I fretted all weekend, looking for new reports from Cambodia and China about their H5N1 cases. No reports on NCoV turned up either, though Gregory Härtl certainly gave us all an earful today about the misuse of "SARS-like" in describing the novel coronavirus.
When I think about it, these two stories have something in common, even if NCoV has little in common with SARS and H5N1 has even less. The common thread is that they're stories—narratives with beginnings, middles, and ends. The disease itself is what we writers call the McGuffin, the device (like the Maltese Falcon, or the One Ring) that triggers the plot. And the plot is what most of us nonspecialists care about.
So the sudden stutter of H5N1 cases around Phnom Penh in recent weeks got our attention like a burst of machine-gun fire. With a plot clearly under way, we wait for the next burst. How will the good guys respond? Is this a skirmish or a full-blown war? The suspense is agonizing. When an eighth suspected case was reported this morning, I dropped everything to post it. Now I'll fret until the case is confirmed or not. In the meantime, another plot turn: an H5N1 death in Egypt.
The emergence of a family cluster of NCoV cases in London was another alarming plot turn, telling us that the stakes are higher than we thought. And like a writer, I keep thinking about the first outbreak, the nosocomial cases in Jordan last April: surely the solution to the NCoV mystery, as in any good story, must be hidden in its beginning, awaiting a dramatic revelation by some Hercule Poirot of virology.
One way we understand a story is to relate it to others in the genre. The James Bond franchise has been flourishing for half a century, each film and novel drawing on what we know from previous ones. So NCoV seems to make more sense, to be more of a McGuffin, if it's linked to a previously known outbreak like SARS. With H5N1, we seem to have more at stake if we invoke the pandemic of 1918-19. As a story, H1N1 was anticlimactic precisely because we compared it to 1918-19 rather than judging it on its own terms.
A story, whether gritty and realistic or surreal and fantastic, is a kind of anecdotal evidence for the author's view of the world. Better said, a smart author knows what the audience's view of the world is, and writes stories that strengthen that view. That, after all, is what makes popular fiction so popular: cheaters never prosper, the hero gets the girl, the villain gets his comeuppance, and the world is saved.
For people in public health, this demand for a popular storyline must be worse than frustrating. I suspect it's why neglected tropical diseases are neglected: they don't offer a mysterious and dramatic onset, the stakes aren't high (except for the unfortunate people who contract them), and no climactic resolution is anywhere in sight.
The problem is even worse because we like stories with characters we can identify with. For the affluent white nations of the west, that means we see no story in diseases afflicting poor nonwhite people in countries that are not tourist destinations. Dengue barely exists in the North American consciousness because the people who live in the worldwide dengue belt are mostly nonwhite and non-English-speaking. Similarly, cholera afflicts black people in poor countries: not exactly big box-office.
Worse yet, in stories disease is often a consequence of some moral lapse, the punishment of a vengeful god. That means the victims get the blame, and the story carries an implicit racism: Well, what can you expect from those backward people in Haiti or Sierra Leone or Zimbabwe? What kind of ignoramus would chow down on a mysteriously dead chicken? The only way to make such stories palatable to white western readers is to send NGOs (preferably led by whites) to the rescue, and make them the story.
So you could say that the psychology of the well-fed and healthy is a significant problem for the malnourished and ill. As La Rochefoucauld famously said, "Somehow we always find the strength to bear the misfortunes of others." Worse yet, we don't even want to think about those misfortunes unless they will entertain us—that is, tell us that our view of the world is absolutely correct. We don't want to hear that maybe the good guys brought cholera to Haiti (even if they did).
This does not excuse the public health community from its duty to alert and where needed, to alarm. I'm really glad Gregory Härtl came after us with his impatient reminder that NCoV is not "SARS-like." We need more experts to sit down with more media people and aggressively promote sound science and hard facts in their reporting. And unlike vaccination, the media will need endless booster shots to keep them from relapsing.
That also means the experts need to understand their audience at least as well as the media do. It's idle to wish that everyone was intelligent, rational, and well-informed. They're not, and they're not likely to improve much in our lifetime. But that audience is still susceptible to a good story, well told. If the experts can trace the genome of H5N1 or NCoV, surely they can also understand the minds of their fellow-humans well enough to explain such diseases—their causes, cures, and prevention—in the storytelling terms we all understand.