By Ng Weng Hoong, March 9, 2020, Monday
Word count: 1,728, minus headline and footnotes

This has the feel of an opening scene from a novel by medical thriller writer Daniel Kalla himself: a gathering of book club members on a chilly Vancouver evening to focus on deadly contagious diseases.

As they await his arrival, the audience of over 100 people inside the Jewish Community Centre on West 41 Avenue is already in lively discussion about the new coronavirus that is starting to spread fear and death across the world. Their anticipation grows for the local-born writer who will speak about his best-selling novel based on the modern-day return of the Black Death. From 1347 to 1351, history’s most devastating pandemic caused the death of between 100 million and 200 million people, or more than a third of Europe’s population at that time.

But “We All Fall Down” is not a new title. Published by Simon & Schuster in March 2019, it has already achieved strong reviews and sales.

Amid the global spread of the little-known COVID-19 disease beyond its birthplace in China’s Hubei province, Kalla’s 10^th novel is suddenly hugely relevant. It imagines the re-emergence of the ancient bubonic plague from its original epicentre in Genoa, Italy to potentially devastate today’s interconnected world. The book lovers are as curious for fresh insights as they are to meet the author in the flesh.

Might COVID-19 present challenges as real and as terrifying as those faced by the people who lived through the Black Death?

It’s too early to tell, Kalla says, this being February 11, barely two months after the outbreak was first reported in Wuhan city. The audience presses on, aware that he’s not just a writer of paperback fiction.

In his day job, Kalla, 53, is a senior frontline medical doctor dealing with emergencies at St Paul’s Hospital in downtown Vancouver. He and his colleagues are among the city’s first line of defence against infectious diseases: he was there when the severe acute respiratory syndrome (SARS) epidemic struck Vancouver and other parts of the world in 2003.

Constructing reality from fiction
Kalla is as engaging a speaker as he is a writer. His answers are down-to-earth intelligent, spiced with the occasional dose of dark humour. As a storyteller, he offers a window to what the global spread of a contagious fatal disease might look like. Most of us have little idea what contagious deadly terror means. The questions flow smoothly, helped by Marsha Lederman, The Globe and Mail’s correspondent who turns on the tap almost as soon as she starts hosting the event.

What motivated him to write about a contagious fatal disease that occurred nearly eight centuries ago? His first book, Pandemic, also a best seller in 2005 that established his story-telling credentials, is also about the emergence and spread of a new killer flu.

“I’m just an upbeat guy”, he says.

When the laughter dies down, the answer that follows is rooted in his observation of people’s responses to three recent epidemics this century. None of them made it to become a pandemic, the status accorded a disease when it meets all the nasty criteria of having a major global impact.

He believes the world would have benefited from a slightly longer bout of SARS in 2003 as it presented a major learning opportunity. But people soon forgot the fear and panic that they had experienced.

Likewise, with the H1N1 flu in North America in 2009 and Ebola in West Africa in 2014, he felt people and governments did not learn as much as they could and should have.

“It’s amazing how much fear we see every time we have an outbreak (of new diseases).”

But it is “equally amazing how quickly you all forget, as soon as the epidemic dies down,” he says.

With these diseases consigned to history, Kalla sets out to write a reminder “what if” horror story that carries the threat of a worst-case outcome.

The book’s cover says it best: “The plague killed millions. Today, it might kill billions.”

The intention isn’t just to entertain, but to educate, he says.

“What if something like this, the same strain came back? How will we deal with it?” he says pointedly to what motivated him to write about the bubonic plague.

“The Black Death is the worst single natural disaster to befall humankind in the history of recorded time. If you put that in perspective, it killed more people per capita than both World War 1 and 2 combined. It was a spectacular phenomenon. It changed everything”.

How much of the book is rooted in reality?

The entire plot is obviously fiction, starting with how the pathogen emerges from the rubbles of a demolished monastery building.

“I try to make it plausible. The explanation may be far-fetched but the science is possible,” he says.

The light talk takes a backseat when the focus turns to COVID-19.

Given the context, any miscommunication might have the public service doctor sounding too alarmist and stoking fear, or too patronising and dismissive of people’s legitimate concerns. He does neither, skilfully navigating the potential minefield.

“While there is legitimate reason to be concerned, it’s too early to panic,” he writes in a follow-up email to this writer on February 15. At the time of the interview, doubts about the potency of the new disease abound as skeptics argue that the common flu alone caused some 80,000 deaths (1) in the US in 2018.

COVID-19 will soon fizzle out, they say. But in the weeks that follow, it becomes clear that the alarm is justified: this new strain of the coronavirus transmits faster, is less detectable, and far more lethal. Worse, scientists may not develop a cure (2) for at least another 18 months.

Kalla says the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) are doing a great job under very trying circumstances. WHO is taking heat for refusing to declare this a global pandemic even as experts say it already was by late February. WHO officials have also been criticized for seemingly being too effusive in their praise of China’s handling of the crisis.

The Global Panic of 2020
With the fiction writer keeping his message mild and tempered, it is left to the experts to deliver the alarmist talk worthy of a Hollywood doomsday movie. These are not members of a survivalist cult, but top government officials, eminent scientists, and reputable analysts.

Two weeks after Kalla’s talk, the mass panic that started in Asia and Europe reaches the United States and Canada.

On February 25, the CDC tells Americans to begin “preparing for significant disruption” (3) to everyday life. A day later, Canada’s health minister, Patty Hajdu (4), tells Canadians to stockpile food and medicines as “things can change quickly.”

By the first week of March, COVID-19 (5) has infected more than 103,000 people and killed over 3,700 people around the world. Mass panic-buying of household goods and medical products sweeps major cities across North America, Europe, Asia, and the Middle East. The world’s stock markets are plunging. There are growing reports (6) of racially-targeted attacks against Asian-looking people in different parts of the world amid fears that they are carrying the virus. Jews (7), scapegoated during the Black Death, are also blamed. Conspiracy theories are flying that the pathogen is manufactured in military laboratories, depending on whom you believe, either by the Chinese or US governments.

Gabriel Leung (8), one of the world’s top experts on coronavirus epidemics, told The Guardian newspaper that between 40% and 60% of the world’s 7.8 billion people could be infected if countries fail to take stringent measures to stop the transmission. This means an infected population of between 3.1 billion and 4.6 billion. The vast majority will survive, but the death count will still be enormous.

Using WHO’s calculation of COVID-19’s fatality rate of 3.4% (9), the disease could kill as many as 150 million people over the next few years. Even the more accepted conservative 2% rate applied on 3.1 billion infected people would yield a death count of over 60 million This puts it in the same class as the Black Death and the Spanish flu of 1918.

The economic damage will be just as catastrophic. In separate papers, analysts at Oxford Economics (10) and PwC Australia (11) forecast the world could lose more than US$1.1 trillion (or over 1.2%) of its 2019 gross domestic product of US$88 trillion. The World Bank (12) is more drastic with a call for an economic contraction of 4.8%, or more than US$4 trillion, in a 2013 paper forecasting the cost of a global flu pandemic. If so, the world economy is headed not for a severe recession, but a depression. The last depression in 1929 accelerated the conditions for conflict in Europe that led to World War Two.

Reality meets fiction

Three months into the COVID-19 crisis, the dark themes from “We All Fall Down” are showing up in real life. The symptoms of a sickly world are increasingly reflected in the questions and comments made by politicians and opinion makers.

Is COVID-19 a bioweapon created by the world’s leading governments? Are we at the threshold of mass bioterrorism? How extensively might it rupture the long supply chains that deliver our food, fuels and medicines, and for how long? Will the economy crash as the spectre of shortages and hyperinflation loom? Will societal collapse follow? Are ethnic conflicts inevitable? Will authoritarianism come to the fore as the democratic process fails to contain the disease? Are quarantine centres a guise for long-term detention centres?

As COVID-19’s spread intensifies, the fabric of our integrated globalised world is starting to tear apart. Borders are being shuttered. Cities and regions are under lockdown. People and goods can no longer move freely. Political tensions rise within and between nations. Millions of people are forced into quarantine, with more to follow. Air travel is curbed. Passengers are trapped on ships. Mass events, sporting competitions, and concerts are cancelled. Offices, shops, schools, and places of worship are closed. Production and economic activities decline. Distrust and xenophobia become the default response for dealing with “outsiders”. Life is completely disrupted and may not return to what it was before.

This has the feel of a Dan Kalla novel, and we are its actors. But unlike “We All Fall Down” that has a clear plot, we have no idea who is narrating the COVID-19 story. And how it will end.

FOOTNOTES

1. September 26, 2018. https://apnews.com/818b5360eb7d472480ebde13da5c72b5
AP: 80,000 people died of flu last winter in US

2. March 3, 2020. https://www.youtube.com/watch?v=zy7id9U7-MI
CDC officials, Fauci grilled in Senate hearing on coronavirus outbreak

3. February 11, 2020. https://www.theguardian.com/world/2020/feb/25/coronavirus-outbreak-severe-disruption-america-cdc-united-states
Coronavirus could cause ‘severe disruption’ in America, CDC says

4. February 26, 2020. https://nationalpost.com/news/world/coronavirus-live-updates-who-covid19-covid-19-italy-china-canada-wuhan-deaths
Stockpile food and meds in case of infection, Canada’s health minister says.

5. March 8, 2020. https://www.bloomberg.com/graphics/2020-wuhan-novel-coronavirus-outbreak

Covid19 data update: Total infections: 103,258. Death: 3,729

6. March 6, 2020. https://time.com/5797836/coronavirus-racism-stereotypes-attacks
As coronavirus spreads, so does xenophobia and anti-Asian racism

7. March 5, 2020. As coronavirus spreads in New York Jewish community, fears rise of antisemitic backlash
https://www.algemeiner.com/2020/03/05/as-coronavirus-spreads-in-new-york-jewish-community-fears-rise-of-antisemitic-backlash

8. February 11, 2020. https://www.theguardian.com/world/2020/feb/11/coronavirus-expert-warns-infection-could-reach-60-of-worlds-population
Coronavirus ‘could infect 60% of global population if unchecked’

9. March 3, 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—3-march-2020
WHO Director-General’s opening remarks at the media briefing on Covid19

10. February 19, 2020. https://www.theguardian.com/world/2020/feb/19/coronavirus-could-cost-global-economy-1tn-in-lost-output
Coronavirus “could cost global economy $1.1trillion in lost income”

11. March 4, 2020. https://twitter.com/jeremythorpe/status/1235265898371362816
PwC Australia: The impact of a #coronavirus pandemic on global economic activity

12. http://siteresources.worldbank.org/EXTNWDR2013/Resources/8258024-1352909193861/8936935-1356011448215/8986901-1380568255405/WDR14_bp_Pandemic_Risk_Jonas.pdf
2013. “Pandemic risk”, by Olga B. Jonas for the World Bank