Duncan.