When most people think about the future of COVID-19 in the United States, they’re unlikely to think about this: orphanages.

“People don’t remember the world as it was a hundred years ago,” said Yaneer Bar-Yam. “To live in that world, a world where orphans are common, and children dying is common, and the destruction of society is ongoing because of disease, is very hard for people to imagine.”

Bar-Yam is an expert in complex systems who has consulted on everything from how Wall Street can better handle market uncertainty to how the Navy integrates new defense concepts. But his greatest impact may be in the area of epidemic disease. 

With social, political, and economic issues compounding the science of transmission and treatment, epidemics stretch the boundaries of complex systems. Finding the best way to deal with them can be extraordinarily difficult. As Bar-Yam showed in a 2006 paper, a small change in one area—like incremental increases in international travel—can have a huge impact on the course of an epidemic.

In 2013, Bar-Yam played a key role in ending the Ebola epidemic in West Africa. In 2020, he founded EndCoronavirus.org to advocate for the best way to not just live with COVID-19, but to bring the pandemic to a real and definitive end. 

On Tuesday, the scientist and activist spoke with Daily Kos about how the science behind complex systems, and the experiences of dealing with previous diseases, can be brought to bear in ending what is already the worst global pandemic in a century. The answer isn’t so much “It takes a village” as it is treating the pandemic as if it’s made of villages. 

Yaneer Bar-Yam is the president and founder of the New England Complex Systems Institute (NECSI). He’s been affiliated with MIT’s media lab, Harvard University, and is a former professor from Boston University. A specialist in complex systems, Bar-Yam has consulted for the National Security Council, the Federal Reserve Bank, and Congress on topics ranging from stock market crashes to terrorism. He’s written works on topics ranging from evolution to food prices, and has been recognized for regularly producing insightful visualizations of difficult concepts.

In talking about why he is so dedicated to the idea that COVID-19 has to be essentially eliminated rather than accepted as an endemic disease, Bar-Yam was insistent that there’s little understanding of what it means to live with deadly disease as a constant of daily life. 

“This disease has all of the qualities of a disease that becomes more severe over time rather than milder.”

“I lost an uncle to scarlet fever,” said Bar-Yam, “and a grandfather to typhus. That wasn’t that long ago.” The modern expectation is that you can live your life without concern over contagious disease. People don’t worry about getting cholera from a glass of water or think about polio when they jump into the community pool. “What they know is this promise that they see from TV commercials. That you can take a trip, enjoy the beach, and come home—all without worrying that you pick up a virus and die from it.”

During the pandemic, the United States has already slid backward toward that plagued past. At least 1 in 500 children in the United States have lost a caregiver. However, as the daily toll of cases declines, many people—and dozens of editorials and news articles—seem to be advocating that endemic COVID-19 is inevitable and acceptable. What they don’t explain is the consequences.

“One of the pieces of the picture being put forward is that the disease somehow becomes milder,” said Bar-Yam. “They didn’t become milder a hundred years ago. This disease has all of the qualities of a disease that becomes more severe over time rather than milder. We’ve seen that through several generations of variants.”

Another word that rarely appears in discussion of what a future with COVID-19 might look like is disruption. Right now, schools, businesses, and sporting events are being suspended when large numbers of people become ill. Continuing that into the future is asking for systems that are constantly delayed or derailed. The many businesses engaged in “knowledge work” can’t continue that work when someone with critical knowledge can go missing at any moment. And few businesses or schools can long continue when there’s a chance those critical resources are out for an extended period. A big part of the reason that the last century has seen such progress on all fronts is simply that processes can continue without the disruption of disease.

“We have this vision of a well-oiled machine,” said Bar-Yam. “Everyone gets up in the morning and they go to work and they go home, all with the assurance of safety.”

Without that assurance, when sitting next to the wrong person at lunch can mean weeks in the hospital, the machine breaks down.

The idea that endemic COVID-19 will be a kinder, gentler COVID-19 is being sold to the public as part of a vision where the future looks much like it did before the pandemic began; one where everyone can go back to that beach trip dream. But, Bar-Yam notes, that narrative is being “selectively presented” with the science “cherry-picked” to produce a story that’s reassuring. Which is exactly what the world doesn’t need.

“In the context of uncertainty, you really want to act according to things that might hurt you the most rather than the things that might turn out for the best,” said the researcher. “If you’re walking along a cliff that might crumble, you change your course. You don’t continue along the cliff edge saying ‘Well, it might not crumble.’ But that’s exactly what we’re doing.”

If endemic COVID-19 is unacceptable, the alternative is to fight for elimination of the disease. That doesn’t have to be extinction of the SARS-CoV-2 virus. But it does have to be bringing cases of COVID-19 down to rare events in localized areas.

“The entire community has to be involved in the action when you’re talking about a pandemic.”

That localization is key to the solution Bar-Yam is promoting. In 2013, he took his expertise to West Africa, where he discovered that national programs and global organizations like the World Health Organization—while necessary—were insufficient to deal with a fast-moving epidemic. His answer was to step back from treating each infection as if it affected only an individual, and change the unit of both measurement and treatment to communities.

“The entire community has to be involved in the action when you’re talking about a pandemic,” said Bar-Yam. “It’s a shared action. Whether you’re talking about wearing a mask or getting vaccinated, it has to be a shared action.”

State and national governments can provide resources and help in other ways, but that works best only where trust in government institutions is high.

“It works well when everyone’s on board, when everyone’s aligned. Clearly we don’t have that. So if we don’t have that, where is the right place to start?” 

According to Bar-Yam, government is not the place to start. That’s not because government solutions are ineffective. In fact, government institutions are vital, especially when it comes to making vaccines available, conducting research, providing testing materials, or managing things like a database of cases. But that government response can’t be the only response, expressly because it invites “an amplification of conflicts,” especially when those creating the conflict can draw on a history of distrust in government.

“The purpose of those conflicts is to gain attention and to draw attention from the press,” said Bar-Yam. “The idea that we can’t do it—because of this objection, or that disagreement—creates tension. And tension gets much more attention. We’ve heard about Facebook creating conflict, because that’s how they generate more attention. That may be true of Facebook, but it’s true of other media. They generate attention by creating conflict. By making people angry.”

Because the media focuses on the conflict, giving air time to the worst behavior and the most outrageous statements, it obscures the fact that most people are in agreement. That’s true even of people who have been duped by misinformation into resisting vaccination or opposing masks.

“The truth is there’s a lot less opposition than people are being told,” said Bar-Yam. “Aside from a small fringe group of people, everyone wants to be safe. They want their children to be safe. This has been true from the beginning of the pandemic. It’s just that the narrative of conflict gets more attention. It’s a lot less interesting in the news if you say ‘everyone’s on board, let’s do it.’ “

Limiting the response to government, whether federal or state, invites the political conflicts to overwhelm that nearly universal desire to make things safer for individuals and their families. That’s why, in the Ebola epidemic, Bar-Yam pushed beyond the use of individual case management and encouraged communities to be considered as a whole. Rather than trying to backtrack all interactions of individuals, it proved more effective to monitor local communities—whether that meant isolated villages or neighborhoods inside large cities—as a whole.

Dealing with communities in this way allowed for a localized response to treatment, testing, and social distancing measures. It also encouraged enlisting members of the community to work for their community. 

“What we’re learning is that there really needs to be community leadership,” said Bar-Yam. “When the traditional leadership is not serving the community, there are ways for new leaders, leaders who are engaged in the safety of their community, to arise.” When those leaders can focus on their community rather than being part of some larger conflict in society, they are able to achieve things that can’t be done by government, or by those tied to special interests that go beyond protecting the community.

“The door to door process is the traditional process of public health in addressing contagious diseases.”

Earlier in the year when President Joe Biden mentioned going door to door, Republicans immediately launched a fear campaign that Biden was proposing sending Food and Drug Administration (FDA) “storm troopers” into people’s homes to force vaccinations on them. Those statements were then amplified by the conflict-driven media, always anxious to pick up the most over-the-top statements and turn them into attention.

However, the most successful communities in the nation are those where people are going door to door, with local volunteers out there checking on their neighbors and understanding their situations.

“It’s very hard to know what people need, and what they need help with, without engaging with them,” said Bar-Yam. “Do they have other health concerns? Do they have financial needs? Do they know what to do if they get sick, or how to keep their family members from getting sick? The door to door process is the traditional process of public health in addressing contagious diseases.”

Bar-Yam also insisted that one of the places where America had failed throughout the pandemic, and continues to fail, is in not providing safe places for people to go when they are sick. Those who are very ill may get admitted to a hospital—assuming their local hospitals are not already overrun—but those who test positive and have mild to moderate disease are simply sent home. And once they’re home, they spread the disease to other family members, reducing the whole family’s ability to deal with the illness and increasing the chance of a tragedy.

Again, this is an area where disinformation and the media’s desire for conflict has made it extremely difficult to provide an adequate response. Anything that might be done by the federal government is sure to be painted in terms that compare it to “communist China” or “FEMA camps.” 

But someone in the community can provide “Safe spaces. Trusted spaces in the community, away from home, to protect their family. It creates a tremendous need for communities to engage in mutual support.” That support may also include those in the community providing the financial support necessary to maintain these safe spaces. 

If all of this sounds like work … that’s because it is. Eliminating COVID-19 isn’t something that can be done by implementing the right policy. It won’t happen when vaccination passes some magic number. It can’t be done with a wave of a universal masking policy. Eliminating COVID-19 rather than just living with it will take vaccines, and masks, and government policy, and intense activity at the community level, including in—especially in—communities where distrust in government is high.

And if that all sounds like a great deal of effort, here’s the alternative: orphanages.

How to get involved

The Daily Kos community has proven again and again that its capable of managing large campaigns and engaging in community organization in states both sky blue and solid crimson. If you want more information on steps you can take to organize to eliminate COVID-19 in your community, check the resources at EndCoronavirus.org. You can sign up for more information, register as a volunteer, or engage in further discussion on what it means to deal with COVID-19 as a community. You can also read about existing community efforts that have been successful in pushing back COVID-19 in their areas.

Recognizing the abilities of many of Daily Kos readers, Yaneer Bar-Yam also recommends a visit to the World Health Network, not just to check out the available resources but to consider signing up for the upcoming summit on Nov. 3 and leadership training that can help lift a community.

The example of India

Yaneer Bar-Yam on the difference between having “the best medical system” and the best public health care system—and how India turned around their pandemic response while many countries with supposedly more advanced medical systems have not.

YouTube Video