A vaccine reality check: So much hope is riding on a breakthrough, but a vaccine is only the beginning of the end

Our species isn't very good at calculating risk, but even so there's no reason to believe that a serious pandemic wouldn't result in better cooperation with restrictions. I'm speaking anecdotally here, but people ignore social distancing guidelines because they believe that the risk of them getting and dying from the disease is too low to warrant changes to their lifestyle. Humans are selfish creatures and do not act "rationally" (whatever that's supposed to mean). They certainly don't act altruistically unless they 1) have very strong morals or 2) doing so doesn't inconvenience them. Which, in the case of COVID-19, it very much does. Convenience and perception are the measures that should be used to judge compliance rates, not the "severity" of the disease outright (that word has no unified meaning to a population decidedly not comprised of virologists). This is especially true in a country like the United States, where "freedom" is ingrained in our very souls. But everyone knows that death is an awfully bad inconvenience.

Americans do not care that 2,000 people died on 9/11 in New York; they care that every time they board a flight, they could be the ones whose plane is being hijacked, or that they could die whenever they're at the office. Likewise, 25,000 people dying from some "Chinese virus" in New York state has literally zero significance to a potato farmer in rural Idaho. Distance turns news into an abstraction, and any number pressing beyond the three-digit range becomes increasingly difficult for us to conceptualize. "Oh, how unfortunate. I hope they figure it out. Good thing I don't live in Manhattan." Only because a virus can spread to other people does that potato farmer recognize that it has any bearing on her life. Someone contracting the disease in Boise might raise an eyebrow, and 100 dying from it is potentially more concerning. But 10,000 dying in a week will ring massive alarm bells in her and everyone else's head. With distance accounted for, such a figure is well past the "BIG NUMBER" threshold that signifies fear and loathing.

The death rate for COVID-19 in the United States is almost 0% for anyone under the age of 40. Thinking about this from an individualized standpoint, a sickly 25-year old who also has pneumonia will recognize that they'd be seriously putting their life in danger by not quarantining, so they'd go ahead and do it. A healthy 25-year old will comply with the regulations that are convenient for them because they care about their public image, but will ignore the ones that are inconvenient—as far as they're concerned, there is no substantial threat to their life by doing so. A 65-year old might see "5% death rate" for their age group and take it seriously. They also might not; that's not really a big number. Even 30% for 85-year olds is low enough that I can see why they might dismiss it. I have no interest in pedantic arguments about precise numbers (they're subjective), but my point is that people are ignoring the coronavirus because the death rates just aren't that high, not because they don't fear viruses or death in general. If the death rate were substantially higher, and/or the side effects of surviving the disease were more severe, fear would set in.

Imagine that an Ebola outbreak were to occur in the United States, a virus with an average death rate of about 50% (but up to 90%). That's a big enough number to strike fear into any sane person's heart! Perhaps more importantly, Ebola is an absolutely terrifying disease. Here's an excerpt from Richard Preston's The Hot Zone, which I read some years ago:

On the third day after his headache started, he became nauseated, spiked a fever, and began to vomit. His vomiting grew intense and turned into dry heaves. At the same time, he became strangely passive. His face lost all appearance of life and set itself into an expressionless mask, with the eyeballs fixed, paralytic, and staring. The eyelids were slightly droopy, which gave him a peculiar appearance, as if his eyes were popping out of his head and half closed at the same time. The eyeballs themselves seemed almost frozen in their sockets, and they turned bright red. The skin of his face turned yellowish, with a brilliant starlike red speckles. He began to look like a zombie. His appearance frightened the temporary housekeeper. She didn’t understand the transformation in this man. His personality changed. He became sullen, resentful, angry, and his memory seemed to be blown away.

[...]

He is holding an airsickness bag over his mouth. He coughs a deep cough and regurgitates something into the bag. The bag swells up. Perhaps he glances around, and then you see that his lips are smeared with something slippery and red, mixed with black specks, as if he has been chewing coffee grounds. His eyes are the color of rubies, and his face is an expressionless mass of bruises. The red spots, which a few days before had started out as star-like speckles, have expanded and merged into huge, spontaneous purple shadows: his whole head is turning black-and-blue. The muscles of his face droop. The connective tissue in his face is dissolving, and his face appears to hang from the underlying bone, as if the face is detaching itself from the skull. He opens his mouth and gasps into the bag, and the vomiting goes on endlessly. It will not stop, and he keeps bringing up liquid, long after his stomach should have been empty. The airsickness bag fills up to the brim with a substance know as the vomito negro, or the black vomit. The black vomit is not really black; it is a speckled liquid of two colors, black and red, a stew of tarry granules mixed with fresh red arterial blood. It is hemorrhage, and it smells like a slaughterhouse. The black vomit is loaded with virus. It is highly infective, lethally hot, a liquid that would scare the daylights out of a military biohazard specialist. The smell of the vomito negro fills the passenger cabin. The airsickness bag is brimming with black vomit, so Monet closes the bag and rolls up the top. The bag is bulging and softening threatening to leak, and he hands it to a flight attendant.

[...]

He appears to be holding himself rigid, as if any movement would rupture something inside him. His blood is clotting up and his bloodstream is throwing clots, and the clots are lodging everywhere. His liver, kidneys, lungs, hands, feet, and head are becoming jammed with blood clots. In effect, he is having a stroke through the whole body. Clots are accumulating in his intestinal muscles, cutting off the blood supply to his intestines. The intestinal muscles are beginning to die, and the intestines are starting to go slack. He doesn’t seem to be fully aware of pain any longer because the blood clots lodged in his brain are cutting off blood flow. His personality is being wiped away by brain damage. This is called depersonalization, in which the liveliness and details of character seem to vanish. He is becoming an automaton. Tiny spots in his brain are liquefying. The higher functions of consciousness are winking out first, leaving the deeper parts of the brain stem (the primitive rat brain, the lizard brain) still alive and functioning. It could be said that the who of Charles Monet has already died while the what of Charles Monet continues to live.

[...]

He becomes dizzy and utterly weak, and his spine goes limp and nerveless and he loses all sense of balance. The room is turning around and around. He is going into shock. He leans over, head on his knees, and brings up an incredible quantity of blood from his stomach and spills it onto the floor with a gasping groan. He loses consciousness and pitches forward onto the floor. The only sound is a choking in his throat as he continues to vomit while unconscious. Then comes a sound like a bedsheet being torn in half, which is the sound of his bowels opening and venting blood from the anus. The blood is mixed with intestinal lining. He has sloughed his gut. The linings of his intestines have come off and are being expelled along with huge amounts of blood. Monet has crashed and is bleeding out.

There exists no possibility in my mind whatsoever that any human being capable of any level of coherent thought would be able to read about those symptoms in the context of an Ebola pandemic literally happening around them and then continue on to say, "I don't care if I get the disease. I'll be fine." There is no world where they could laugh it off with the words "it's probably a hoax" and not simultaneously feel a cold, invisible grip squeezing their heart, subsuming them in a dark cloud of revulsion and fear that lurks in the back of their mind at all times; the very real threat that they, too, will die in this horrific, disgusting, repulsive way. It's the very embodiment of pestilence, all but riding in on a white horse. No doubt some group of evangelical loonies would begin preaching about the Apocalyptic End Times and the Great Bloodletting to Come (for the bad people, that is), but I have a seriously hard time believing that this would keep up once the actual process of death becomes clear to them. They wouldn't be taken seriously anyway; this country isn't as religious as it pretends to be. There's also a very real possibility that a potentially catastrophic plague on this level would prompt governments to declare martial law and enforce it with military strength. The populace might complain about fascism or liberals or whatever from their homes, but they wouldn't come outside to protest in crowds like they do right now. Self-interest outweighs any fledgling moral quandaries they might have. They don't want to die, and that's the end of the story. I can predict any number of nightmarish, dystopian characteristics and effects of a modern-day plague, but people just ignoring the disease and letting it take its course is definitely not one of them.

Edit: that excerpt from Preston's book actually doesn't seem to include the most frightening part of the Monet case. Good thing I have a copy on-hand. I've added the fourth and most gruesome paragraph for extra emphasis.