FROM NEWSWEEK | APRIL 21, 2020
At many of his press conferences, Governor Andrew Cuomo of New York—who has rightly emerged as a prominent and cogent voice of leadership—reflects, as he announces the grim daily death toll that of all the challenges of COVID-19, there is nothing worse than death. Such sentiments are understandable and may be necessary just now for a public official. But, in truth, there are things much worse than death. There always have been. Death is as much a part of the human condition as birth, love, sex, hunger, community, war, family. It is a natural part of the cycle of life, however, challenging that is for most of us.
The modern world has been erected on an edifice of death denial. In 1973, the psychologist Ernest Becker penned The Denial of Death, a sweeping, not always easy to read, jargon-filled tome about the modern world and its complicated relationship to mortality. It touched a chord and won the Pulitzer Prize, but it is little read now. If you can wade through turgid passages on Freud and obscure philosophers, you will find much that is relevant for today, and nothing more than the central message: that one of the bulwarks of Western civilization, in particular, is the fraught relationship to death, our paralyzing fear of it and the immense efforts we have taken to delay it and make it as unseen as possible.
That has had undeniable benefits. The thrust of modern medicine and science has been to extend life far beyond what pertained for most of human history. If you were born in 1800 in Europe, your life expectancy at birth was between 30 and 40, though you fared better if you made it out of infancy. If you were born in the United States in 1850, you could expect to live for 40 years, though into your late 50s if you made to double-digits. By the 1920s, life expectancy at birth was 60. The rest of the world didn't catch up to that until the middle of the 20th century. In China in 1950, your life expectancy at birth was about the same as in the United States a century earlier; by 1980, it was the mid-60s. The rest of the world has followed suit.
Advances in medicine, such as antibiotics, certainly helped, but more than anything, it was public hygiene in the form of freshwater, elimination of raw sewage, and more aggressive public health measures that were the key. After much of human history was punctuated by waves of disease and epidemic ranging from cholera to polio to measles, the past fifty years of human history has been the most disease-free in all of human history. That has helped support a population boom globally, but it has now made us—from China to Chile, from Hong Kong to New York—less resilient in the face of death and disease and less equipped than at any point in human history to confront the fatality of disease with any degree of perspective, let alone equanimity. We used to be intimately familiar with death; today we are barely on speaking terms.
It is common now to harken back to the last great global pandemic, the Spanish Flu of 1918. That caused approximately 50 million deaths out of a global population of 1.5 billion, nearly 700,000 in the United States on a population of 100 million. That disease was indiscriminate in which age cohorts it hit hardest, with the very young, those 20-40, and those over 65 equally impacted. The equivalent mortality today would more than 2.5 million deaths in the United States across most age groups. As of this writing, COVID-19 has cause 40,000 deaths in the U.S. and that figure will rise, but nowhere near the 2.5 million of 1918-1919.
And yet, when the story of those days is written, and indeed when the story of those days was written in real-time, in newspapers and the media of the day, the flu was one issue among many, ranging from the end of World War I, to the gatherings in Paris at the end of 1918-1919 to decide the shape of the post-war world. President Wilson himself fell ill with the flu in the spring of 1919 at the Paris Peace Conference, but not much fuss was made. And while parts of life in multiple cities were shuttered, and the death toll grim, everything did not halt in the face of it. Why? Because with the horrors of the war fresh in mind, and with centuries of sense memory of plagues and diseases, the perils of the flu, deadly though they were, were not sufficient to derail the rest of life. Societies everywhere had a high death tolerance, for better and for worse. That made them more resilient in the face of death, and more indifferent to needless suffering.
Today, our death tolerance is low, and we are anything but indifferent to death that we believe we can prevent and avoid. That "we" is no longer just the developed world. It is increasingly in most of the world. That is remarkable—how quickly every corner of the globe has come to value and treasure every life and how every government believes that it must stand for the sanctity of life in order to have legitimacy. China is only 50 years removed from the brutal depredations of Mao that cost tens of millions of lives, and now the Communist Part urgently shuts down economic activity and quarantines cities to preserve life. The contrast there is more striking than in Europe and the United States, which have structured government and society with an explicit determination to keep more of us alive for as long as possible. Hence why after decades of vaccinations and advances in health care, child mortality is lower than it has ever been in human history; lifespans are longer than they have ever been; and other than cancer and heart disease, more people live a healthy life until their late 70s and early 80s than any would have imagined possible until very recently.
The flip side of these changes in how long and well we live is that we are everywhere less able to grapple with death, especially from a new pathogen that catches the world by surprise. The inelasticity of healthcare systems in almost every country is a symptom of the fact that we have, literally, been unprepared for unexpected waves of disease. It's been so long since most societies have faced a lethal pandemic that most of the public health responses are theoretical drills. East Asia, which dealt with the SARS scare in 2003, has been able to marshal resources more quickly—whether testing, tracing, or distancing—precisely because they have most recently confronted that threat. The United States, which had reams of careful planning that were ignored, found that confronting an actual lethal pandemic was beyond the ability of prior planning—much the way an army that has only been training for decades always finds itself inadequate to the task of actual combat.
Yet, the shut-downs and the fear are signs of a greater malady than the disease per se. They are indications of societies that have forgotten (if they ever really knew) that death comes for everyone, and that while preventing suffering that can be ameliorated and providing as many of us with longer fuller lives are powerful signs of progress, treating the death as the ultimate tragedy serves none of us. The challenge of how to manage a sudden surge of disease so that it doesn't overwhelm the brittle health-care system is not the same as the challenge of how we live with death.
Those who attempt now to point out that car accidents kill tens of thousands, as does cancer and opioids and a slew of other things, are routinely lambasted for speaking of trade-offs and not valuing life. And indeed, they sometimes seem to sound that way. But ridiculing those who raise those comparisons does none of us much good in trying, individually and collectively, to grapple with the wrenching question of how much risk of death is worth living for. At some point, each individual and all of us collectively have to confront what the eminent former dean of the Kennedy School Joseph Nye once observed, namely that perfect security only exists in a supermax prison and the grave and we don't want to live in either place. He used to make that point in the context of nuclear war and the threat of global Armageddon, but it is even more relevant now. There is no life without death, and there is no scenario in the arc of COVID-19 where we will be perfectly safe from death.
Right now, the denial of that death, and the fear of it, is at an apex. But even as the acute fear fades in the coming months, we will be left rudderless unless we begin to have a more mature conversation about death. The native cultures that preceded the modern world, the tribes of America that were defeated and nearly obliterated to make way for the experiment of the United States, did not excel at innovation as we understand it today, and ultimately lost to waves of disease and privation. But they did treat death as a natural stage of life. Just before Becker published the Denial of Death, the late great Chief Dan George of the Tsleil-Waututh Nation starred with Dustin Hoffman in the blockbuster film Little Big Man. George was nominated for an Academy Award, and his signature line in the film was when he woke up one morning, turned to Hoffman, and said, "Today is a good day to die."
That sentiment is alien in our culture now. Today is never a good day to die. And most of us would prefer our death to be as late in the game as possible. That's fair enough, but faced with a disease that we cannot control and whose arc remains at best unclear, today is, at the very least, a good day to step back and think about something that most us prefer to think of not at all. That won't cure the disease, but it may make us more resilient in the face of it. We are going to need that resilience more than ever in the days to come.