Double Threat

A global health check

According to a Chinese proverb, the best time to plant an oak tree is twenty years ago. In the case of climate change, it was 127 years ago that a Swedish chemist determined that an increase in atmospheric carbon dioxide would lead to an increase in the global mean temperature. Of course, we didn’t plant an oak tree then, nor did we plant one sixty-six years ago when two American scientists asserted that, through the combustion of fossil fuels, we are conducting a “vast geophysical experiment.” Thirty-three years ago, the Intergovernmental Panel on Climate Change predicted a global mean temperature increase of 1 degree Celsius by 2025 and 3 degrees by 2100.

The last time the earth was 3 degrees warmer was three million years ago, when sea levels were seventeen to twenty metres higher and Lucy was teaching herself to walk upright in what is now Ethiopia. True, the IPCC’s First Assessment Report compelled us to plant a series of oak trees in the form of non-binding climate treaties and anemic domestic policies, but those efforts have not made a dent in global emissions, to the point that we now face civilizational collapse.

Meanwhile, experts warned us that we were overdue for a pandemic. In 2003, the coronavirus that causes severe acute respiratory syndrome briefly “shook the world,” according to the World Health Organization. But we largely dodged a bullet because, although lethal, SARS-COV wasn’t easily transmissible, and then, for reasons that are not fully understood, it disappeared. But the risk of another virus didn’t. In 2017, researchers in Mexico maintained that the next pandemic would be caused by an RNA virus and — in order to mitigate zoonotic, or animal-to-human, transmission — urged us to put in place “conservation policies that control the disturbance of natural ecosystems.” Twenty-seven months later, SARS-COV-2 jumped the species barrier. To date, more than 6.8 million people have died.

In other words, although we can sometimes see the future, we’re not very good at avoiding it. Two new books — one by an expert in risk management and risk communication, the other by a hematologist who is also a historian —
underscore this basic truth.

Humanity has faced a lot of catastrophes, William Leiss argues in Canada and Climate Change, but nothing on the scale of climate change. A fellow and past president of the Royal Society of Canada, Leiss wants readers to understand the magnitude and urgency of climate risk and to support government policies to both reduce and manage it. Across eight brisk chapters, he covers a lot of ground, from climate science to climate diplomacy. Earth’s climate system, he reminds us, is dynamic, not static. After all, palm trees grew in the Arctic fifty-five million years ago. But there is no analogue in the geological record, and there is certainly no analogue in human history, to how quickly things have changed and are changing. Indeed, we may be past the point of no return, when tipping-point events or positive feedback loops will lead to more heating regardless of our efforts — such as they are — to reduce emissions. “The clock,” Leiss concludes, “is ticking.”

There is much to admire in Canada and Climate Change. The research is impeccable, the writing accessible, and the tone measured. It clearly identifies the problem, and its proposed solution is spot-on, although deep decarbonization will not be easy. In fact, it will be bloody hard because, as Leiss notes, it will require halving global emissions in every decade between now and 2050 in order to achieve net zero — itself a controversial idea because net zero is not zero.

Leiss reviews a handful of policy options, including geo-engineering, a relatively straightforward technological fix but a governance and risk management horror show. What could possibly go wrong if we were to put mirrors in space or inject aerosols in the stratosphere? Practically everything. Yet we are so far down the highway to climate hell, to paraphrase the secretary general of the United Nations, that not intervening in the climate system may be the greater risk. As someone once said about geo-engineers, “They’re the realists.” But for now, Leiss argues, a safer and saner solution is a $2.5-trillion global decarbonization bond that will make money available to developing countries to build energy networks free of fossil fuels, using instead wind, solar, and, yes, Generation IV nuclear reactors. (Leiss likely won’t win friends in the Green Party of Canada, but the Green Party may be out to lunch on the question of small modular reactors.)

Published in Canadian Essentials — a new series by McGill-Queen’s University Press and the McGill Institute for the Study of Canada that seeks “to illuminate Canadian society and to understand the opportunities and challenges that Canada faces”— Canada and Climate Change is both more and less than its billing. It surveys climate change, climate treaties, and climate solutions — at times really well. But it doesn’t survey Canada. Indeed, just two chapters focus on this neck of the woods, an odd thing for a book with “Canada” in its title. Moreover, the book has an identity problem. Is it a primer for the educated general reader? Is it a treatise for the specialist? Is it an introduction to Canada and climate change for the Canadianist? Or is it all of the above, making it none of the above? The general reader will like the early chapters on climate change and climate science. The specialist will like the later chapters on treaty framing and risk management. And the Canadianist will like the chapters on Canada. Although this country likes to think of itself as a climate boy scout, pledging to reduce its emissions, it’s a self-interested actor, playing hardball both at home and abroad. As Leiss notes, we have yet to meet a single target. In fact, our emissions increased by 21.4 percent from 1990 to 2019.

All risk scenarios, according to Leiss, come with uncertainties, and climate change is no exception. But those uncertainties — in the rate of sea-level rise, for example, or in the length of time before the Amazon is a net source of emissions, rather than a net sink — make action more urgent, not less. Unfortunately, some people use those same uncertainties to urge caution or, worse, to deny climate change altogether. In the name of life, liberty, and the pursuit of lower taxes and fewer regulations, they prefer to take their chances, or to roll the dice in what Leiss aptly calls “the climate casino.”

How do we tell people that the house never loses? Not easily. Just ask Jacalyn Duffin, a member of the Canadian Medical Hall of Fame and the author of COVID-19: A History. One of the recurring themes in her short, sharp, and shrewd book is what she identifies as the “infodemic”: we are drowning in information, some of it correct, some of it incorrect, and too many of us lack the ability to distinguish sound science from loopy nonsense. Spread through social media and amplified by people who ought to know better, from presidents and prime ministers to doctors and even public health officials, COVID misinformation was, and remains, a real and persistent problem.

Also published in Canadian Essentials, COVID-19 began with a phone call from her editor. Initially incredulous — a history of a disease that is still unfolding? — Duffin agreed to sleep on the idea. The more she thought about it, the more it made sense. It may even have been destiny. Her thesis supervisor, Mirko Grmek, had written a history of AIDS in real time. Thirty-plus years later, it was Duffin’s turn to write the real-time history of a new disease.

With verve and skill, Duffin tells a compelling story that is familiar in its big picture and new in its fine details. Doctors reported a mysterious pneumonia in Wuhan, China, in December 2019; scientists quickly identified a novel coronavirus in early January 2020; and the WHO declared a “public health emergency of international concern” a few weeks later — on January 30, to be precise. Then all hell broke loose. Cruise ships were stranded at sea; grocery stores were emptied of flour, rice, and toilet paper; and mass graves were dug on Hart Island in Long Island Sound, New York. Meanwhile, borders were closed, lockdowns were enforced, and learning moved online. Physical distancing, directional arrows, and family bubbles became the new normal. In Canada, some establishments asked their patrons to stand one moose, or two metres, apart; in France, bakeries encouraged their customers to keep two baguettes, or nine croissants, apart; and in Australia, the government told its citizens to stay either one kangaroo or three koalas apart. Clearly, the pandemic had its lighter moments.

Mercifully and in quick succession, vaccines were developed, tested, and approved, and mass vaccination programs were rolled out, although the global disparity between those populations with access and those without was glaring. Then came the highly contagious omicron variant, and “soon everyone knew someone who was sick.” Vaccine mandates led to protests in cities around the world, but nothing matched what happened when truckers pulled into Ottawa, parked their rigs, honked their horns, and refused to leave. Authorities eventually got their act together and cleared the self-declared freedom fighters out of the downtown core, but not before Pierre Poilievre served them coffee and donuts.

Because it was only a few blocks from my house, I checked out the “Freedom Rally” in Fredericton, a much smaller and better-policed affair. One speaker was a well-known anti-vaxxer who, when he’s not denouncing vaccines, urges his online followers in the Semen Retention Army not to masturbate. Another speaker, who identified herself as a teacher, insisted that vaccines cause cancer, as do rapid tests. “I read it on the internet,” she told her cheering supporters. Everyone, or so it seemed to me, wanted to “F*** Trudeau”; a handful of climate deniers protested the carbon price; and a few QAnon types claimed that the world is run by a secret network of Satan-worshipping pedophiles. There was not a single mask, unless you counted mine and those worn by the police, which was hardly surprising because, as Duffin explains, over the course of the pandemic, masks and mask mandates were politicized in really awful ways. Refusing to wear one became a political statement and a personal right. (I remember seeing a bumper sticker that even claimed not wearing a mask was a “First Amendment Charter Right.” As a historian, I wanted to correct their thin grasp of the Charter; as a citizen, I wanted to ask when, exactly, their definition of freedom came to include the right to harm others.) With the speeches over and the streets thinning out, I headed home, at once encouraged that the organizers had attracted such a small crowd and depressed that they had attracted a crowd at all.

In the hands of most any other scholar, a short history of COVID-19 would be a blur, but in the hands of this leading medical historian, it’s a tour de force of smart analysis and clear writing. Among Duffin’s many strengths are her ability to draw on ancient, medieval, early modern, and modern history to deepen our understanding of the present, as well as her ability to weave different themes in and out of her text. Two stand out: scapegoating and the social determinants of health.

The pandemic became an opportunity to point fingers, sometimes at entire countries, sometimes at specific individuals. Scapegoating, Duffin reminds us, occurred in past pandemics, but that doesn’t exculpate the president of the United States for referring to SARS-COV-2 as “the China virus” or to COVID-19 as “the kung flu.” Nor does it excuse the premier of New Brunswick for publicly and effectively naming a Congolese-born doctor as patient zero in a local outbreak, a decision that emboldened trolls and racists to drive him out of the province altogether. At the same time, the pandemic confirmed what researchers already knew: health is socially determined, meaning if the necessary cause of COVID-19 is SARS-COV-2, the sufficient causes are socially determined. Put another way, race, ethnicity, age, gender, income, housing, and food security, among other factors, can and do affect who contracts the disease and the subsequent severity of the illness. For example, women are more likely than men to have long COVID, itself a public health nightmare. According to one report, 65 million people worldwide have post-COVID conditions, and that is a conservative estimate. If some long-haulers have recovered, others have had their lives turned upside down.

Writing contemporary history carries obvious risks. China’s decision to abandon its zero-COVID policy, for instance, means that some of Duffin’s statistics are dated. But that doesn’t make her book dated. If anything, its lessons remain vital. First and foremost, there will be another pandemic. We don’t know when, and we don’t know what the pathogen will be, although avian influenza, specifically the H5N1 strain, is keeping scientists up at night. But we do know that we need to be better prepared.

According to that same Chinese proverb, if the best time to plant an oak tree is twenty years ago, the second-best time is now. To this end, we have a lot of planting to do. We have to address the social determinants of health, repair the social safety net (by bringing in paid sick leave, among other measures), and fix the national shame of long-term care. Finally, Duffin insists, we have to take climate change more seriously, because “caring for our planet is also health care.”