Society’s immune system

Every government likes to think of itself as the all-seeing arbiter of what needs to be done to protect the people from a catastrophe like the coronavirus pandemic. But even in the most tightly managed societies, this capacity for control and overarching wisdom is illusory.

It is no match to the inherent predisposition of society’s subsystems to act in accordance with their own perceptions of the threat and the urgency of their own necessities. The rule has always been: The more the response from the center appears incoherent, the more the different parts of society will take the initiative and assert their autonomy.

I think we are seeing this already in our country. The national government has not only failed to mount a timely and effective response to this pandemic, it has also been unable to offer a clear and plausible strategy for easing the restrictive quarantines it has imposed.

This paralysis, I believe, stems not only from our political leaders’ rude awakening to the unimaginable costs in financial and manpower resources that an adequate response would entail, but also from the real fear of a second wave that could cause more deaths and uncontrollable outbreaks once the quarantine measures are loosened.

President Duterte himself, perhaps the living epitome of the illusions of stern political control, recently admitted to being “humbled” by the coronavirus. There he was pensively acknowledging the “support” that has come from the private sector during this crisis, and sheepishly apologizing to some businesspeople he had subjected to his “harsh” tirades in the past.

A show of remorse eases strained relationships, but it is not a strategy for solving a problem as complex as this pandemic. The government might wish to carry this mood forward by doing some soul-searching on the limited efficacy and dysfunctional consequences of its own accustomed coercive approach to the complex tasks of governance.

Think of the lockdown and physical distancing restrictions as the activation of society’s immune system. They were intended for one sole purpose: to contain the spread of the virus. But, just like the human body’s immune system, these defensive measures may trigger unintended consequences that could be more destructive in the long run than the virus itself. In the worst cases, they may promote conflict, foster divisions, and ultimately destroy the fabric of the human community.

It is perhaps the supreme paradox: The body’s immune system sometimes gets confused in its effort to contain the rapid spread of an infection. In the process, it blindly attacks even the healthy cells in the various organs of the body. Doctors treating coronavirus patients have alluded to the dangers of “cytokine storms.”

Here’s how a New Yorker article (4/29/20) by emergency medicine doctors Clifford Marks and Trevor Pour describes this baffling phenomenon: “Within hours of a viral invasion, the body’s immune system swings into action. The ‘innate’ immune system, which recognizes protein structures common to many pathogens, reacts first, by releasing a family of chemical distress signals called cytokines…. Without cytokines, the immune system would slumber while infections wreak havoc. But the cytokine system has a weakness. Some pathogens can provoke it in a perverse way, so that it goads the immune system as a whole into overdrive. In what’s known as a cytokine storm, fever and inflammation spike out of control. It’s unclear why some patients might experience this phenomenon while others do not.”

Here, the prescribed course of action is to try to modulate the response of the body’s immune system. This involves a very delicate balancing act, often using medications aimed at suppressing some of the aggressive responses of the immune system, but taking care not to overdo it lest the body is left totally defenseless.

One can imagine what it takes to promptly distinguish the harm done when the virus grafts itself onto the body’s healthy cells, from the unintended injury the autoimmune system itself may cause as it contends with the viral invasion. It is no different, I suppose, from what happens at the societal level. After a while, it is almost impossible to tell which one causes the more lasting damage—the epidemic itself or society’s reaction to it.

Clinicians tell us that every case has its specificities. Some COVID-19 patients have shown a remarkable capacity to withstand the viral assault without any need for anything stronger than paracetamol. Others have found themselves suddenly besieged by low oxygen saturation and needing to be hooked onto a ventilator, with no assurance they will survive the disease.

Not to belabor the analogy — but so too do we need to be conscious that what works for one society may kill another, simply because their circumstances are different. We have seen that a lot depends on how the nation as a whole perceives and reacts to the threat, how much the people trust their leaders, how healthy their institutions are, and how much social solidarity they can mobilize in the worst of times.

Comparisons are tricky because the realities on the ground are, more often than not, different. There may be “co-morbidities” like poor health systems and glaring inequalities that make some societies more vulnerable than others. This virus has shown that it can wreak the greatest havoc in dense living spaces—in the care facilities for the elderly, in overcrowded prisons, in congested workers’ dormitories, and in the teeming urban slum communities where multiple households often live under a single roof.